TNRI Final Design Report R01

February, 2024
Final Design Report

REVISION NO 1
Republic of Tajikistan
Mother-Child-Care and Emergency Care VI - TNRI
BMZ No.: 2014 68 321

BMZ No.: 2014 68 339
TABLE OF CONTENTS
1. EXECUTIVE SUMMARY.......................................................................................................1
2. INTRODUCTION...................................................................................................................2
2.1. PROJECT BACKGROUND...........................................................................................2
2.2. THE SITE.......................................................................................................................2
2.3. ARCHITECTURAL DESIGN STATEMENT....................................................................3
3. CONTEXTUAL PLANNING...................................................................................................4
3.1. DESIGN (OVERALL).....................................................................................................4
3.2. SERVICES ORGANIZATION IN THE FINAL DESIGN..................................................4
3.3. DESIGN PARAMETERS CONSIDERED.......................................................................5
4. ARCHITECTURAL.................................................................................................................7
4.1. INTRODUCTION...........................................................................................................7
4.2. PLANNING PARAMETERS...........................................................................................7
4.3. BUILDING PROGRAM (SRP) SUMMARY....................................................................8
4.4. HEALING ARCHITECTURE, INTEGRATION OF NATURE AND GREEN....................9
4.5. FLOOR LAYOUT OF ANNEX BUILDING (PLANS, SECTIONS, AND ELEVATIONS). .9
4.5.1. BASEMENT FLOOR..............................................................................................9
4.5.2. FIRST FLOOR.......................................................................................................9
4.5.3. SECOND FLOOR................................................................................................12
4.5.4. THIRD FLOOR.....................................................................................................13
4.5.5. CONNECTION BRIDGE......................................................................................14
4.5.6. ELEVATIONS.......................................................................................................15
4.5.7. SECTIONS...........................................................................................................16
4.6. ENERGY-EFFICIENT BUILDING DESIGN..................................................................18
4.7. DESIGN PRINCIPLES.................................................................................................21
4.7.1. EXTERNAL WALLS (CAVITY WALL)..................................................................21
4.7.2. PARTITION WALL................................................................................................21
4.7.3. WINDOWS...........................................................................................................21
4.7.4. DOORS................................................................................................................22
4.7.5. FLOOR.................................................................................................................22
4.7.6. EPS ROOF...........................................................................................................23
4.7.7. PLASTERING......................................................................................................24
4.7.8. PAINTING............................................................................................................24
4.7.9. SUSPENDED CEILING.......................................................................................24
5. STRUCTURAL.....................................................................................................................25
5.1. PROJECT SCOPE.......................................................................................................25
5.2. GENERAL CONDITION...............................................................................................25
5.3. DESIGN CRITERIA.....................................................................................................25
5.4. ANTI-SEISMIC MEASURES........................................................................................26
5.5. FOUNDATIONS...........................................................................................................26
5.6. REINFORCED CONCRETE SLABS...........................................................................26
5.7. REINFORCED EXTERNAL WALLS............................................................................27
6. ELECTRICAL.......................................................................................................................28
6.1. INTRODUCTION.........................................................................................................28
6.2. ELECTRICAL DESIGN ASPECTS..............................................................................28
6.3. DESIGN CONSIDERATION & PARAMETERS FOR ELECTRICAL WORKS.............28
6.4. CONDUITS..................................................................................................................29
6.5. GROUNDING SYSTEM...............................................................................................29
6.6. EMERGENCY POWER SUPPLY................................................................................29
6.7. LIGHTNING PROTECTION SYSTEM.........................................................................29
6.8. FIRE ALARM SYSTEM................................................................................................30
6.9. TELECOMMUNICATION SYSTEM.............................................................................30
6.10. NURSE CALLING SYSTEM........................................................................................30
7. MECHANICAL.....................................................................................................................31
7.1. HVAC SYSTEM...........................................................................................................31
7.1.1. STANDARD AND CODES...................................................................................31
7.1.2. DESIGN CONDITION..........................................................................................31
7.2. AUTOMATION SYSTEM.............................................................................................32
7.3. HEATING SYSTEM.....................................................................................................33
7.4. MEDICAL GAS SYSTEM.............................................................................................33
7.4.1. OXYGEN GENERATOR......................................................................................33
7.4.2. MANIFOLD SYSTEM...........................................................................................34
7.4.3. MEDICAL AIR PLANT..........................................................................................34
7.5. PATIENT TRANSFER LIFT SYSTEM..........................................................................35
8. PLUMBING..........................................................................................................................36
8.1. STANDARD AND CODES...........................................................................................36
8.2. PUMPING UNITS........................................................................................................36
8.3. HDG WATER TANK.....................................................................................................36
8.4. DECENTRALIZED HOT WATER SUPPLY (BOILER TYPE).......................................36
8.5. FIREFIGHTING SYSTEM............................................................................................37
8.6. WASTE WATER TREATMENT....................................................................................37
8.7. CLEAN WATER TREATMENT SYSTEM (SOFTENER)..............................................37
8.8. SEWERAGE SYSTEM................................................................................................38
9. COST ESTIMATE................................................................................................................39
9.1. SUMMARY OF CONFIDENTIAL COST ESTIMATES.................................................39
9.2. COST ESTIMATE PER SQM.......................................................................................40
9.3. FINAL COST ESTIMATE (OVERALL-CIVIL WORK)...................................................40
ANNEXES
I. Detailed Drawings
II. Confidential Cost Estimate (BoQ)

