{a Translated trom French ta English - www.oninedectranslaror.com, COMMERCIAL TECHNO PROPOSAL DEVELOPMENT OF FIVE (05) REGIONAL WORLD-CLASS HOSPITALS THROUGH IVORY COAST SUBMITTED TO THE MINISTRY OF HEALTH AND PUBLIC HYGIENE GOVERNMENT OF COTE D'IVOIRE SUBMITTED BY PLANETONG FROM IMAGINATION TO IMPACTil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE TABLE OES OMTERRES EXECUTIVE SUMMARY. 1. COUNTRY OVERVIEW... 1.1 SECTOR AND INSTITUTIONAL CONTEXT... 2. HEALTH SECTOR - OVERVIEW .. 2.1 Organization of the health sector 2.2. CURRENT HEALTH PROBLEMS AND CHALLENGES IN COTE DIVOIRE 2.3. HEALTH OF THE POPULATION 2.4 Profile of dominant diseases - Céte d'Ivoire 2.5 Areas of intervention 3. PROJECT JUSTIFICATION .... 4, CONCEPT OF THE REGIONAL HOSPITAL PROJECT... 5. SPECIALTY ANALYSIS .. 5.1 Proposed facilities for regional hospitals 6. SPACE PROGRAMMING .... 5.2 Proposed combination of facilities and beds for regional hospitals 5.3 Proposed space program... 53.1 Space program proposes Direction 5.3.2 Space program offers Offices Entrances .. 53.3 Space program offers External Consultations 534 Space program offers Mother-Child 5.3.5 Space Program Offers Resuscitation 5.3.6 Space Program Offers Emergencies... 53.7 Space Program Proposes Medico Technique 5.3.8 Space Program Offers Support Logistics 7. ARCHITECTURAL CONSIDERATIONS. 7.1 Geography 7.1.1 Climate .. 7.1.2 The grounds 7.2 Likely Rentals 7.21 Kabadougou 722 Tehologoil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 7.23 GDOKIE corocnnnnnen soe snes enn BB 724 Iffow 725 Moronou 8, CONCEPTUAL PLAN OPHON 1 9.1. Expansion possibilities Option 1 9.2 Movement of vehicles Option 1 ... 9.3. Conceptual Images Option 1 9.4 Advantages and disadvantages Option 9. CONCEPTUAL PLAN OPHON 2... 9.1 Pros and Cons-Option 2.. 10, INDICATIVE IMAGES AND DRAWINGS -- INTERIOR... 11, MEDICAL EQUIPMENT - LIST OF EQUIPMENT... 11.1 List of specialized medical equipment with their technical parameters... 11.2 Medical equipment by department 11.3 List of non-medical equipment 11.4 Various companies for major equipment and machinery 12. PROFILE OF PROMOTERS .. 13.1 Planet One Education - Experience of the key management team 13.2. Key Management Team 14 ABOUT STELLAR HEALTHCARE 15 HEALTH CARE REFERENCES .. 16 ENGINEERING AND CONSTRUCTION OF HEALTH FACILITIES .. 16.1 Context 16.1.1 Phase 1: Project definition and planning . 16.1.2 Phase 2: Design, documentation and authorization... 16.1.3 Phase 3: Construction, procurement,.. mise.en ceuure.et.mise.en service 16.2 Methodology for the construction of health facilities 16.2.1 STEP 1 - Hospital master plans .. 16.2.2 STEP 2 - Feasibility studies and technical proposals. 16.2.3 STEP 3 Design and engineering 16.2.4 STEP 4- Architecture, MEP, HVAC, Interiors. 16.2.5 STEP 5 - Movable property 16.2.6 STEP 6 - Installation and commissioningil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 17 HOSPITAL ORGANIZATION 18 PROJECT COMMERCIAL PROPOSALS ..nnnnn 19 FRAMEWORK OF THE PROJECT... 20 APPENDIX-1 - DESIGN RENDERINGil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE LIESTEGES ABRES'&/ FRG EIBERES ‘TABLE 1 DESERIPTION OF THE DEPARTMENT OF LREGIONAL HOSPITAL ‘TABLE 2 RSwMMARY OF PROGRAMS AND SECTORS OF THE DEPARTMENT. “Taste 3 RSUMMARY VSOMMERCIAL. ‘TABLE 4 IKEEHEALTH EDICATORS FOR VSOTE D'SEE wr Figure 5 COTE D'ISEE~ PRESTATION OF HEALTH SERVICES. FIGURE 6 PSTAKEHOLDERS IN THE HEALTH SECTOR IN VSOTE O'ISEE ‘TABLE 7 PMANISTERIAL HEALTH ROGRAMS FIGURE 8 EUIFE SPERANCE Figure 9 tersés 10 MAIN CAUSES OF THE TOTAL NUMBER OF DEATH FicuRe 10 Hterses 10 MAIN CAUSES OF DEATH AND D'DISABILITY TABLE 11 lte#SES 10 MAIN CAUSES OF THE TOTAL NUMBER OF OEATH ‘TABLE 12 AHOSPITAL COST NALYSIS.. “TaB1e 13 LEXSTING HEALTH FRASTRUCTURES IN VSOTE D'ISEE ‘TASLE 14 litersisTe OF HEALTH FACILITIS AVAILABLE IN VSOTE D'ISEF. FIGURE 15 PMAIN HEALTH CARE FACILITIES AVAILABLE IN VSOTE TSEC FIGURE 16 PGROUPING ROPOSITION D'REGIONAL HOSPITALS... FIGURE 17 GEASTING BEARING D'REGIONAL AND DISTRICT HEALTH FACILITIES... ‘TABLE 18 ESUGGESTED LOCATIONS FOR REGIONAL HEALTH CARE FACILITIES ‘Taste 19 AYEARS OF LIFE LOST (AVP) 2010, STUDY OF L HME, WnsiancrOn.. “TAaLE 20 DINDICATIVE DESCRIPTIONS OF DEPARTMENTS FOR REGIONAL HOSPITALS. ‘TASLE 21 [PROPOSED FACILITIES FOR REGIONAL HOSPITALS... Ficure 22 Baoposeo SPAct PRoGaAM, : Ficuae 23 CPROPOSED OMBINATION D'FACILITIES AND BEDS FOR REGIONAL HOSPITALS. ‘TABLE 24 PROPOSED SPACE PROGRAM FIGURE 25 PAVERAGE ANNUAL RECIPTATIONS IN TOWEST FRlQUE FIGURE 26 SUN RACE IAGRAM crn FIGURE 27 TAVERAGE EMPERATURES AND PRECISTATION FIGURE 28 MEDIUM EMPERATURES. FIGURE 29 SCHEMA OF THE WIND ROSE. FicuRe 30 FAGES VSONCEPTUAL EXPANSION Ficure 31 IMAGES VSONCEPTUAL -TOERIENNES. Figure 32 IMAGES INDICATIVES SOPERATION AREA. FiGuRe 33 NDICATIVE MAGES PAHENTWWARDS FicuRe 34 IANDICATIVE MAGES INTERIOR VSORRIDOR AND ICU .. FIGURE 35 ENDICATIVE MAGES ICUWARDS. ‘TABLE 36 lterSISTE OF SPECIALIZED MEDICAL EQUIPMENT ‘TASLE 37 litersisTe OF DEPARTMENTAL MEDICAL EQUIPMENT — ‘TABLE 38 LISFOF TOPPROVEOMAKES FORMAJOR MEDICAL EQUIPMENT ‘TABLE 39 RSUMMARY OF THE COMMERCIAL PROPOSAL,il REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE EXECUTIVE SUMMARY Céte d'ivoire is an economic powerhouse in West Africa, posting an average growth of 8% between 2011 and 2018. However, the growth rate of GDP in real terms fell to 6.7% in 2019 and is expected to grow. contract to 2.7% in 2020 due to the Covid-19 pandemic and the widespread shutdowns that ensue. Looking ahead, the IMF forecasts growth to rebound to 8.7% in 2021 - underscoring the country's economic resilience. While Céte d'Ivoire shows high performance, alongside its strong regional integration, the country's epidemiological profile remains comparable to that of low-income countries, and health outcomes need to be significantly improved. Communicable, maternal, neonatal and nutritional diseases are the leading causes of disability and death, accounting for 62% of the disease burden. Increasing prosperity, increasing urbanization and increasing unhealthy lifestyles have led to an increase in the burden of noncommunicable diseases (NCDs), resulting in a double burden of disease on a system. already fragile health. The delivery of health care services varies widely in Cote d'ivoire. Urban centers are well served and are home to most of the country's hospitals, clinics and pharmacies. Rural areas often lack modern health care. The national vision of the Ivorian government is to transform Céte d'Ivoire into a middle-income country by 2030. This is an ambitious goal that will require strong commitment and a vision to strengthen social sectors, including the health sector. As part of its strategic efforts, Céte d'Ivoire seeks to increase the capacity of the health sector if itis to achieve the health-related Millennium Development Goals (MDGs) and the health objectives defined in its National Plan. of Health Development. The Planet One group, promoter of the project, proposes to strengthen the regional health care ecosystem in the country by establishing a partnership with the Ministry of Health and Public Hygiene (MoHPH) and other key actors in Céte ivory. Planet One supports the vision of the Ministry of Health and Public Hygiene and proposes to develop Regional Hospitals across key strategic regions in Céte d'lvoire. In this regard, in order to formalize Planet One's intention to develop regional hospitals across Céte d'Ivoire, an MOU was signed with the Ministry of Health and Public Hygiene on November 4, 2020. The project promoter plans to develop five (05) new state-of-the-art regional hospitals in Céte d'Ivoire, which would provide an ideal opportunity to reform hospitals in a holistic manner and upgrade its facilities, building systems, his, 5 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE medical equipment and its medical procedures with modern technology that will take advantage of holistic efficiency. The Planet One Group proposes to develop five (05) Regional Hospitals with 150 integrated beds, located in the regions of Kabadougou, Tchologo, Gbokle, iffou, Moronou across Céte d'Ivoire where infrastructure and health equipment are not available. currently available. This regional hospital project provides a strong and sustainable platform for the delivery of health services across Céte d'Ivoire, thereby providing access to modern and better health care frameworks in regions where health services are available. are not adequate. This regional hospital establishment is planned on the basis of the following concepts: * Offer adapted services to facilitate residents and extend support to other regions for serious illnesses. Capture demand based on changing disease profile and provide critical care locally. Increase the efficiency of medical personnel thanks to intelligent systems of the Digitally SMART installation. Have a modular facility to convert into an isolation area in the event of contagious disease. Ecological building and zero discharge installation to protect nature and HSE quality. Optimize space planning to accommodate more facilities. Have low cost and high quality with more specialties. After analyzing the disease profile in all regions of Ivory Coast, we propose the departments listed below to respond to diseases according to the current trend with the provision of unforeseen diseases. However, the facility can be adapted as directed by officials to suit geographic location and budget constraints.il REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Emergency Department Emergency Department |, Diagnostics - Imaging In Pationt Accommodation = + Miner OT General + Procedure + Single Deluxe Diagnostics Laboratory Single Room ‘+ Twin Sharing room + General ward Surgical Department * Pretabour Rooms + Labour room + Post Labour room Critical Care Departments ‘Outpatient Department —_Qut Patient Department + ICU Adult + 0POSeneral + OPDConsutation + IU Paediatric Nephrology + Isolation —_—s Daycare icy Table 1 Description of the regional hospital department Here is the indicative program of the department that we suggest subject to finalization after discussion with the authorities. GENERAL ADMINISTRATION 400 ENTRY OFFICE