Kuwait Medical Center - Skardu - Pakistan (UnderConstruction)
Kuwait Medical Center was decided by the Management to establish a full-fledged smaller 63 bedded hospital with the boundaries of themain hospital to carter for immediate needs of local population. Now after the changes of plan KMC is a 86 beds hospital project of Marafie Foundation in Skardu, Baltistan. This state of the art center will provide quality health services to the people of the region. KMC will emerge as one of the best health care provider in Gilgit Baltistan, capable of tertiary health care services. Establishment of this hospital will strengthen the local curative health system.

Kuwait Medical Center - Skardu
Skardu,which is the largest District in the Northern Areas, has a fast-expanding population. As such, it is difficult to keep up with the demand of the population for facilities such as health, education, housing, land etc. Although the Government is invest­ ing in these sectors, the process is slow due to the paucity of funds. Therefore, there is a need to revitalize the concept of Public-Pri­ vate Partnership in order to cater to the demands of the popula­ tion. The private sector should have a vast experience in the health sector in the region and should have undertaken a number of projects in this respect. The public sector can provide support in the shape of land while the private sector can invest in the con­ struction and running of the hospital.
The Marafie Foundation, since its inception in 1986, has worked extensively in the sectors of health, education, infrastructure de­ velopment and women empowerment in the Northern Areas of Pakistan. Involvement of the foundation in health sector has helped it to understand the extent and depth of serious gaps in health cover for the population of the region in general and of women and children in particular. In order to meet this pressing and important requirement, the Marafie Foundation has offered to construct a modern hospital with state of the art diagnostic facili­ ties at Skardu. The hospital will provide free medical cover to the poor and provide paid medical care to those who can afford it.

Details of Covered Areas

Brief on Kuwait Medical Center
Location
The proposed Medical Center is located in the Northern region of Pakistan namely Gilgit-Baltistan. Located amongst the high peaks of the Karakorum and Himalayas range, it remained cut off from the outside world for centuries till the construction of KKH. This highway passes through a winding route flunking the Indus River in one of the most difficult and inhospi­ table terrains to be found anywhere in the world. The highway goes straight to the Chinese border Khanjrab Pass. At Thirty kilometres short of Gilgit, it branches off with the Indus River to east to Siachin and two districts of Ghanchey and Skardu. The region has international borders with the Chinese region of Xinjiang, Wakhan corridor of Afghanistan and an active control line with Indian-held Kashmir.

Problems of the Health Sector in Gilgit-Baltistan
The problemsofthe health sector are summarized below:- 1) In adequate Facilities. The facilities are insufficient to deal with the health requirement of the population of the region. Add to this the diffi­ cult terrain, scattered villages in a vast mountainous region that has very harsh and long winters you are faced with one of the most daunting challenges of providing health cover to the people exposed to these environments
2) Financial Constraints. The local Government of Gilgit-Baltistan has a very limited budget and out of this allocation it is not possible for it to meet the financial require­ ment of these hospitals.Resultantly there is always a shortage of medical supplies, staff particularly for Maintenance/cleanliness and availability of required specialists particularly female Gynecologists
3) Absence of any credible and quality diagnostic facilities. Quality-Diag­ nostic Services are not available as the hospitals do not have necessary equipment nor the consumable goods/kit required for running such facilities.
4) Non-availability of female gynecologists. Due to non-availability of female doctors and nursing staff the female population has suffered the most with very high rate of mortality during child birth and high rote of infant mortality
5) Absence of specialist. Since there are no specialists in some of the important disciplines,serious medical cases related to plastic surgery and pediatrics and cancer go untreated.

The Project
In order to address these problems and fill a serious gap in the health services structure in Baltistan and also in the entire region including four districts of Gilgit, the Marafie Foundation has taken up construction of a State of the Art Hospital of 300 bed hospital with all the required facilities. This was necessary because the existing facilities are compromised in terms of availability and quality.
In order lo enlist the public sector and forge a public-private partnership, we approached the government of Gilgit-Baltistan, After a lot of persuasion, the local government provided a piece of land measuring about 30.000 square meters at a central location in Skardu town free of cost. The market value of this land is Rs.100 million.
After taking over the possession of the land, the Marafie Foundation has com­ pleted the following steps;-
i) Detailed topographic survey of the land.
ii) Preparation of a master plan by engaging a professional company of Architects. iii) Extensive consultation with a team of doctors who provide voluntary services to
the Marafie Foundation.
iv) Appointment of a doctor as consultant to coordinate with the architects.
In the first phase of this project the main block and the services building with wards for 100 patients and the essential residential accommodation for the members of the staff will be taken in hand and completed within three years.
Services to be Provided by Kuwait Medical Centre/Staffing Kuwait
Medical Centre will provide the following services
Diagnostic facilities. The main block has State of the Art diagnostic facili­ ties that broadly include radiology. Wood bank and laboratory. The hospital will cater for the diagnostic facilities with a properly resourced and staffed unit.
Staffing arrangement. There will be a permanent staff of the doctors and specialists who will be dealing with cases of gynecology, pediatrics, medical specialists and general surgeons. In these disciplines full time round the year services including surgery and in house admission facilities will be available,
Visiting doctors and medical camps. The treatment by the doctors coming on rotation will be carried out in medical camps and will provide much needed treatment in unavailable medical specialist at the door steps of the local popu­ lation. The hospital will give the logistic support and the post-operative care to the patients treated by these visiting doctors. We are in the process of formal­ izing this arrangement with Jinnah Hospital Lahore by entering into a twining agreement for continued support for this program.