III. Technical Specifications
ABBREVIATIONS
ADB Asian Development Bank

AM Accompanying Measures
BCC Behavior Change and Communication
BoQ Bill of Quantities
BP Blood Pressure
BMZ Federal Ministry for Economic Cooperation and Development
CDH Central District Hospital
CIM Center for International Migration
CME Continuous Medical Education
CSSD Central Sterile Supply Department
DICOM Digital Imaging and Communications in Medicine
DLP Defects Liability Period
EOP Equipment Operation Procedures
E&S Environmental and Social Requirements
ESCP Environmental and Social Commitment Plan
ESHS Environmental, Social, Health and Safety
ESS Environmental and Social Standards
FGI Facility Guidelines Institute
FS Feasibility Study
GIZ German Agency for International Cooperation
GRM Grievance Redress Mechanism
HAI Hospital-acquired infections
HAIPC Healthcare Acquired Infection Prevention & Control
HCWM Health Care Waste Management
HVAC Heating, Ventilation and air conditioning
IC Implementation Consultant
ICB International Competitive Bidding
ICD International Classification of Diseases
ICU Intensive Care Unit
IEC Information, Education and Communication
IsDB Islamic Development Bank
IM Investment Measures
IPC Infection Prevention and Control
JCI Joint Commission International
JICA Japan International Cooperation Agency
KfW Kreditanstalt für Wiederaufbau
LDR Labor Delivery Rooms
LEED Leadership in Energy & Environmental Design
M&E Monitoring and Evaluation
MI Module Indicators
MCH Mother and Child Health
MEP Mechanical, Electrical and Plumbing
MOF Ministry of Finance
MoHSPP Ministry of Health and Social Protection of Population Operation
MoM Minutes of Meeting
NICU Neonatal Intensive Care Unit
OI Output Indicators
OT Operation Theatre
PDR Preliminary Design Report
PIU Project Implementation Unit
PPE Personal Protection Equipment)
RCMRME Republican Center for the Maintenance & Repair of Medical Equipment
RIMC Risk Identification, Measurement and Control
RT Republic of Tajikistan
SEP Stakeholders Engagement Plan
SES Sanitary and Epidemiological Service
SOA Schedule of Accommodations
SOE Schedule of Equipment
SOPs Standard Operating Procedures
TL Team Leader
TMU Tajik Medical University
TNRI Tajik National Research Institute
ToR Terms of Reference
ToT Training of Trainer
TWG Technical Working Group
WG Working Group
PIM Price Increase Margin
1. EXECUTIVE SUMMARY
TNRI is the key institution providing maternal and child health services in Tajikistan and serves
as a tertiary referral level hospital. The institute is a national training institute for medical staff
and provides supervisory services for lower-level health facilities. The institute conducts
research on matters related to obstetrics, gynecology, and perinatology and provides support to
health authorities and participates in working groups for the development of norms and
regulations.
TNRI has 234 inpatient beds with an overall average bed occupancy of approximately 135%.
With certain services averaging more than this, it is apparent that the hospital cannot
accommodate any further growth in services utilization and indeed cannot reasonably
accommodate the current levels of utilization.
There exists a clear need for expansion in infrastructure and equipment to address the current
as well as future services demand.
The investment measures foreseen in this project will address these needs.
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TNRI Mother-Child-Care and Emergency Care VI – Detailed Design Report/ Feb 2024
2. INTRODUCTION
2.1. Project Background
The German Financial Cooperation (FC) Mother and Child / Emergency Care Programme
Phase VI builds on the ongoing Mother and Child / Emergency Care Programme Phases II-V.
The overall program objective is to improve accessibility of all population groups and genders,
especially in rural areas, to basic and sustainable health services of international quality.
The Tajik National Research Institute for Obstetrics, Gynecology and Perinatology (TNRI) is the
key institution providing maternal and child health services in Tajikistan and serves as a tertiary
referral level. The institute is a national training institute for medical staff and provides
supervisory services for lower- level health facilities. The institute conducts research on matters
related to obstetrics, gynecology, and perinatology. It furthermore provides support to health
authorities and participates in working groups for the development of norms and regulations.
Currently the TNRI is limited in serving as a central (tertiary level) referral center for Mother and
Child Health (MCH) services because of deficiencies in both infrastructure and equipment.
2.2. The Site

The project aims to increase accessibility for all population groups and genders and strengthen
the Maternal and Child Health reference system by constructing a new building at the TNRI in
Dushanbe in addition to accompanying Measures. The new building will be located annexed to
the existing building and connect to it by bridge/corridors on the first, second and third floors.
The site investigation has been carried out to confirm its suitability for healthcare facility.
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2.3. Architectural Design Statement
The final design considered the project's goals and requirements, the optimal functional and
spatial relationship between the two buildings, the constraints of the TNRI site, and compliance
with international and national regulations. The new design concept for the TNRI Hospital
focused on the development of a new building.
The proposed site plan for the annex building.