EXTERNAL CONSUTATIONS MOTHER-CHILD MEDICO TECHNIQUE INTENSIVE CARE HOSPITALIZATION ‘SUPPORT LOGISTICS ACCOMMODATION AND GUEST HOUSE DIRECTORil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE No Departments ‘Area of the department (m?) K SERVICE AREA 1,539 Built-up area factor, etc. 30% — - Total Construction Area Total plot of land required 810 hectares Table 2 Summary of programs and sectors of the department This comprehensive technical-business proposal is prepared by a team of health care experts from the project promoter and aims to provide the ministry with relevant information to make an informed decision on strengthening and improving health services and networks. hospitals across Céte d'Ivoire. The technical planning of the regional hospitals offered across Céte d'lvoire conforms to the requirements provided by the Ministry of Health and Public Hygiene, an approximate estimate of 150 beds has been delineated for each hospital. These 150 beds are considered as hospitalization, there will be 37 additional beds which will be used for observation and other clinical facilities and services of regional medical hospitals. In addition, the regional hospital will be a digital SMART facility, have flexibility for isolation, and address the problem of shortage of doctors, medical personnel and para-medicalil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 1, COUNTRY OVERVIEW Céte d'Ivoire, a country of around 26 million people and an area of 322,463 km2, is the second largest economy in West Africa after Nigeria, and a prosperous country in Africa, West is Africa's fastest growing economy. Céte d'Ivoire is currently among the most promising economies in West Africa and the continent and has recently grown faster than the average for these two groups. The country's phenomenal growth rate of 8.5 percent stands in stark contrast to the rest of sub-Saharan Africa, which only experienced 3 percent growth. The Ivorian economy continues to record strong growth despite the downward trend in the prices of the country's main exports. Since the end of the crisis, the dynamism of the three sectors of the economy has stimulated growth. Growth is supported by external demand for agricultural exports and the domestic acceleration of public and private investment, as well as by robust consumption driven by the gradual improvement in purchasing power. Despite an unfavorable global environment, the Ivorian economy has continued to record strong growth of between 8 and 10% since 2012, in a context of contraction in world prices for agricultural products. Growth is supported by external demand for agricultural export products, domestic demand for public and private investment, and robust consumption. The macroeconomic framework is solid, and the medium-term economic outlook remains favorable. The country has the potential to maintain its current growth trend and mitigate the impact of external shocks on commodity prices. To do this, economic diversification must be consolidated through the development of agro- industrial value chains. In this regard, and in order to attract foreign and national direct investment, the country must launch second generation economic and sector reforms. These reforms should aim to make the business environment more attractive, strengthen the financial management framework and continue to ensure debt sustainability. It should be noted that the country’s economic performance has not had a substantial impact on reducing the poverty rate, which is still high. 1.1 SECTOR AND INSTITUTIONAL CONTEXT HEALTH SECTOR IN COTE D'IVOIRE Céte d'Ivoire has an annual population growth rate of 2.6% and a high proportion of young people (41.5%). The health situation of the population is characterized by high maternal mortality and children under 5 due to the poor quality of health care. The epidemiological profile is dominated by a high prevalence of HIV and a high incidence of malaria and tuberculosis in the population, respectively 3.7% (Demographic and Health Survey / Multiple Indicator Cluster Survey, 2011-2012), 10 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 295 per 1000 in children under 5 years old (Annual report on health statistics, 2013) and 170 cases [157-188] per 100,000 (WHO, 2013). Non-communicable diseases (NCDs) are on the increase, especially cancer and high blood pressure. They are a matter of national concern because of changes in the way of life of the population and in particular delays in diagnosis and treatment. NCDs are responsible for 31% of deaths in Céte d'Ivoire. In addition, the mismanagement of household, industrial, biomedical and other types of waste and the inappropriate use of sanitary facilities are the main causes of communicable diseases such as cholera, typhoid fever and foodborne illnesses, requiring preventive and health promotion measures to combat these diseases. In the context of Ebola virus disease in West Africa, especially in two countries that share a border with Céte d'Ivoire, the risk of epidemics and other emergencies remains high. This justifies the strengthening of national capacities in the fields of prevention, preparation and response to health emergencies In 2018, Céte d'Ivoire ranked 165th out of 189 countries according to the United Nations Human Development Index. Although life expectancy at birth fell from 50.6 years in 2006 to 57.4 years in 2018, it remains arnong the lowest in the world, according to the World Bank. Céte d'Ivoire also performs poorly in other indicators. The maternal mortality rate was 617 per 100,000 births in 2017, one of the highest in the world, while the neonatal mortality rate was 33.5 deaths per 1,000 births. However, these indicators are expected to improve as health spending increases, along with demographic and economic expansion. Planned health spending, excluding pharmaceutical drugs, amounts to $ 2.3 billion for 2021, estimate of $ 2 billion in 2019 and $ 1.8 billion in 2016. Key health indicators - Céte d'Ivoire 1 Total population (2019) 25.07 million Gross national income per capita (International PPP US $, 2019) 5238.30 Life expectancy at birth m /f (years, 2019) 55/52 Probability of dying between 15 and 60 years old m/f (per 1,000 inhabitants) 406/362 * Data from WHO and Population Reference Bureau *Data derived by Aarka Consultants from World Bank data 11 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Key health indicators - Céte d'Ivoire 1 Total health expenditure per capita (US $ 2018) Total health expenditure as% of GDP (2018) Infant mortality rate (deaths per 1,000 live births) Maternal mortality rate (deaths per 100,000 live births) HIV prevalence (%) Incidence of tuberculosis (per 100,000 people) Table 4 Keyhealth indicators for Cote d'Ivoire An increase in the middle class, the incidence of non-communicable diseases (NCDs) et la mise en ceuvre d'un programme de soins de santé universels devraient entrainer une further increase in health spending. The Ministry of Health and Public Hygiene is responsible for the health system and includes 20 regional health directorates and 86 smaller health districts. Céte d'Ivoire has 2,027 first-contact health establishments, 84 general hospitals, 17 regional hospitals and two specialized hospitals. There are five university hospitals - including four in Abidjan - as well as five specialized national institutes and four national public establishments: the National Blood Transfusion Center, the National Public Health Laboratory, the Urgent Medical Aid Service and the New Health Pharmacy. public, the latter regulating the distribution of drugs.REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE eee Secondary level 19 regina Dee eee ee Se teed eas “ ~ eet DC Eton ‘Source. PNDS 2016, updated with stakeholder interviews Figure 5 E6te d'lvoire - Delivery of health services Despite the infrastructure available, it is necessary to further improve the quality and access to care. Many Ivorians travel to places such as Europe and the Maghreb for treatment due to the lack of equipment to perform diagnostics. To address this concern, the authorities have rehabilitated and re-equipped a number of hospitals and health centers in recent years to improve access to services. In 2016, the government launched a Program in partnership with the World Bank to rehabilitate 100 health centers in 25 districts. As of December 2018, 85 of them had been delivered. More recently, in December 2019, His Excellency the President of the Republic of Céte d'Ivoire announced plans to build, rehabilitate and equip 50 hospitals and 600 health centers. In July 2019, the National Assembly adopted a bill that plans to significantly modify the management of the health system. The legislation transforms public health centers into public hospitals, increasing the revenues of public hospitals and improving the quality of services. The newly created EPHs will remain under state supervision but will be managed as private companies with a results-based management approach in order to increase revenues and reduce costs. Limited access to health care due to its high cost remains a problem for most Ivorians, especially since 47% of the population lives below the poverty line and health centers are not easily accessible in other areas. many rural areas. If the use of 13 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE public health services increased from 27.5% in 2013 to 45.3% in 2016, the lack of trained professionals, long waiting times and poor quality deters many people from seeking treatment. This has consequences, since no less than 80% of Ivorians, especially in rural areas, turn to traditional medicine. To improve access to care, annual health spending is expected to almost double to reach $ 128 per person by 2050, of which $ 43 will be paid by patients. Health spending in the national budget increased from 330.4 billion CFA francs (US $ 568 million) in 2016 to 446 billion CFA francs (US $ 776.7 million) in 2020, The sector's share of expenditure in the budget has however remained stable, fluctuating between 5 and 6% of the total. Officials are looking to increase this percentage and the government should aim to increase it to 