Public Health. This hospital will work as a Center for public health and health issues that will cover the following areas ;-
i) Immunization program
ii) Population planning and welfare iii)Environment and hygiene iv) Food and nutrition
v) Preventive health care
vi) Awareness programs in the region,
The above program will be promoted and implemented in close coordi­ nation with the Government of Gilgit-Baltistan and concerned Ministry of Federal Government dealing with the health issues.
5) Training of support staff for the hospital. The Hospital will also become a Center for training of the nurses, paramedics, medical equipment technicians and physiotherapists. Marafie Foundation is working on an agreement with Allama Iqbal Medical College,Lahore and Jinnah Hospital, Lahore to pro­ vide the technical support for this purpose.

Area to be served
The catchment area for the population will not be confined to the Baltistan but will also be available to the other four districts of Gilgit as upcoming up-gradation and improvement of the road of Skardu. The journey to Skardu by road will reduce the journey to only three hours. It will save the people of the entire region from travelling to far-flung cities for treatment. Even now, in medical camps of high specialties the patients from Gilgit and Chilas are being treated.
Governance
The hospital will be run under the Management Board comprising the following:­ i) Chairman and four members to be nominated by the Marafie Foundation. ii) Four members to be nominated by the Government of Gilgit- Baltisian by designation.
iii)Two members to be nominated for fixed period from the civil society by consensus between both the stakeholders i.e. Marafie Foundation and Gilgit-Baltistan government.
This Board will oversee the working of this hospital, lay down the broad policy guidelines, approve the budget, appoint the auditors and approve the annual audit report by external auditors.
Management of the hospital and arrangement of the funding would, however, be the sole responsibility of the Marafie Foundation through this Board.

Sustainabillty
The challenge for this hospital is to sustain its operation and ensure quality economical health services for the population of the entire region. In order to sustain its regular flow of income for the dissemination of free treatment to the poorest of the poor through cross subsidy will need to be ensured and matched.
In order to generate the resources the following frame work has been determined:­
i) The patients visiting the hospital will make full payment of the charges
the Management Board keeping in view the actual cost and minor addition of some prolit for cross subsidy for the poor.
ii) The hospital will also seek donations from philanthropists and funding from Zakat and Baitul Mal.
iii) Government grants.
iv) Steps will also be taken to introduce health insurance cover to the population in partnership with the leading insurance companies of the country so that more people could benefit from the services of this hospital without straining their resources.
v) Budget allocation for hospital will however be ensured by the Management Board. Even the poorest of the poor will make payment for the treatment. Marafie Foundation will however fund the treatment charges from the cross subsidy of the hospital and donation/allocation from other sources. This will be done through an independent committee outside the management structure of the hospital.


Financial Layout for 1st phase
The first phase including the full facilities of diagnostic, operation theatres, emergency, physicians block, ancillary services and residential accommo­ dation for the essential staff with 100 beds ward will cost approximately US$ 07.00 million. The cost of equipment including transportation and an­ cillary services for first phase will be US $ 01 .50 million. Operational expenses for one year will be US$ 500,000.

Sources of Funding for the project
Present donors will continue their support for the project, Seek donation from multinational and other business entities as part of their corporate social responsibility, Seek support from the donors who are investing in the NGO sector in
Pakistan.
Government grants and funding support
Equipment from international donors (DRI).They have already committed the provisions of hospital beds and instruments. New donors from Kuwait,
Once completed this hospital will meet, the urgent need for quality health facilities for the population of Gilgit-Baltistan, This facility will also focus the mast vulnerable segment of the population namely female and the children. Investment in this hospital will not only address the health issues but also result in poverty alleviation in the region by providing employment and commercial activities.

NEW PROPOSED 86 BED HOSPITAL
Due to delay in the implementation of the main project, it was decided by the management to establish a full-fledged smaller 86 bedded hospital with the boundaries of the main hospital to carter for immediate needs of local population