After comprehensive study of different shapes and discussions with the TNRI technical working
group, an ‘L’ shaped building was selected for further development. The new building proposed
has an L-shape with a single central corridor and all the rooms with sunlight and possibility of
natural ventilation when required (refer to approved concept design available under Annex VII).
The L-shape with a wing on the right side of the building provides the opportunity for a direct
access for vehicles and ambulances other than the creation of a garden in front the
reception/admission area.
The annex building will be connected to the existing building on the 2nd and 3rd floors through a
bridge.
The workflow in the new building was worked out keeping in mind the scope of reorganization of
services in the 2nd and 3rd floors of the existing building while keeping in mind the inter-
relationships and inter-dependencies of the functional areas in the new building vis-à-vis those
post partial reorganization of functional areas on the 2nd and 3rd floors of the existing building.
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3. CONTEXTUAL PLANNING
3.1. Design (Overall)
The design took into consideration the following which was further incorporated in the detailed
drawings:
 Improving the indoor air quality by providing natural ventilation in the majority of the rooms
and internal circulations
 Improving the user well-being and reduce the need for energy consumption by providing
natural light in all rooms
 Reducing the circulation area (corridors) in order to reduce construction costs and to
increase space for clinical and patient care areas
 Having a modular structural net with a simple shape to reduce the time for construction and
construction costs.
 Incorporation of additional requests from the TNRI administration like additional storages
and wardrobes room
3.2. Services Organization in the Final Design
The proposal for the distribution of the services between the new and the existing buildings
intended to create an optimal organization of clinical activities between the two buildings. The
proposed allocation of services per floor/building was planned in a way that the existing building
serves as a support to the critical services performed in the new building, especially on the
second and third floor. Additionally, the design presented aimed to reduce as much as possible
the need for modifications of the layout in the existing building, thus reducing the need for
rehabilitation/construction works in the existing building.
The following table summarizes the allocations for the different functional areas in the new
building while providing a comparison between the original request, preliminary design and final
design
Functional Area Original Request Preliminary Final Design

Design
LDRs 16 14 14
ICU Bed 10 10 10
NICU Beds (including 16 16 16
the Isolation Room)
NICU Level I 20 20 20
(Including isolation
beds)
NICU Level II 11 11 11
(Including isolation
beds)
TOTAL BEDS 73 71 71
Surgical Suite
OT 4 4 4
Preoperative Care beds 4 4 4
Post-Anesthesia Care 5 5 5
beds
4
Admission &
Emergency
Procedure Room 0 2 2
Observation room 0 2 2
The following table summarizes the number of beds allocated across the different floors by
functional area concerned:
Level l / First Floor

Admission/ Emergency Dept. 2 Admission/ Procedure rooms
2 Observation Beds
Labor/Delivery Dept. 14 LDR (Labor, Delivery and Recovery rooms)
CSSD (Sterilization) 1
Level ll / Second Floor
Surgical Suite 4 Operating rooms
4 Preoperative Care beds
5 Post-Anesthesia Care beds
Intensive Care Unit (ICU) 8 Intensive Care beds (ICU)
2 Isolation Rooms
Level Ill / Third Floor
Neonatal Intensive Care Unit 14 NICU beds
2 Isolation Rooms
NICU Level I 18 NICU beds
2 Isolation Rooms
NICU Level II 10 NICU beds
1 Isolation Room
Level -l / Basement Floor
1 Technical Area
3.3. Design Parameters Considered