15% in the coming years. To allow Céte d'Ivoire to progress rapidly towards an emerging country status by 2020, and to achieve the Sustainable Development Goals (SDGs) related to health by 2030, la mobilisation des ressources pour la mise en ceuvre efficace d'interventions a fort impact must be undertaken at all levels. DUMINISTRY STAKEHOLDERS The Ministry of Health is responsible for regulating the entire health sector through its various policies. The main function of the ministry is policy formulation, coordination and regulation of actors in the health sector. In formulating these regulatory policies or guidelines, the ministry collaborates with various ministries, departments and agencies as well as with other partners and stakeholders in the health sector. Asa critical sector of the economy, the Ministry of Health seeks to improve the health status of all people living in Céte d'lvoire, thereby contributing to the government's vision of universal health coverage and a healthy population, The Ministry of Health, in partnership with its agencies and stakeholders, aims to improve human capital and "create wealth through health" through development and la mise en ceuvre de politiques proactives qui garantiront une meilleure santé et une plus great vitality. Policy objectives 14| Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE The main objective of the Ministry of Health is to provide and continuously improve the health services of Céte d'Ivoire by offering preventive, curative and rehabilitation health care, thus contributing to poverty reduction and improving the general well-being of the population. To achieve this objective, four specific objectives have been defined: - 1. Provide leadership and management of adolescent and youth health programs; 2, Provide children, adolescents and young people with adequate and quality health care; 3. Increase the level of use of information access points 4, Improve the management of health information relating to adolescent and youth health services. The main objective of the Ministry of Health is to provide and continuously improve the health services of Céte d'Ivoire by providing preventive, curative and rehabilitation health care, thus contributing to poverty reduction and improving the general well-being of the population. Health spending is expected to increase significantly in the coming years, driven by economic growth, the rise of the middle class and the expansion of universal health care. This should put pressure on capacity while providing opportunities for public and private investment to build and rehabilitate health centers, as well as to develop the local pharmaceutical industry. It remains to be seen what the impact of Covid-19 will be on the sector in the long term, but efforts to expand access and quality of healthcare services to meet growing demand and expectations of bigger and bigger bodes well for the industry 15 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 2. HEALTH SECTOR - OVERVIEW The mission of the Ministry of Health and Public Hygiene is to promote "health and vitality through access to quality health for all inhabitants of Céte d'Ivoire through motivated staff”. Achieving this ambitious goal will be a challenge. In addition to the significant disparities in services between north and south and between rich and poor, factors such as cultural and religious beliefs, poor physical infrastructure and limited resources are obstacles to the provision of health services. equitable, thus creating challenges for planners and decision-makers. The hospitals and emergency services available in Cote d'lvoire do not meet Western standards. The availability of health institutions and professionals is limited, while traveling long distances for treatment is not affordable. The cost of health care and expenses related to disease prevention and treatment are on the rise. In this context, the National Health Development Plan (PNDS) 2012-2015 has set itself the objective of creating a quality health system in order to guarantee the best possible level of health to all citizens and, in so doing, to promote sustainable growth and development in Céte d'Ivoire. The PNDS has made health financing a strategic priority for improving the health and well- being of the population through the following points: Increase in health financing by mobilizing internal and external resources. Strengthening the integration of health financing. Allocation of resources giving priority to primary health care; and Good management of financial resources. Céte d'Ivoire has a decentralized health structure and with the reforms of the health sector, services are integrated as one descends in the hierarchy of the health structure, from the national level to the sub-district. At the regional level, curative services are provided by regional hospitals and public health services by the district health management team (DHMT) as well as by the public health division of the regional hospital. The regional health administration or directorate (RHA) supervises and manages the districts and sub-districts of each region. 16 | PageREPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Creare ee Health Care Administration Figure 6 Health sector stakeholders in Cote d'Ivoire 2.1 Organization of the health sector The Ministry of Health and Public Hygiene is responsible for health sector policy, governance and oversight. The Ministry of Health and Public Hygiene and its different divisions face a variety of challenges as they work to achieve their common goals in the health sector. These challenges are both internal and external to the national health system Central level * This level develops national capacities in health policy, strategic planning and reflection, research, monitoring and evaluation in the sector. Emphasis will be placed on equity, rights, gender balance, efficiency and a results- based approach in health management. It consists of the minister's office, strategic departments such as planning, human resources, etc. Regional level 17 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE * This level promotes an effective control capacity that promotes easier supervision and the achievement of high performance in the set objectives and infrastructure development. ‘There are 20 bureaux régionaux de la santé dans le pays, qui mettent en ceuvre la politique de health District level # The district is an operational level that aims to broaden the participation of all service providers within the district and to promote a network of practices. There are 83 © districts. HEALTH PROGRAMS CARRIED OUT BY THE MINISTRY Maternal and child health Traditional medicine Malaria School and university health AIDS Oral care TB Hepatitis Mental Health Fight against smoking and addictions No communicable disease Cancer Development of activities related to Nutrition medications Neglected tropical diseases Traditional medicine Table 7 Departmental health programs In May 2014, the government promulgated compulsory health care coverage for all residents of Céte d'Ivoire. The National Health Insurance Fund (NHIF) is a unique national fund created to consolidate, manage and regulate existing health financing schemes. The NHIF is intended to manage risk and oversee the operations of individual plans.il REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE The NHIF offers two schemes: a contributory General Basic Scheme (RGB) and a non- contributory Medical Assistance Scheme (RAM) for people with low income or living in extreme poverty. The RGB is a contributory scheme based on the principle of third party payment and co-payment. It is accessible to all residents who are not eligible for RAM. Registration is compulsory for those who are subject to income tax. The National Health Insurance Scheme (NHIS) is mainly funded by membership fees under the RAM. A membership fee of 1,000 West African Francs (FCFA) per person per month is required for all persons over the age of five. The RAM is a non-contributory scheme, subsidized by the State and based on the principle of national solidarity. People living in extreme poverty are exempt from paying a monthly contribution; the government pays 49 million FCFA to the national fund. In addition, the government of Céte d'Ivoire made an initial donation of CFAF 20 billion to the NHIF. RGB revenues come from mandatory contributions, late fees, investment income, government grants, donations and other funding mechanisms. RAM is funded by subsidies from central government and regional resources, investment income, donations and assigned taxes. The NHIS provides coverage for all citizens. The first step in the rollout of the scheme prioritizes private and public sector employees, retirees, and rubber and palm oil producers. All the services provide basic coverage of health services, in particular: consultations (nurses, midwives, general medicine and specialists), drugs, surgery, examinations, laboratory tests and hospitalizations (births, Cesarean sections and emergencies are already covered). 