The final design developed based on the approved preliminary design. Besides functionality and
workflows as well as adherence to available funding, one of the key aspects considered for the
TNRI healthcare facility design is compliance with codes and regulations.
This includes understanding and respecting local building codes and regulations, safety codes,
healthcare regulations, infection control requirements, fire safety, and accessibility which the
design team already obtain the required construction permits from the State Architect in
Dushanbe.
The following Design Parameters were considered in final design
1 SNaR 31.09-2021 The Building Regulations for Hospitals
2 SanPiN 2.1.3.1375- Sanitary Rules for the Arrangement Equipment and operation of
03 hospitals, maternity hospitals, and other therapeutic hospitals
3 SP 158.13330.2014 Buildings and premises of medical organizations. Design rules.
4 SNaR 50.01-2007 Basis and foundations of buildings and structures
5 SNaR 22.07-2018 Earthquake-proof construction. Design standards
6 SNaR 2.03.01-84 Concrete and reinforced concrete structures
7 SNaR 22.08-2004 Buildings and structures on subsidence soils
8 SNaR 3.02.01-87 Earth structures, foundations and foundations
9 SNaR 12.03.2001 Workplace safety in construction
10 SNaR 2.04.01-85 Internal Water Supply and Sewerage of Buildings
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11 SNaR 31-02-2007 Public buildings and constructions
12 SNaR 21-01-2007 Buildings and constructions fire safety
13 SNIP 41-01-2003 Heating, ventilation and conditioning
14 Guidelines for Design and Construction of Hospital and Health Care Facilities - The
American Institute of Architects Academy of Architecture for Health
The Facility Guidelines Institute.
15 IHFG guideline
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4. Architectural
4.1. Introduction
The design of the proposed development has evolved following a full analysis of the land and its
surrounding landscape, the team took the location and surrounding areas into consideration
especially factors such as topography, existing building engineering systems, existing layout of
civic amenities (electrical supply lines, plumbing lines, sewage system) climate and building
codes, taking into account the basic principles described below:
 Space availability for fire point
 Space availability for parking
 Availability waste water connection to the main public line
 Availability fresh water connection to the main public line
 Availability of electricity connection to the main public line
 Reduced dust and noise impact for the existing hospital due to short distance from main
entrance
 Improve privacy, dignity, and comfort of patients
 Minimize the risk of healthcare-associated infections
 Enhance the Prevention and Control of Infections (IPC)
 Promote good practice and safe health care delivery
 Increase the efficiency of operation.
4.2. Planning Parameters
The following planning parameters were applied in developing the final design (An excerpt from
the Preliminary Design Report):
1 Construction of a new three store building in addition to the basement floor.
2 New construction of the sheds for generator and transformer.
3 New construction of the sheds for waste disposal structure.
4 New construction of the sheds for medical gas system
5 Patients and staff privacy needs and maximization of natural light in order to provide
comfortable spaces to support not only patient recovery and adequate working
environment for staff but also contribute to energy efficiency.
6 Ancillary spaces, such as mechanical and electrical installation rooms, storage and
cleaning rooms as well as waste management spaces.
7 Compliance with the requirements of the building permit authority and exterior design
authority of the city of Dushanbe
8 International standards or guidelines where Tajik regulations are not available.
Compliance with standards and guidelines of the Republic of Tajikistan with regard to
distances to neighboring buildings on site, distances to site boundary walls, fire
protection, escape routes, and urban planning aspects.
9 Construction dimensions that allow the use of prefabricated elements that are common in
Tajikistan.
10 Use of locally available and produced building materials to minimize construction delays
related to material supply.
11 Creating a patient-friendly environment through interior color schemes and exterior
landscaping and recreational areas for patients and their families.
12 Improved accessibility for people with special needs.
13 Construction of the internal water supply system, including all plumbing and sanitary
fixtures for the new three-store building, and necessary connections to the existing
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external system. An additional booster pump will be installed to increase water pressure.
14 Installation of a new internal power supply system with switches, sockets, distribution
panels and fuse boxes with redistribution of load transfer.
15 The sewage from the annex building will be connected to the existing municipal sewage
system for Dushanbe city. The sewage discharge from the annex building is estimated at
32m3/day at this stage. The Design Organization Department in Dushanbe re-confirmed
the additional sewage discharge loads can be tolerated by the municipal sewage system.
16 Design Organization Department in Dushanbe re-confirmed additional loads, which can
be tolerated based on the existing capacities of the city heating plant.
17 Connecting the new annex building to the city's power supply through new transformers
(2x620 kVA) and (2x350 kVA) generators. The approximate calculated load of the annex
building is at 620 kVA; the capacity of main power line is sufficient to bear the additional
loads (The Design Organization Department in Dushanbe confirmed that the additional
loads can be tolerated.)
4.3. Building Program (SRP) Summary

The total gross areas of the building were calculated on each floor through which it passes
inclusive the outside faces of its exterior walls, including all corridors, vertical penetration areas
for circulation, columns, share walls, shaft areas, stairways, elevator shafts and vertical duct
shafts. The following tables summarize the overall area allocation per floor in the new building
and the secondary structures along with any total area allocation adjustment was required
between the preliminary and final design stages.
Total Area - Main Structures:

Total Sqm (Gross Area) Total Sqm (Gross Area) Sqm
Level/ Floor
Preliminary Design Final Design Difference
Basement Floor 503 595 +92
First Floor 1386 1411 +25
Second Floor 1183,5 1212 +28,5
Third Floor 1183,5 1212 +28,5
Total Gross Area 4256 4430 +174
* The size of the basement was increased by +92 m2 to accommodate additional storage space
at the request of the TNRI working group.
** Increasing the insulation of the external wall in annex building 5cm to 10cm led to an increase
in calculation of gross area.
Total Area - Secondary Structures:

Level/ Floor Total Sqm (Gross Area) Total Sqm (Gross Area) Sqm
Preliminary Design Final Design Difference
Bridge (2 floors) 192 182 -10
Generator “Slab” -
50 102 +52
Transformer Room
Medical Gas Room - 48 +48
Waste Disposal
97 32 -65
Structure
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4.4. Healing Architecture, Integration of Nature and Green
All patient areas have adequate window openings to provide natural light and the connection to
the outside greenery. Avoiding noisy environment will be considered especially in the NICU /
ICU environment. For privacy, interior roller blinds as well as perforated privacy screens are
considered for lower windows on the first floor while maintaining the architectural aspect of the
hospital.
4.5. Floor Layout of Annex Building (Plans, Sections, and Elevations)

4.5.1. Basement Floor
The basement is providing all needed technical and store rooms as follows:
Electrical room, stabilizer and UPS system, pump room, water tank Room, firefighting room,
workshop and staff room, additional storages and mechanical room.
This arrangement has ensured a compact arrangement and connection of building engineering
as well as support systems with the functional areas across the three floors above.
4.5.2. First Floor
Based on discussions with the TNRI working groups and MoHSPP, the revised concept for the
new annex building considered bringing critical services like emergency, admission, delivery
care, surgical services, critical care and sterilization under one roof to enhance workflow
efficiency and optimize the transfer of patients between admission and delivery/labor
department and surgical suite. This led to the following agreed upon changes:
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1 Admission and emergency were relocated to the new building from the existing building
(1st floor)
2 Allocation of delivery services space in the new building (1st floor)
3 Relocation of surgical suit coupled with its expansion in the new building (2nd floor)
4 Relocation of sterilization services to the new building (1st floor) instead of a separate
building originally proposed
5 Centralization of the entrance/reception on the first floor of the new building
6 Assembling all the waiting areas and visitors' amenities foreseen to be located on the 1st,
2nd, and 3rd floors in one central waiting area on the first floor
The agreed changes as mentioned above has ensured the following:

1 Improved admission process through reduction in time required for transfer of critical
patients to the LDR, OT or critical care areas
2 Improved building access control through provisions of one major point of control of the
building at the main entrance (centralized access to critical services for patients and
visitors / relatives)
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3 Provision for separate circuit/flow for the admission of patients (especially emergency
cases arriving by ambulance) and for visitors, guaranteeing privacy and security
4 Improvement in overall circuit of sterilization services particularly functional relationship
of CSSD services with critical care areas and surgical suit through provisions of material
movement via two lifts (one each for dirty and clean items)
5 Optimal space allocation for the different functional areas, overall functional efficiency
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4.5.3. Second Floor
Optimized workflow efficiency was further addressed through location of the critical care area
(ICU for post-surgical patients and high-risk pregnancy patients) along with the surgical suit in
two separate sections of the same floor divided by a cross-cutting corridor. Connectivity for
users to the floor above and below is ensured through staircases and two lifts (both can be used
as patient lift).
It has been recommended that the 2nd floor of the existing building continues to support the
high-risk pregnancy cases. This has ensured the following:
1 Minimized needs for any services reorganization on 2nd floor of existing building
2 Easy access to patient wards in existing building through bridge connection
3 Scope for fast and efficient transfer of emergency admissions to the surgical suit or
critical care area as necessary
4 Enhanced IPC
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4.5.4. Third Floor
The functional areas allocated to the 3rd floor focused on neonatal critical care including
provision for mothers to stay with their new-born with introduction of NICU, Level I NICU and
Level II NICU. Connectivity to the existing building has been ensured through provisions of a
bridge. It has been recommended that the wards in the third floor of the existing building
continue to support the NICUs in third floor of the new building. This approach has ensured the
following:
1 Minimized need for any services reorganization on 3rd floor of existing building
2 Even within the building section housing the NICU and NICU Level I, these two services
could be completely segregated from each other
3 NICU and NICU level I with the more critical patients remains separated completely
from NICU level II (mothers staying with babies) by the cross-cutting corridor thus
ensuring better IPC
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4.5.5. Connection Bridge
The new building will be connected to the existing building at level of the 2nd and 3rd floors
through a bridge. Location and design of the bridge took into account the following:
1 Consideration of connecting point with existing building directly in front of the existing
staircases and elevators
2 Existing functional areas in the existing building and need to minimize any rehabilitation
of existing building due to bridge connection
3 International regulations on permissible slope / inclination percentage
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4.5.6. Elevations
15
4.5.7. Sections
16
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4.6. Energy-Efficient Building Design
To improve energy efficiency in the final design of the annex building, the following approaches
have been considered:
Building - This will include insulation of the building envelope, high-performance
Envelope windows and doors, and building materials that reduce heat loss and in
Design the interior solid stone masonry walls to increase the heat storage
capacity.
- The optimization of the building envelope can be achieved at relatively
reasonable cost especially for annex building. The measures also
result in relatively low operating costs. All necessary materials and
expertise are available in Tajikistan.
Lighting Design - The intelligent lighting solutions, such as motion sensors and automatic
timed daylight-dependent sensors are considered in the design.
- All patient rooms are naturally lit.
- High-efficiency LED lighting fixtures.
Green Spaces - Incorporated plants and green space to improve air quality, reduce the
and heat island effect, and promote patient and staff wellness.
Landscaping - In addition, it was important to take a holistic approach to energy
efficiency, considering all aspects of the building and its systems to
achieve the best possible results with the available budget. This means
considering the orientation of the building, its location, the materials
used, the building systems and infrastructure, and the staff who will use
the building.
The heat losses for the components are assumed as follows:
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The design principles and coefficients are the basis of our design, the window area does not
exceed 40% on each side of the facade which is currently achieved with the values mentioned
below on each side of the façade.
1 Window/wall area ratio is on the North Facade (Axes 13-1) %20.49