2.2 CURRENT HEALTH PROBLEMS AND CHALLENGES IN COTE D'IVOIRE The government of Cate d'Ivoire is firmly committed to ensuring equitable access to quality health care for all. This commitment is reflected in the emphasis placed on infrastructure development and the provision of quality health services. In accordance with the Ivorian government's commitment to achieve universal health coverage (UHC), the National Development Plan1 provides that by 2020, health services 19| Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE diversified and quality health will be made accessible to all populations. Under the leadership of the Ministry of Health and Public Hygiene (MSPH) and with the support of technical and financial partners, the General Directorate of Health coordinates the implementation ceuvre de cette vision ambitieuse de la CMU & tratowards major efforts aimed at improving financing and financial management, improving the supply, quality and use of services, with an emphasis on maternal and child health, and strengthening governance of the health sector. health. Since the 2010-2011 crisis in Céte d'ivoire, the government has pursued governance reforms in all sectors to improve accountability and transparency. Céte d'Ivoire ratified the United Nations Convention against Corruption in 2011 and developed a roadmap to improve its score on the Transparency International index and its eligibility for a Millennium Challenge Corporation compact.4 This reform Global laid the foundation for MHPH's commitment to strengthen health sector governance, which underpins its efforts towards CHU. The MPHH shares the view of the WHO Regional Committee for Europe that "governance is an essential function of health systems which requires special attention, In the health sector, considerable efforts are still needed to improve the quality of life. The health situation is worrying because of the high morbidity and mortality due to malaria and HIV / AIDS. Life expectancy (54.3 years in 2015) is one of the lowest in the world. In terms of nutrition, the proportion of underweight children under 5 was estimated at 14,9% in 2012; the government plans to reduce this rate to 5% by 202015. In addition, the poor quality of health care and limited access to essential drugs exacerbate unmet health needs, especially among the vulnerable population. To progress towards the achievement of the development goal Uobjectif de dsustainable development (SDG) 3 on health, the law of March 24, 2014 established the Universal Health Coverage (CMU). In addition, in terms of resources, the Government intends to allocate 5.4% of the resources mobilized to the health sector as part of its 2016-2020 PND. Like other countries, Cate d'Ivoire was affected by the Covid-19 pandemic in early 2020, confirming 1,275 cases and 14 deaths as of April 30. Health technologies have played an important role in managing the impact of the disease. To help with the response, in April, the integrated Anticoro platform - developed by 10 local start-ups in collaboration with the MHPH and the Ministry of Digital Economy and Post - was launched, offering educational tools, self- testing health and temperature measurement from a distance, as well as 20 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE range of useful solutions to deal with the pandemic, such as e-commerce, digital payment solutions and digital health services. Symptom data is collected and shared with app administrators, helping to map those at risk and enabling health officials across the country to conduct contact tracing. Companies are also participating in the fight against the Covid-19 pandemic. At the end of April 2020, the telecommunications company Orange announced that it would donate 325 million CFA francs ($ 559,000) to health research establishments, non- governmental organizations, charities and municipalities. Société Générale, Coris Bank, the National Investment Bank and the Sahelo-Sahélienne Bank for Vinvestissement and Commerce also made a cumulative contribution of 200 million CFA francs ($ 344,000). 2.3 HEALTH OF THE POPULATION The population of Céte d'Ivoire is expected to grow from 26 million currently to around 50 to 60 million by 2050. Life expectancy at birth in Céte d'Ivoire is 66.6 years. The country has made significant improvements in the health of the population in recent years, although the progress varies (Science Daily, 2010). Given that the southern half of the country is more populated than the northern regions and that more than half of the Ivorian population is urban, accessibility to quality care often depends on geography. The main health problems that continue to affect the Ivorian population are maternal and child health, child nutrition, infectious diseases, non-communicable diseases and mental health. Céte d'Wvoire's maternal mortality rate (MMR), which stands at 64,511 deaths per 100,000 live births, is one of the highest in the world. Céte d'lvoire ranks 173rd out of 179 countries according to the mother index12, lagging behind countries such as Chad, Benin and the Republic of Congo. Maternal deaths are due to preventable and treatable complications, including hemorrhage (36%), obstruction of labor (20%), eclampsia (18%), abortion-related complications (15%) and postpartum infections (4.8%). 13 The high prevalence of teenage pregnancies (30%) is of particular concern14 and accounts for 14.8% of maternal deaths. Almost all (80%) of maternal deaths are due to direct medical causes15, 21 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Only 51% of women attended four antenatal visits (ANC 4) during pregnancy (2016), 73.6% of women gave birth in the presence of skilled birth attendants (2016) and 83.1% of women are seen by a health professional during the postnatal period16. Even though births attended by skilled birth attendants are high according to administrative data, coverage of ANC4 is 30% and postnatal exams 22%, indicating the poor capacity of the health system to retain women in the system. of health after seeking care. High MMR is associated with insufficient coverage of obstetric care, insufficient prevention and management of complications during pregnancy, childbirth and postpartum, and inadequate nutritional care. The number of cesarean sections is low with a rate of 0.61% compared to the minimum of 5% recommended by the World Health Organization (WHO). Only 11 out of 100 hospitals (10%) currently provide all emergency obstetric and neonatal care (EMONC) and 18 of 412 primary care facilities (4%) provide basic emergency obstetric and neonatal care (BEMONC ). The least practiced BEMONC functions in Céte d'Ivoire are vacuum assisted delivery (14%) and newborn resuscitation (39%). Lack of access to services contributes to maternal mortality. In the richest quintile, 95, percent of women give birth with the assistance of skilled health personnel, compared to 49 percent of women in the poorest quintile18. Seventy-five percent (75%) of women in the poorest quintile indicated that lack of money was a major barrier to maternity care, compared to 55% of women in the richest quintile19. Long distances to the nearest facility and weak referral systems are also a barrier, with 33 percent of the population living outside a 5-kilometer radius of a health facility, and only 0.22 ambulance per health facility. In Céte d'Ivoire, one in ten children died before the age of five (96 deaths per 1,000 live births) and more than a fifth of children were stunted (21%) in 2016. Malnutrition is the leading cause of immunodeficiency worldwide, and malnourished children are more susceptible to other infectious diseases (diarrhea, pneumonia, malaria, measles), and respond less to vaccinations.22 In addition, moderate growth retardation and severe in children increases the risk of death by 1.6 and 4.1 times, respectively. While deaths of children under five, infants (66 per 1,000 live births) and newborns (33 per 1,000 live births) 23 have decreased by 28%, 26% and 19% since 2005, they remain high (Figure 3). More than half of these deaths (60%) are due to preventable and treatable communicable diseases and perinatal causes, the main causes of under-five mortality being malaria (25%), pneumonia (15%) , diarrhea (9%), premature births (13%) and asphyxia (10%). The blanket 22 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE immunization remains lower than in peer countries, with only 40% of infants fully immunized. The low quality of care is a major problem. According to the HAQ (Healthcare Access and Quality) index of the Institute for Health Metrics and Evaluation (IHME), Cote d'ivoire ranks 187th out of 195 countries in terms of quality, measured by the prevalence of adaptable mortality (deaths which should not occur in the presence of effective care). 25 With 51,029 excess deaths in 2015, including 29,117 due to poor quality of care and 21,912 due to non-use, Céte d'lvoire has one of the highest manageable mortality prevalence in sub-Saharan Africa ; and the rate of 128 deaths per 100,000 due to poor quality in Céte d'Ivoire is higher than that of most West African countries, including the poorest countries like Liberia. Poor quality leads to suboptimal care. Twenty-three percent of women do not have their blood pressure, blood, or urine tested during pregnancy, 27 indicating that while ANC visits are common, high-quality ANC visits are less so and are significantly higher. less common for the poorest and those living in rural areas. Cate d'Ivoire also does poorly in terms of the availability of essential inputs: the average operational capacity of health establishments, all levels combined, is 57%, and only 22% of establishments have all the items necessary for prevention. infections. The main problems identified in terms of structural quality are the management of blood transfusions (only 5% at the primary care level), supply chain disruptions leading to stockouts, and management and data capacities.28 On estimates that 87% of health facilities have experienced at least one drug stockout in the past year, and 53% several stockouts. This results in a low rate of use (48% of the population has not sought treatment in a health facility during the past year) and a low rate of satisfaction (39% of the population considers the "bad" or "very bad" quality of health services, the inhabitants of rural areas judging the quality to be much worse (29%). Health is one of the main concerns of Ivorians, in second place, just behind unemployment. Poor infrastructure and the unavailability of drugs and medical equipment are major challenges, especially for maternal and child health. Forty-five percent of primary and secondary schools have no electricity, 35 percent have no water and 32 percent have neither water nor electricity.31 For maternal health, the poor availability of services is also a significant concern: although ANC was offered in 90 percent of health facilities in 2015, only 45 percent of staff were trained in the correct protocols, 36 percent of facilities had guidelines, 12 percent had a hemoglobin test and 36 percent a protein- urea test.32 For deliveries, not a single health facility had 23 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 21 monitoring indicators for basic obstetric care. Only 33% of facilities had treatment for sepsis, 34% of facilities had staff trained in neonatal resuscitation, 21% offered neonatal resuscitation, and 62% of facilities monitored and managed the work using a pantograph. Thirty-seven percent of facilities had delivery guidelines, 42 percent of staff were trained in essential childbirth care, and 54 percent of providers were trained in the latest national obstetric guidelines. Regarding child health, only 34% of establishments have staff trained in neonatal resuscitation and 42% of establishments have staff trained in the latest child health guidelines, and there were significant stockouts for key commodities like zinc and vitamin A, as well as a low rate of growth monitoring. Overall, stockouts of essential drugs were a significant challenge. In addition, Cote d'Ivoire experiences persistent shortages of modern contraceptives: male condoms and oral contraceptive pills are the most used methods, but 74% of, facilities were out of stock of condoms and 42% of pills. contraceptives on the day of their last assessment; of all service delivery points surveyed, only 4.2% had all methods in stock. 