2 Window/wall area ratio is on the South Facade (Axes 13-1) %21.97
3 Window/wall area ratio is on the West Facade (Axes 13-1) %14.9
4 Window/wall area ratio is on the East Facade (Axes 13-1) %19.43
The values above take the nature and use of the building as well as the regional climate
conditions into account.
Positive therapeutic environment
 Designing a "way-finding" system for patients, visitors, and staff by applying a color
concept for each of the floors and departments which is highly recognizable and includes
a special color concept for the doors for each department
 Providing views to the outside from every patient bed, and elsewhere as much as possible
 Admitting ample natural light wherever feasible and lighting in interior spaces
 Using friendly and varying colors and textures
 Use familiar and culturally known and accepted materials wherever consistent with
sanitation norms and other functional needs. This means that material from the region is
used which people use at home and with which they feel comfortable always keeping in
mind the applicable hygiene regulations. In our design understanding of a patient friendly
design, this is important for patients who will have to stay in hospital for a long time.
Cleanliness, sanitation and ease of maintenance

 Use of special materials, finishes, and details for spaces which are to be kept sterile
 Adequate and appropriately located staff spaces
 Industrially manufactured doors, windows, doors and window frames with specified quality
standards
 Appropriate, durable finishes for each functional space, with tile flooring and washable
wall and ceiling coverings.
Building aesthetics
 Providing compatibility of the exterior design with its physical surroundings which means
an outdoor area concept which is adapted to the hospital environment
 Creation of bright, open, generously-scaled public spaces
 Use of natural light, natural materials and textures in patient rooms, corridors and the
entry areas.
Security and safety

 Ensure good accessibility ramps and lift
 Reception area to monitor patients and visitors flows to and from the hospital
 Good overview in each department to observe the patients and visitors
 Protection of hospital property and assets, including drugs, in special rooms and lockable
doctor/nursing rooms
 Labelling of exits, rooms, ramps, elevator etc
 Emergency lighting of escape routes
 Quickly accessible sanitary facilities for all users
 Steps and heights over 60 cm are provided with railings to protect the user from falling
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 The fire protection system is used to extinguish or control the fire and prevent further
spread. For the active firefighting, powder fire extinguishers will be available in the corridor
of our hospital every 10 m
 Another active fire protection system is a smoke detector system which will be installed in
the hospital in each patient and examination room as well as in storage rooms and
corridors. It will be evaluated further if it is possible to also install a fire alarm control panel
collecting all information about smoke and fire. This panel would be installed centrally and
allow an overview of the whole building.
Staircases can be reached quickly and safely. All fire protection and evacuation stair cases
are reachable in less than 25 m distance.
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4.7. Design Principles
4.7.1. External Walls (Cavity Wall)
Wall thickness: Brick masonry 250mm +

100mm EPS (rockwool) insulation +
120mm veneer brick, the EPS insulation
will increase the thermal efficiency of
buildings.
Heat Transfer Coefficient: U-value 0.24
W/m²K
Rsi Inside Surface 0.17 W/m²K
Rsi Outside Surface 0.07 W/m²K
4.7.2. Partition Wall

The interior walls are made of bricks with a thickness of 120mm and 250mm for shear walls.
20mm thick cement & sand (1:5) plaster finished semi rough with wood float on external faces,
on masonry walls or concrete surfaces.
The aluminum glass partition walls (6mm+6mm) will be applied for the ICUs and NICUs rooms
(1) ICU and NICU:
(2) ICU Isolation Room
4.7.3.
Windows
Double-glazed aluminum window (6mm+12mm+6mm) will be
used.
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The gap between glass in will be filled with argon gas.
Input Parameters Double Glazed Window: U Value 1.9 W/ m2.K
4.7.4.
Doors
Non-combustible rock wool insulation should be applied for all steel and wood doors. Heat
Transfer Coefficient: U-value 1.48 W/m²K
Single Door - 6mm thick L 120cm, H 220cm for Standard LDR and Patient Rooms
- 6mm thick L900cm, H 220cm for Standard Patient Toilet
Sliding Door - Hermetically sealed Manual sliding door for operating theatre
Swing Door - Swing leaf door in 2 nr side hung panels glazed with laminated clear
glass, 5mm thick for the corridor’s accesses.
Fire Door with - L 120, H 215 Single leaf fire door 60 min (EN 1634-1) for all
Panic Bars Emergency Exit Doors.
Automatic - Automatic sliding double-glass door for Patient and Emergency main
Sliding Door entrance (DW. L1 - Room No 104)
Revolving doors - Standard annual revolving doors for the visitor entrance (DW. L1 -
Visitors Lounge Room No. 100)
4.7.5. Floor
 Matte surface anti-skid, acid-resistant and wear-resistant hospital floor porcelain Min. 10mm
 Hydro insulation of 2 layers of bitumen under the floor finishing in all wet areas
 Epoxy paint (antibacterial, antifungal & waterproof) for all mechanical rooms and storages in
basement floor
Floors and floor insulation with

U = 0,15 W/(m²·K)
22
4.7.6. EPS Roof
U= 0,219 W/(m²·K)
The flat roof is insulated against water infiltration with a layer of vapor retarder and bitumen
sealing, insulation over the last reinforced concrete monolithic floor with 130mm thick of
Polystyrene sheet and a layer of expanded clay gravel of fraction along the slope, on top of
polyethylene film screed made of cement-sand mortar M150 will install 2 layers of bitumen
sealing and 50mm gravel (Round Stone Ballast).
(Refer to detailed drawings- architectural drawings- sheet No 20 -27 for more details)
River Washed Round Stone Ballast HVAC Equipment Screen Cladding
4.7.7. Plastering
Mix of cement and sand in the ratio of 1:5 (1 part cement and 5-part sand) used for inner
plastering of brick wall. Thickness of plastering 20mm.
23
4.7.8. Painting
One coat of primer and two coats of Microbicide/ Antibacterial paints to internal faces of walls.
Colors and codes will be selected during the construction period.
4.7.9. Suspended ceiling

Plaster Board Ceiling: 15 mm thick single face gypsum board (bacterial & moisture resistant) for
OTs and recovery rooms
Waterproof Plaster Board Ceiling (bacterial and moisture resistant) for bathrooms and toilets
Gypsum panel for false ceilings 600x600mm corridors and patient rooms
Thermal conductivity: 0.47 W / mK
Fire reaction class: Euro class A1; non-combustible according to EN 13501-1
24
5. Structural
5.1. Project Scope
Tajikistan is located in a seismically active zone. Therefore, the structural design considers
concrete columns and beams with reinforced masonry and the chosen grid ensures a high level
of earthquake safety. The Earthquake design is based on loads (i.e. acceleration, so called
peak ground acceleration) which results from statistical evaluations of earth-quakes and
judgments of the situation of faults and continental shifts. For the peak ground acceleration
(PGA) a value of 10 % probability of occurrence in 50 years is normally used as value given in
earthquake zoning maps. Mostly 4 to 5 zones are used and also the steps be-tween the zones
indicate that it is a realistic approach.
The material used in Tajikistan is reinforcement steel A 3 for the main reinforcement and A 1 for
stirrups and distribution reinforcement. A 3 is a well-known and good quality steel with 390
N/mm² (3,900 kpa/cm²) yield stress and ultimate strength of 590 N/mm² (5,900 kpa/cm²) and
minimum 14 % elongation. Tests show normally even much more elongation, which is good for
earthquake resistance. As earthquake secure construction requires a safety factor, a partial
factor of about 1.3 is used for reduction, which allows to use the admissible stress tables for the
German steel BSt 500. The A 1 is a mild steel of little requirements and adequate for the
elements for which it is used.
The project is designed for construction in IVA climatic region with design temperature - 9,5 °С
The construction site is characterized by the following data:

 Seismicity of the construction site - 9 points.
 Weight of snow cover for the III district - 0.7 kPa
 Wind velocity pressure for II-district - 0,38 kPa
 Pebble soils lie at the base of the foundations.
Structurally, the building is designed in a complex construction system.
5.2. General Condition

 According to the technical report on engineering and geological surveys carried out in 2023,
the construction site is composed of loamy soils, type II in terms of the manifestation of
subsidence properties up to -12.00. Groundwater is located at a depth of more than -12.0m.
 The soil cushion should be made 1.4m thick from a mixture of pebble fraction 20-60mm
(70%) + loam (30%) with a dry density (skeleton) of 1.90-1.95 t/m³. 3.
 Laying of soil is carried out in layers not more than 20 cm, with rolling self-propelled rollers
weighing 10 tons, with the number of passes 8-10 times with the inclusion of vibration.
 In order to avoid the ingress of precipitation from the surrounding area into the excavation,
the latter should be fenced with a berm 30 cm high.
 Quality control of works is carried out by technical inspection of the customer and the
construction organization. Only after the relevant conclusion of the inspection, further works
are allowed.
 When performing works to be guided by the requirements of SNiP 3.02.01-87 "Earth
structures: bases and foundations".
5.3. Design Criteria
(Refer to Structural Drawings and Specifications).
25
5.4. Anti-seismic measures
Anti-seismic measures are envisaged in accordance with the requirements of the chapter of
ICSH CHT 22-07-2018 "Construction in Seismic Areas"
5.5. Foundations
Compacted soil from local soil 30%,
gravel 70%, the thickness of each layer is
no more than 20 cm, density Р=1,90-
1,95т/м³
The foundations are designed for gravelly
soils, monolithic reinforced concrete
(class B 20). The foundations are
prepared with 100 mm thick concrete of
class B 7.5
 Porches are made of concrete of
class B 15
 Around the building there is a
concrete pavement on a layer of
crushed stone 0.15m thick. The mark
of the pavement edge should exceed
the planning mark of the ground by
0.05m. Pavement slope is not less than 0.03. The width of the pavement is not less than
1,000m, with the edge of the trench overlapped by at least 30cm.
 Waterproofing of foundations from ground moisture is carried out by bituminous mastic in 2
layers on the prepared surface.
 Welded connections of reinforcement and embedded parts shall be made in accordance
with the requirements of GOST 14098-85. In accordance with SNiP 2.03.11-85 all metal and
embedded parts should be protected against corrosion by a zinc coating with a thickness of
140 microns.
 In the specifications, the length of the structures is given taking into account the overlapping
of overlaps on the installation products.
 Grids should be connected by overlap with overlap of not less than 40d of working
reinforcement.
5.6. Reinforced Concrete Slabs