2.4 Profile of dominant diseases - Céte d'Ivoire Overall, the three risk factors that represent the greatest burden of disease in Céte d'voire are household air pollution from solid fuels, food risks and high blood pressure. The main risk factors for children under 5 and adults aged 15 to 49 were underweight in children and iron deficiency.REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Females Males ++ Expected Year Observed Life expectancy, 1990-2017 Figure 8 Life expectancy The five main causes of AVI (years of disabled life) in Cte d'lvoire are iron deficiency anemia, major depressive disorders, low back pain, schistosomiasis and chronic obstructive pulmonary disease. The 10 main causes of the total number of deaths in 2019 and the percentage change 2009-2019, all ages combined.il REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE © scerietis, ria naan vole @ Norcommnicsecseases © ies ss change, 2009-2018 Walers 294% vias Nema aserseS Neonoil sicorders Loner reapiater)infe=: Loner respirtery infect nage 165% 5978 22m 1808 200% se 1 Darrheal iseases Ischemic hezn disease “Tuoereuloa sre ‘eongentl detec Cengeninl defees crons Gimmes Figure 9 Fhe top 10 causes of the total number of deaths The 10 leading causes of death and disability (DALY) in 2019 and the percentage change 2009-2019, all ages combined. malduordes | ia Conger cefecs Figure 10 Fop 10 Causes of Death and Disabilityil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE The 10 main causes of death in Céte d'Ivoire2 Neonatal disorders Stroke HIV/AIDS Tuberculosis Lower respiratory infections Congenital malformations Malaria Road accidents Ischemic heart disease Diarrheal diseases Table 11 The-10 main causes of the total number of deaths Malaria In Céte d'Ivoire, malaria is the main cause of death among children and continues to be the primary reason for medical consultations and hospitalizations, In 2015, approximately 2.3 million suspected and confirmed cases of malaria in children under five were reported by health facilities. Malaria is endemic throughout Céte d'Ivoire year round, with peaks during the rainy season. The current malaria control strategy in Cate d'Ivoire aims to reduce morbidity and mortality due to malaria by increasing the proportion of the population sleeping under an insecticide-treated mosquito net, pregnant women taking sulfadoxinepyrimethamine, and malaria cases that are confirmed and treated according to national guidelines. The strategy emphasizes the introduction of an integrated approach to community interventions (malaria, pneumonia and diarrhea) and a more participatory and inclusive role of the private sector in the fight against malaria, Other endemic diseases Yellow fever, sleeping sickness, yaws, leprosy, trachoma and meningitis are endemic. A large program was put in place in 1961 to control these and other diseases. Compulsory vaccination against smallpox and yellow fever has been instituted, efforts by mobile health units to detect cases and provide treatment have been intensified, and general health measures have been strengthened within the country and at the borders. In 1999, Cote d'Ivoire vaccinated children up to one year of age as follows: diphtheria, pertussis, and tetanus, 62 percent, and measles, 62 percent. Malnutrition affected 24 percent of children under five. 2Souree-GDP Compare 2018, Cote d'Ivoire 27 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE HIV / AIDS The prevalence of HIV / AIDS in Céte d'Ivoire was 0.60 per 100 adults in 2003. In 2004, there were approximately 570,000 people living with HIV / AIDS in the country. The number of AIDS deaths was estimated at 47,000 in 2003. According to the CIA World Fact- book, Céte d'Ivoire had a total of 460,100 people living with HIV / AIDS in 2014. high HIV / AIDS rate is attributed to a lack of HIV education programs. Maternal and child health care The maternal mortality rate per 100,000 births in 2010 for Céte d'Ivoire is 470. This figure should be compared with 944.1 in 2008 and 580.3 in 1990. The under-5 mortality rate, per 1,000 births, is 121 and neonatal mortality as a percentage of under-five mortality. 5 years is 33. In Céte d'Ivoire, the number of midwives per 1,000 live births is 4 and the lifetime risk of death for pregnant women is 1 in 44, About 36% of women have undergone female genital mutilation (in 2006). The birth rate in 1999 was 41.8 per 1,000. The infant mortality rate in 2005 was 90.83 per 1,000 live births, and 14% of all births were classified as low birth weight. In 2005, the average life expectancy in Céte d'Ivoire was estimated at 48.62 years. Diseases caused by hunger Hunger is the root of many diseases and ailments. Cote d'Ivoire has decided to contain certain diseases in its national development plan. These were issues related to hunger. Whether it’s not being able to access the right food or starving to death. Chronic diseases The United Nations Economic Commission for Africa predicts that NCDs such as cardiovascular disease, cancer, chronic respiratory disease and diabetes will overtake infectious diseases as the leading cause of death in Africa by now 2030. Due to the combination of urbanization, physical inactivity and lack of diagnostic resources, the risk of dying from NCDs in sub-Saharan Africa is the highest in the world, according to the World Health Organization (WHO). NCDs are estimated to be responsible for 37% of all deaths in Cate d'Ivoire. The incidence of high blood pressure almost doubled, jumping from 13.7% in 1979 to over 25% in 2018. Diabetes was prevalent in 4.8% of the population in 2017, while in 2016, about 9 % of all adults over 18 were obese, according to WHO figures. Distributed by gender, women had a higher incidence of obesity, at 13%, than their male counterparts, at 5%. Cancer incidence is also on the rise, jumping 12 28 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE 002 new cases in 2012 to 13,209 in 2016. The government predicts that the number of cancer diagnoses could increase dramatically, reaching more than 17,000 by 2030. The diseases or conditions that the Ministry of Health and Public Hygiene of Céte d'Ivoire wants to reduce: Women's anemia ~ Growth retardation before the age of 5 - Low birth weight ~ Breastfeeding from 0 to 5 months - Emaciation in children under 5 (death) The Centers for Control and Prevention (CCPM) have established a field research station in Céte d'Ivoire working closely to combat HIV, tuberculosis, malaria and influenza, as well as to strengthen its capacities laboratory, surveillance and labor d'ceuvre afin de répondre aux épidémies de maladies l'appui du global health security program. More than 18,000 cases of tuberculosis were diagnosed at sites supported by PEPFAR in 2018; 98% of them were tested for HIV, with a tuberculosis / HIV co-infection rate of 20%, and 10% of infected patients received antiretroviral therapy (ART). The Ministry of Health and Public Hygiene adopted preventive treatment for tuberculosis with the support of the CDC. Two-thirds of eligible patients had access to viral load testing at least once a year, with 82% coverage in children under 15 and 78% viral suppression in the general population. COUTS D’HOPITAL Cost per bed-day per hospital levels* Int $ 2005, LCU 2005 Primary 16.16 4538.17 Secondary 08.21 5920.52 Tertiary 28.80 8086.73 2Public establishment, occupancy rate of 80%, excluding drugs and diagnosticsil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE Cost per outpatient visit by hospital levels Int $ 2005 cu 2005 Primary 4.42 1241.34 Secondary 6.27 1760.72 Tertiary 9.27 2604.61 COSTS IN HEALTH CENTERS Cost per visit to the health center per population coverage for a visit of 20 minutess Int $ 2005 Lu 2005 6.76 1897.16 7.96 2235.35 12.08 3301.98 Table 12 Analysis of hospital costs Density of hospital beds: 0.4 beds / 1,000 inhabitants (2006) The density of hospital beds (per 1,000 inhabitants) in Cote d'Ivoire has gradually declined, from 1.35 per 1,000 inhabitants in 1960 to 0.4 per 1,000 inhabitants in 2006 The total population in mid-2020 was estimated at 26,378,274 according to UN data. 26,378,274 people This entry provides the number of hospital beds per 1,000 people; it serves as a general measure of the availability of inpatient services. Hospital beds include inpatient beds available in public, private, general and specialized hospitals as well as in rehabilitation centers. In most cases, acute and chronic care beds are included. Since the level of hospital services required for each country depends on several factors such as demographics and disease burden, there is no overall target for the number «Public failty, 6% occupancy rate, excludes drugs and diagnostics public facility, at different population coverage, excludes drugs and diagnostics 30 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE number of hospital beds by country. Thus, while 2 beds per 1,000 inhabitants in one country may be sufficient, 2 beds per 1,000 inhabitants in another may be completely insufficient due to the number of people hospitalized by illness.There were 1,794 medical establishments in Céte d'ivoire in 2019, The table below lists the hospitals locate: Wory Coast (by district). Abidjan 59 Bas-Sassandra Comoe Denguele Goh-Djiboua Lakes Lagoons Mountains Sassandra - Marahoue Savannahs Valee of Bandama Woroba 79 Yamoussoukro 25 Zanzan 141 Table 13 Existing health infrastructure in Céte d'Ivoire The table below presents the list of health care establishments available throughout the Ivorian geography, as well as a satellite map indicating the location of these establishments. including all public and private health facilitiesil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ACROSS COTE D'IVOIRE ‘Types of health facility Number Teaching hospitals (CHU) National specialized institutes Regional haspitals (CHR) General hospitals (HG) Urban health units (FSU) Community-based FSUS (FSU-COM) Urban health centres (CSU) ‘Specialized urban health centres (CSUS) Rural health centres (CSR: dispensaries + maternity wards) Rural dispensaries and maternity wards 4 9 7 4B 10 39 300 108 405 383 Table 14 Listof health facilities available in Cote d'IvoireREPUBLIQUE DE COTE D'IVOIRE MENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE [0 voto Pye uri ie Patents Laer H chrbeman Cte d'ivoire iy Peer Wi o Cesta ine meat Piper eo) Reese : Petes Eee} H Hospital center Regional ci Hospital General Gintdaccr Orc PAIS OVE 33 | Pageil REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE ‘The map opposite clearly shows the grouping of regional hospitals, general hospitals and district health centers in all districts and sub-districts of Céte d'Ivoire. Figure 16 Proposal for a grouping of regional hospitalsREPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE Légende EE HOPITAL GENERAL [CENTRE HOSPITALIER REGIONAL DISTRICTS SANITAIRES (reecions sawraines ‘once O71 Baan yaoi Figure 17 Existing cluster of regional and district health facilities The authorities of Céte d'Ivoire have chosen the decentralization of health infrastructure as a means of bringing health care closer to citizens. In this regard, the supply of public health care has been organized into three main groups. First, there are public primary care facilities such as rural and community health centers that provide curative, preventive, educational and promotional services to patients. Then there are outpatient and inpatient care facilities such as regional, district or departmental hospitals that provide advisory care in internal medicine, pediatrics, maternity and surgery. Finally, there are centers 35 | Pageit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE specialists such as university hospitals and specialized establishments which provide the diagnosis and treatment of complex ailments and also offer research activities. Céte d'Ivoire has two administrative regions (out of the nineteen in the country) and has university hospital centers (CHU). These are the CHUs of Cocody, Treichville and Yopougon in Abidjan (Lagunes Region) and the CHU of Bouaké (Region of the Bandama Valley). The other regions have regional hospital centers (CHR) while, in the other agglomerations, urban or rural health centers are installed in the case of village communities. In addition, there are the most famous military hospitals in Bouaké and Abidjan, the hospital for civil servants in cceur du plateau, les léproseries de Manikro (Bouaké), de Daloa et les hépitaux psychiatriques de Bingerville The two maps above show the five targeted regions. The district of Denguele (Kabadougou) has a total of 42 health centers. The district of Savanes (Tchologo) has 123, that of Lakes (Iffou and Moronou) 163 and that of Bas Sassandra (Gbokle’) 142 health structures. Abidjan which is an autonomous district and also known as the economic capital of Cate d'Ivoire has the best hospital facilities and is well connected with the neighboring districts. The concentration of health facilities, as shown in the map below, is lower in the districts of Denguele and Savanes. Upgrading the general multi-specialty hospital and maternity ward will reduce maternal morbidity and mortality rates. 2.5 Intervention zones Kabadougou The Kabadougou region, one of the components of the Denguele district, is located in the north- west of Céte d'Ivoire. It covers an area of 14,000 km? or 6% of the national territory. According to data from the General Population and Housing Census (RGPH) carried out in 2014, 93,988 people lived in this vast territory, or about 1% of the national population. The Kabadougou region is sparsely populated and nearly 4 out of S inhabitants lived below the poverty line in 2008 (Confere DSRP, 2008). To date, this population is estimated at around 250,000 inhabitants. In terms of health structures, this region has a Regional Hospital Center, 10 Santé Urbains, 22 Centres de Santé Ruraux et un Hépital des Sceurs Italiennes. This area has full potential which is still under-exploited. The business opportunities to make Kabadougou an emerging region are numerous and can be found in several sectors of activity linked to the regional sustainable development mechanism. Tchologoit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE Tchologo is located in the north of Céte d'Tvoire. The region is bounded to the south by the Hambol region, to the east by the Boukani, to the west by the Poro, to the north by Burkina Faso and the Republic of Mali. It covers 17,728 km? and is populated by 249,602 inhabitants (RGPH 2014). However, while the World Health Organization (WHO) recommends one doctor for 9,000 inhabitants, one nurse for 3,000 inhabitants and one midwife for 1,700 women of childbearing age, human resources in the Tchologo region are insufficient in quality and quantity to ensure the well-being of the population. The analysis of the situation of health establishments reveals a lack of personnel, equipment and health infrastructure. The Tchologo region has 30) public health structures and 25 private health structures and NGOs. The categorization of health structures in the region reveals 11 rural health centers and 4 rural dispensaries. Conversely, there are 2 general hospitals and 5 urban health centers. 6 specialized services are located in the region. At the private level, there are 1 clinic and 9 infirmaries and pharmacies. Tfou The Ifou region is one of the 31 regions of Céte d'Ivoire. Since its creation in 2011, it has been one of the regions of the Lakes district. The seat of the region is Daoukro and the population of the region at the 2014 census was 311,642. Ifou is currently divided into three departments: Daoukro, M'Bahiakro and Prikro, This region is full of enormous potential to develop. There is a need to improve the health system to help reduce the infant mortality rate and improve medical density. There was the construction of 4 maternity hospitals in the villages and a dispensary. There are two operating theaters in general hospitals (Daokaro and Prikro). Gbokté The Gb6klé region is one of the 31 regions of Cote d'Ivoire. Since its creation in 2011, itis one of the three regions of the district of 8as-Sassandra. The seat of the region is Sassandra and the population of the region at the 2014 census was 400,798. This region has seen a lot of facility development activity. There is the general hospital of Fresco and the urban center of Sago, which is also equipped with medical equipment and ambulances. There is a lot of development being done and needed in the health sector. Moronou The Moronou region covers an area of 6,670 km? with a population of 159,928 inhabitants. It is an agrifood intensive region, but a lot of development work is underway. In terms of health, this region needs a general hospital and a maternity and childcare hospital.it REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 3, PROJECT JUSTIFICATION “The share of health in total public expenciture, at around 54, Is one ofthe lowest in sub-Saharan Africa and inlaw and middle-income countries. The extremely lw priarity given :o heath inthe national budget reflects, n part, the perceived inefficiency of current spending in the sector as well as donor spending that could crowd out domestic funding. Céte d'ivoire’ strong and sustained politcal leadership and commitment tothe universal health coverage program have not been matched by an increase in financlalesources, As 2 resuk the total government spending on health significantly ower than the estimates need to provide health universal acess to core set of health services targeting the health sustainable development goal (SDGs)- over $80 per capita per year. Notably, only 21% of heath spending in Céte a wo'reis pooled through public pools, which slower than the average for ASS and PREMS, Indicating that the funding mixissvb- ‘optimal, and is net designed to maximize health benefits. In addition to low levels of public spending, most danor spending in Céte dTvote also not channeled by the government, resuking in fragmentation and even more limited ical capacty. only 21% of health spending in Cte ivoire is pooled through public pool, which slower than the average for ASS and PRFMS, indicating thatthe funding mixis. sub-optimal and 1 itis not designed to maximize heath benefits. .n addition to low levels of public spening, most donor spending in Cte dIvoire is aso not channeled by the government, resulting in fragmentation and even more limited fiscal capacity, only 21% of heath spending in Cate d'ivoire is pooled through public pools, which s ower than the average for ASS and PREMS, indicating thatthe funding mixis sub-optimal and nit is not MoTHERCHILD 1.653 E ‘MEDICO TECHNIQUE 1450 F owner 528 6 INTENSIE CARE 326 4 HOSPITALIZATION 2.068 1 support Logistics 2135 J [ACCOMMODATION AND GUEST HOUSE DIRECTOR 350 54 PageDEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OWOIRE [on REPUBLIQUE OF COTE O1VOIRE K SERVICE AREA 1539 Buileup area factor, et. 30% 687 Tota Construction area 197 “Tota plot flan required 10 hectares ‘Table 24 Proposed Space Program 55 | Pacerm - _ REPUBLIQUE 9 COTE O1VOIRE 53.1 Space program proposes Direction DIRECTION service Local Useful/localarea bof ‘Total urface(m) | Nbof ves (mn) Local ‘ADMINISTRATION Reception Service + 2 1 2 o Standard Pool Mall Agent 20 1 20 ° Secretariat Director 14 1 14 ° Waring room bivecor 2 1 2 ° Director office 30 1 30 ° ‘Saneary (WC #58 oFthe 4 1 4 ° recor General supervisory offe 4 7 4 ° ssaneary ‘manager's office + 4 1 14 ° sanitary store (manager) 20 7 20 ° archivist Office 2 1 2 ° archives 50 1 50 ° Sanitary Block (Staff + 8 2 16 ° Visitor) Pool Manager 20 1 20 6 data ec ean pentane 20 1 20 ° Resource agent pool 20 7 20 ° human 56 | Pacei [REPUBLIQUE DF COTE OVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OTVOIRE ‘Guard room + SE 4 1 4 ° otice l 8 1 8 o ‘Meeting room woo 100 ° '5 Total Area management 400 0 “30% Areacirulation area Total 120 ‘area of the department 520 5.3.2.Space program offers Offices Entrances ENTRY Reception hall» Nurse box 100 1 00 ° Corrices “insurer station 6 3 18 ° Head of serie sanitary office 14 1 14 0 Boxes of 4 boxes 18 1 18 o biling ofice 20 1 20 o ‘guard room + SE 14 2 2 ° Manager's office + Sanitary 14 1 14 0 Office Socal Asistant 2 1 2 ° | Registration office (admission / exit) 20 2 40 0 57 | PaceREPUBLIQUE OF COTE O'WoOIRE ‘Archives room 5 shop selling newspapers and other 15 ‘loakrooms + SE 14 once a Personal tollet block + visitor a Total Entrance Office Area (m*) 30% Areairculation area Total area of the department 5.33 Space program offers External Consultations Service HOME ‘CONSULTATION ‘SURGERY External consultations Local area useful ocaliem) Hall d'attente + poste Inirmiére + 100 senting room Storage room (dean / dirty) 6 Cloakroom + SE support staff 14 we Us Office 16 head of department fie + Sanitary 16 Office 8 Personal Sanitary Block a waiting + nurse station 25 Consultation room 2 amount 25 15 2B 8 16 356 107 463 ‘Area “otal/ room (mn) 100 2 28 16 16 8 16 25 os Nb of Beds 58 | PaceREPUBLIQUE OF COTE O'WoOIRE Service ‘GENERAL MEDICINE ‘CONSULTATION External consultations useful calm) local area ‘nestesiologst consultation 12 oor Nursing pool 16 Major desk 2 ‘nursing room (with bench) 2 ‘pena oor SE MF 14 ‘Storage room (clean / dirty) 6 5 /Totalt Surgery Consultation waiting + nurse station 36 Consultation room 2 Nursing pool 16 Major desk. 12 nursing room (with 12 removable bench) Salle e'observation 2 ts + sanitaire 20 (wer sey (Carag oon 36047 4 ‘Storage room (clean / dirty) 6 '§/ Total General Medicine Consultation amount ‘Area “otal room mn’) 12 16 2 2 2B 12 337 36 8 16 ” 2 28 12 164 Nb of Beds 59 | PageREPUBLIQUE OF COTE O'WoOIRE Service OPTHALMOLOGY ENT DENTAL CLINIC DERMATOLOGY External consultations local Waiting hall + Nurse station Salle g'examen ‘Storage room {clean / dirty) Total Ophthalmology Consultation Waiting hall «Nurse station Selle é'examen ORL ‘Audiometry room ‘Storage room (clean / dirty) '§/Tetal ENT Consultation Waiting hall + Nurse office dentist office Salle c'examen dentaire Dental prosthesis room Sterilization room with bench ‘Storage room (clean / dirty) '§/ Total dental practice ‘uty 'attente + poste Infirmiére Consultation room Storage room (dean / dirty) area seul ocalim) 25 36 14 12 6 amount Area ‘otal room mn’) 25 36 14 2 12 99 30 14 25 12 12 3B 30 12 40 12 12 12 1 25 4 6 Nb of Beds 60 | PaceREPUBLIQUE OF COTE O'WoOIRE Service ‘CARDIOLOGY HEMODIALYSIS KINESITHERAPY + RE-EDUCATION External consultations local area useful calm) {reatment room with bench 12 Total Dermatology Consultation Waiting hall + Nurse station 20 Consultation room 4 Sanitary Block (Staff + Visitor) a Total Cardiology Consultation Waiting hall + Nurse post 30 consultation box 8 ‘ursing pool 16 Dialysis room with 1 chair 12 Dialysis room with 2 chairs 16 Dialysis room with 4 chairs 20 Sanitary 2 Dialysis room with 1 VIP chair 20 Sanitary block (Staff + Visitor) a Hemo pharmacy 8 store water treatment 14 plant 12 changing rooms + ES (staff + 14 patient) Storage room (clean / dirty) 6 Proximity maintenance room 16 5 Total Hemodialysis Waiting hall + Nurse station 30 amount Area “otal room mn’) 12 57 20 4 16 50 30 16 16 12 16 20 2 20 16 8 28 12 a2 12 16 266 30 Nb of Beds 61 | PageService FUNCTIONAL 30% AreaCirculation are ‘area of the department External consultations sel ocalim) local area Deets ensukation room + 16 sanitary faces resthet workshop 25 massage box 8 ‘gymnasium rehabilitation 25 track space 25 Storage room (clean / dirty) 6 Changing rooms (staf patient) 12 Rehabilitation pool including 60 Greulation space + toilets Sanitary block (Staff + Visitor) a Total 13 Kintherapy a Total amount REPUBLIQUE OF COTE O'WoOIRE ‘Area “otal room n’) 16 25 24 50 50 6 ry 60 16 301 1.485 446 1931 Nb of Beds 62 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE 53.4 Space program offers Mother-Child MOTHERCHLD Service Local area ‘amount Area Nb of Beds sft ocalin?) Total /ra0m (m2) GYNECOLOGY. waiting + nurse station 36 1 36 o OBSTETRICS Doctor's consuation box 8 4 32 0 CONSULTATION Consultation box (CPN) a 6 43 o Examination room Echo 12 1 12 0 pharmacy 9 1 8 0 head of department «Sanitary 16 1 16 0 Family planning office (FP) 15 7 6 0 Pool Sage Woman 16 1 16 0 Major desk 12 1 2 0 SUS office 12 1 2 0 treatment room (with removable 2 2 24 0 bench) Implant room + bench 12 1 12 ‘oskroom E047A) 4 2 28 0 oftee 8 1 8 Storage room (clean / ditty) 6 2 12 0 'S/ Total Obstetric Gynecology Consultation 292 0 ‘ascot (GYNECOLOGICAL UNIT GYNECOLOGY Gynecology consultation box 8 2 16 0 OBSTETRICS- eee Nursing pool / SF 16 1 16 0 “Treatment room (with bench) 2 1 2 ° 63 | Pacerm - _ REPUBLIQUE 9 COTE O1VOIRE MOTHERCHLD ‘Service Local area ‘amount Area Nb of Beds useful ocal ‘otal room (mn) arab ous 5/9, 4 2 28 0 Observation room 1 bed + 18 1 18 1 Sanitary (WC + SE) Observation room 2 beds + 20 3 60 6 sanitary (WC + SE) ‘observation room with 4 beds + ES 30 2 60 8 Storage room (clean / ditty) 6 2 2 ° SITOTAL EMERGENCY 22 15 PEDIATRICS waiting + nurse station 36 i 36 0 CONSULTATION Consultation box 8 3 24 0 Nursing pool 16 1 16 0 Major desk 2 1 2 0 nursing room (with removable 2 2 24 0 bench) salle d'ec/cce 30 1 30 ° Dietetic 20 1 20 0 Vaccination room 40 1 40 0 ‘Store (vaccine + diet) a 2 16 0 play space PM 1 0 ‘akroom- SEAL 4 2 28 0 64 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE MOTHERCHLD ‘Service Local area ‘amount Area Nb of Beds sel leca em?) ‘otal room (m*) Storage room (clean / ditty) 6 2 12 0 5 Total Pediatrie Consultation 258 0 NEONATALOGY waiting hall + nurse post 40 1 40 0 office SUS 2 1 2 Premature babies room with Box 30 1 30 0 ‘erm baby room under 02 with box 30 1 30 0 “Treatment preparation room with 2 1 12 0 bench isolation room 12 1 2 0 Baby monitoring box with bay 8 1 8 0 window Sanitary Block (Staff + Visitor) a 2 16 0 Baby bottle with bench 2 1 R 0 Mothers room / Breastfeeding 10 1 10 0 ‘ranging oon Ser motes 14 1 14 0 65 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE MOTHERCHLD ‘Service Local area ‘amount Area Nb of Beds useful lecal i?) ‘otal room (mn) ‘changing rooms + SEstaff ta /F) 4 2 28 0 storage room (clean / dirty) 6 2 2 0 5 / Total Neo-Natalogy 236 0 OBSTETRIC BLOCK omy d'attente + poste inirmiére 60 1 60 pea of desarenent WE 16 1 1% 0 Office doctor gynecologist 4 1 4) Office SF majore + sanitary 14 1 nC} Sanitary block Staff a 2 1% OO Immediate nappy suite (2 beds) = 14 1 40 sanitary (WO) Pre-work sanitary 8 3 240 pre-work box 2 1 2) 0 Box e'accouchement 9 5 45/0 Box daccouchement ViPssanitaire 16 1 160 Delivery room circulation 40 1 40,0 Rest room / surveillance + ES 16 1 1% OO 66 | Pacerm - _ REPUBLIQUE 9 COTE O1VOIRE MOTHERCHLD ‘Service Local area ‘amount Area Nb of Beds sel lecal i?) ‘otal room (m*) Laundry / decontamination + sterization 15 1 5) OO + drain pharmacy 8 1 8 Nursery 25 1 20 Baby bottle with bench 12 1 zo sterong sone S04 4 1 40 storage room (clean / dirty) 6 2 zo 5 (TOTAL OBSTETRIC BLOCK (m*) 363 LAYER SUTTE Diaper suite 4 beds + Sanitary (WC * 30 4 120 16 se) Suite of nappies 2 beds + Sanitary (WC + 20 3 60 6 55) Diaper suite 1 sanitary bed (WC + SE) 18 2 36 2 VIP diaper suite 40 1 40 1 Guard room + Sanitary (WC +SE) 4 1 14 0 baby toilet room with bench 2 1 12 0 ‘S/ TOTAL LAYER SUITE 282 5 67 [Pacei [REPUBLIQUE DF COTE OVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OTVOIRE Total Ares 1,653 40 30% Circelation Area 436 Total area of the department 2149 535 Space Program Offers Resuscitation INTENSIVE CARE Waiting hall nurse station 30 1 30 ° ‘Adult Resuscitation Box 70 4 40 4 Child Resuscitation Box 10 4 40 4 Isolation Box 10 2 20 2 Surveillance room m 1 1% ° ong eone SE mz 2 cs 0 enone) 10 1 10 ° Parent visting gangway 6 2 30 0 SUS office 2 1 2 ° sca tang cons 4 1 4 0 Poolaestesingst 6 1 6 ° resusctator office @ 1 @ 68 | Pace[REPUBLIQUE DF COTE OVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OTVOIRE storage room (dean dy) 6 2 1% ° Waste bin 2 1 2 0 Guard toon santany 4 2 28 mergeneypeional 8 1 8 ° office a 1 8 Visitor sanitary 8 1 8 o Total? Resureaton 326 ° 30% AreaCirculatlon area 938 Total area of ‘the department 28 10 ‘MEDICO EMERGENCIES ‘SURGICAL 5.36 Space Program Offers Emergencies ‘COMMON AREA Reception hall + Nurse 15 1 15 0 sation + Offce sorting room 8 1 8 sera era eurtyard > 40 1 40 sanitary block + tenes) changing rooms SE 14 2 28 support stat Personal Sanitary Block 8 2 16 0 US Office 14 1 4 69 | PaceREPUBLIQUE OF COTE O'WoOIRE Service tocal ‘Major office + sanitary wo Head office + sanitary wo Guard room + SE Emergency laboratory with removable bench ‘emergency pharmacy Stretcher trolley room, Consultation box Medicine Gle. ‘Nursing poo! Nursing room (with bench) ‘Observation room bed + Sanitary (WC + SE) ‘Observation room 2 beds + Sanitary (WC + SE) ‘observation room with 4 beds + ES ‘Storage room (clean / Useful area / room (m) quantity Total area / room (m") Nb of Beds: 14 14 4 20 30 1 1 14 14 28 16 16 24 28 18 60 12 ° 0 70 | Pace[REPUBLIQUE DF COTE OVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OTVOIRE rm) Plaster room with bench 2 1 2 o ‘Small surgery room 15 1 15 Dice room 14 1 4 0 chipping / washing Deconstruction room 14 1 4 0 ‘Storage room (clean / 6 2 2 0 dirty) 5/Toal Emergences 528 5 30% Circelation Area 158 Total area of the department 686 537 Space Program Proposes Medico Technique TECHNICAL SERVICE Head of department office + sanitary 14 1 14 o “Technical Service Secretariat 12 4 12 0 Technical service waiting room a 1 8 0 Ts Pool 16 1 16 0 71 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE Medico Technique Service Local Usefularea/room (m) nb of Total surface (m) nb of beds Local ‘Sanitary block a 1 a 0 Bored workshop 25 1 25 0 Cold workshop + plumbing + 30 1 30 0 ectrety Carpentry workshop + ironwork 15 1 15 o ‘Computer workshop 15 1 15 0 Equipment monitoring 4 1 14 o center Server room 25 1 25 o Store 30 2 60 0 oropareoesst 16 2 2 ° sm 274 ° RESTORATION Head of department office +tolets 4 1 4 ° chen 40 1 40 0 Food decontamination area 9 1 9 ‘Air-conditioned taf restaurant with 40 1 40 0 water point Ventilated staff restaurant with 50 1 50 ° water point office (sick dish service) 10 1 10 0 dry store 20 1 20 0 72| Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE Medico Technique Service Local Usefularea/room (m) nb of Total surface (m) nb of beds Local Cold room (positive and negative) 30 1 30 0 leundry (plunge) 8 1 8 0 peeling a 1 8 0 vegetable a 1 a pastry area 20 1 20 local waste 6 1 6 store product maintenance 8 1 8 Personal sanitary Block + visitor's a 2 16 0 cloakroom + SEM) 16 2 32 ° sim 319 0 LAUNDRY Head office + sanitary fait 4 1 14 {area Storage + sorting + 15 1 15 “decontaminaton) Dirty washing area 40 1 40 Clean Area (Drying, ironing, 30 1 30 Sewing) Clean area (distribution storage) 6 1 15 product store 10 1 10 local trolley 6 1 6 siroome 2 2 24 Personal Sanitary Block M/F a 2 16 $7 T Laundry 170 73 | Paverm - _ REPUBLIQUE 9 COTE O1VOIRE Medico Technique Service Local Usefularea/room (m) nb of Total surface (m) nb of beds Local WASTE Local eivalzer 30 1 30 0 dirty bin store 15 1 15 clean bin store 15 1 15 ‘eslrooms 8 1 8 Bin washing area 30 1 30 chemical waste store 15 1 15 industrial waste store 36 1 36 garbage cans household garbage) 20 1 20 0 sre 169 HYGIENE Pool Agents hygiene 4 1 14 department head office 16 1 16 Store 2 1 2 doko 10 2 20 Personal tllet block a 1 a sis 70 Technical local Local Generator local 10 1 10 Transformer 15 1 15 local T6BT 10 1 10 Butane gas bornbone 25 1 25 medical gas room 30 1 30 Genera warehouse 80 1 80 74 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE Medico Technique Service Local Usefularea/room (m) nb of Total surface (m) nb of beds Local 170 ‘MORGUE Room with 30 lockers 25 1 25 Registration office 10 1 10 Body wash 20 1 20 Putin Berre 18 2 30 body lft room preau 60 2 120 body lft Reception of 100 1 100) bodies a 1 a ‘autopsy room 14 1 4 ‘supers oom 10 1 10 coffin room 40 1 40 sire a 2 16 Sanitary Bloc a 1 a Visitor toilet (WO) a 1 8 409 MULTIMEDIA+ Documentation office 12 1 12 DOCUMENTATION “Library ra) 5 0) research room 20 1 20 ‘Multimedia room 20 1 20 atipurpese oom 100 1 100 Technical area a 1 a 75 | Pagerm - _ REPUBLIQUE 9 COTE O1VOIRE Medico Technique Service Local \sefularea/reom (me) nb of | Total surface (m’) nb of beds Local Personal sanitation + visitor (WC) 8 2 16 216 HOUSING OF bedroom P+ SE + 30 1 30 DIRECTOR Dressing room + SE 18 2 36 bedrooms 2 1 2 Bathroom 5 1 5 WC visitor 2 1 2 stay 40 1 40 dining room 16 1 16 latchen + store 16 1 16 ‘coveres parking 20 1 20 terrace 20 1 20 197 5/7OTA offal acommadton 197 LODGING bedroom + SE + Dressing 25 1 5 OFSTRAIN oom + SE 14 2 28 Bathroom 5 1 5 WC visitor 2 1 2 stay 30 1 30 dining room 2 1 2 kitchen + store 2 1 2 ‘covered parking 2 1 2 terrace 15 1 15 141 S/TOTAL On- 3 16 ° ‘te Sones 1 8 0 “reamet preparation 2 2 3 eve storage room (lean / iy) 6 2 0 Sr Suge) ee ERAT 208180 500 Areacieuaon area 20 Tal sea the department tt 79 | Pace[REPUBLIQUE DF COTE OVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE OTVOIRE 80 | Page[on REPUBLIQUE DE COTE D'VOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE DIVOIRE 7. ARCHITECTURAL CONSIDERATIONS 7.1 Geography 7.1.1 Climate The climate is generally hot and humid and is, on the whole, transitional between equatorial and tropical. The seasons are more clearly distinguished by precipitation and wind direction than by temperature. Continental and maritime air masses, following the apparent movement of the sun from north to south, determine the cycle of the seasons which is associated with heat and cold further from. the equator. During the first half of the year, the warm maritime air mass pushes towards the north of Céte d'ivoire in response to the movement of the sun. In front of it, a belt of low pressure, or intertropical front, brings warm air, rain and prevailing southwesterly winds. When the solar cycle reverses in the middle of the year, the continental air mass moves south over the country, allowing the dry northeast harmattan to dominate. Surface winds are mild, rarely exceeding fifteen to twenty kilometers per hour. In Céte d'ivoire, the climate is tropical, with a dry season from December to February and a rainy season from April to October due to the African monsoon. Along the coast, the rains are also heavy in March and November, and even in December on the westernmost part (see San Pédro, Tabou). Precipitation is most abundant on the coast, where it is between 1,500 and 2,500 millimeters (60 and 100 inches) per year, while inland itis generally less intense and ranges from 1,200 to 1,500 mm (47 to 60 inches) per year, although they reach 2,000 mm (80 inches) in the small western mountainous area. ‘NIGER avis neyto 81 | PageREPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE Figure 25 Average annual precipi in West Africa ‘Sun path Today Jone solstice ecember solstice Annual variation Bi Eouinox Qvlarch and September) Sunrise/sunset sunrise Figure 26 Biagram of the path of the sun Average temperatures and precipitationREPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE Figure 27 Average temperatures and precipitation 7 AMIN jn Feb Marge May fy Sep Okay ee jin @>sc @>2c Hp Figure 28 Average temperatures aFigure 29 Biagram of the compass rose s htsps:/Awww.galsma.corn/en/location/abidjan.htm|it REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.412 The grounds The northern part of the country is a savannah which would indicate a mixture of Entisols, and Inceptisols. The lower half is dominated by deciduous, coniferous and tropical forests which are dominated by the forest soils of Alfisols, Oxisols and Ultisols. At the very bottom are swampy wetlands which may indicate more humid soils such as wetland soils like histosols or maybe even less developed soils like entisols or inceptisols again. [avicts —] (9) ntsc] NN frceptioots] (NN Spodoscts NI Rocky Land TH once (tots NN Motion i fits ‘Shitig Sand dso MM so B[oxscs] verso [ena Fig 4.8: Enlarged view of a world soil distribution map created by NRCS, USDA, WSR (Word Soil Resource), SSD (Soil Survey Division).s. shttps://sites.qoogle.com/site/soilsoftheivorycoast/soil-types/soil-types-building-an-image-part-2world- map-anaylsis_ 84 | Pageit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE Wwory Coast Elevation Map by www.FloodMap.net (bet newt I 2 oa 3 se To Bane eacean dy teapet wa ualag nat eH eg ee Fig 4.9: Topographic map showing the diagrams of other soil resources. Fig 4.10: Soils map of The Ivory Coastit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.2Probable Locations 7.2.1 Kabadougou The Kabadougou region is one of the 31 regions of Cote d'Ivoire. Since its creation in 2011, itis one of the two regions of the Denguélé district. The seat of the region is Odienné and the population of the region at the 2014 census was 193,364 inhabitants. Kabadougou is currently divided into five departments: Gbéléban, Madinani, Odienné, Samatiguila and Séguélon. Kabadougouit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.2.2 Tehologo The Tchologo region is one of the 31 regions of Céte d'ivoire. Since its creation in 2011, itis one of the three regions of the Savanes district. The seat of the region is Ferkessédougou and the population of the region at the 2014 census was 467,958 inhabitants. The Tchologo region is currently divided into three departments: Ferkessédougou, Kong, and Quangolodougou. Tchologoit REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.2.3 GbOklé The Gb6klé region is one of the 31 regions of Céte d'Ivoire. Since its creation in 2011, it is one of the three regions of the district of 8as-Sassandra, The seat of the region is Sassandra and the population of the region at the 2014 census was 400,798. The Gbéklé is currently divided into two departments: Fresco and Sassandra.it REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.2.4 Iffou The Iffou region is one of the 31 regions of Céte d'Ivoire. e its creation in 2011, it has been one of the regions of the Lakes district. The seat of the region is Daoukro and the population of the region at the 2014 census was 311,642. L'Iffou is currently divided into three departments: Daoukro, M'Bahiakro and Prikro.it REPUBLIQUE DE COTE D'IVOIRE DEVELOPMENT OF WORLD-CLASS REGIONAL HOSPITALS ON COTE D'IVOIRE 7.2.5 Moronow The Moronou region is one of the 31 regions of Cate d'ivoire. Since its creation in 2012, it has been one of the four regions of the Lakes district. The seat of the region is Bongouanou and the population of the region at the 2014 census was 352,616. Moronou is currently divided into three departments: Arrah, Bongouanou, and M'Batto. Moronou is the most recently created region in Céte d'Ivoire. It was formed in 2012 after the other 30 regions were organized in 2011. Moronow. was created by the split of three departments in the N’Zi region. Moronou[on EVE OPMENT OF WORLD-CLASS REGIONAL NOSPTAISONCOTEOTVOIE 8. CONCEPTUAL PLAN @PTION 1 A T=] 1 ENTRY & RECEPTION 2. ADMINISTRATION 3.0PD BLOCK A 4, BLOC DEL‘OPD 5 AMaULATORY AND EUERGENEKES 6. MATERNAL AND CHILD EMERGENCIES T-MOTHER AND CHILD BLOCK 8 MOTHERAND CHILO LOCK 9, PHYSIOTHERAPY & REHABILITATION, DIALYSIS & LABORATORY 10. DIAGNOSIS 11 INTENSIVE CARE SERVICE 12. SURGERY DEPARTMENT 13. BLOCK A OF HOSPITAL CLINICAL AUXILIARY SERVICES 14 AUXILIARY CLINICAL BLOCK OF HOSPITAL B 15, HOSPITALIZATION ALOCK A 16, HOSPITALIZATION BLOCK & 17, BLOCK C DEPARTMENTS HOSPITALIZATION nae 18, GENERAL AUXILIARY DEPARTMENTS OF a THE HOSPITAL cre van 19,£1 to £6 - 6 expansion modules (Ei one vanes Cd eomonre Te werter asena 91 | Page