The floor slabs in all buildings will be reinforced concrete slabs.
The following structural design principles were taken into consideration and basis of the
structural design of the annex TNRI building.
 Composite structure of concrete columns and beams with reinforced masonry
 Structural grid for the rooms not exceeding 7 m
 Easy-to-build strip foundations
 Cast on site baseplate
 Load-bearing interior walls for reinforcement of the given structure and for load transfer to
the foundation.
 Ceiling heights of up to 4.2 m
 Combined fire compartments and seismic joints
 Well insulated flat roof.
26
5.7. Reinforced External Walls
 Walls and partitions 250mm and 120mm thick - reinforced with vertical cores of concrete
class B15 and reinforced with horizontal grids of Ø5 Vr-I wire every 3 rows (w.630mm) of
masonry, made of cement block on M50 mortar. Category of masonry II. Normal adhesion
180 kPa>Rr>120 kPa (1.2 kgf/cm2).
 Partition walls reinforced brick thickness δ = 120 are made according to the series 2.130-2T
issue 2 "Details of walls and partitions of buildings"
 The ends of the longitudinal reinforcement of the cores should have a rigid connection with
the slab and foundation.
27
6. Electrical
6.1. Introduction
The design concept consists of two major sections:
a) Electrical Design
b) Telecommunication Design
6.2. Electrical Design Aspects
The electrical installation will be done as a TN-S system (5 wire).
All LV cables are low smoke, zero halogen - XLPE/SWA/PVC Type (CU). Wires shall be copper
PVC insulated and max. allowable voltage drop shall not exceed 3%.
TN-S describes an arrangement where separate conductors for Protective Earth (PE) and
Neutral are run to consumer loads from a site’s power supply (i.e. generator or transformer).
The PE and N conductors are separated in nearly all parts of the system and are only
connected together at the supply itself. This type of earthing is typically used for large
consumers who have one or more HV/LV transformers dedicated to their installation, which are
installed adjacent to annex building.
The project is designed for voltage 380/220 kV with blind grounding of transformer neutral. The
voltage at the lamps is 220 V.
The adopted technical solutions meet the requirements:

1. "ПУЭ ed. 2008". - "Rules of the device of electrical installations".
2. "СНиП II-69-78" - "Medical and Preventive Institutions". Design standards.
There are several design aspects, which were considered while designing lighting, socket and
fire alarm layouts. All these are discussed hereunder:
6.3. Design Consideration & Parameters for Electrical Works

a) 2x 630 kVA transformers including 2x switchgears are proposed against the calculated load
of approx. 360 kW. (Need for backup according to local code requirements)
b) The annex building will be connected to the main emergency line, provided by the city power
supply.
c) 2x 350 kVA synchronous gen-set (Modular type sound-proof canopy) is proposed against
the calculated load of 245 kW (excluding the A/C load) will carter maximum load demand of
the hospital other than split units, in event of failure of main generator
d) 200 kVA UPS system
e) 350 kVA Stabilizer
Emergency loads are fed by generators as a backup in case of regular power loss. This
type of load consists of:
 Lighting Load
 Lifts
 OTs Load (Further backed up with UPS)
 Water Supply Pumps
 Power Load (sockets load)
f) Each DB is provided with spare breaker as backup.
g) Each floor have is own distribution board for power and light circuits.
28
h) Main Panel Boards are also provided with spare breakers and additional room for breakers
for future extensions.
i) Lighting levels have been calculated as per requirement and lights are proposed
accordingly.
The illumination levels are listed as follows:
General areas such as stairs and corridors 100-200 lux
General infant areas 300 lux
LDR Room 600 lux
OT 1000 lux
Investigation and treatment areas 500-1000 lux
Waiting areas 300 lux
Toilet and wash rooms 200 lux
Offices 500 lux
The typical patient room installation for a bed is with a unit comprising
 1 bed light (reading) with integrated switch and plug
 1 nurse call system
 4 single plugs (for over beds only + patient room plugs as distributed in the drawings)
 Power outlets for medical gas have been provided where required.
The sockets should be mounted above the bed at the height of 1.2 meters.
6.4. Conduits
Conduits shall be heavy gauge PVC-U/ Fire prevention conduits- fire rated type - UL 94V-0
(ASTM D 3801) the product is self-extinguishing and will not support burning. In addition, we will
insist the contractor to use heat resistant PVC wiring cable according to IEE wiring.
6.5. Grounding System

A central earthing system will be installed to avoid false current. The CEP will be installed in
Main Distribution Board, and then connected to the main Potential bar of the building. All panels
and metallic parts of the building will be connected to the potential bar. The earthing resistance
shall not exceed 1 ohm
6.6. Emergency Power Supply

All essential rooms and areas will be connected to emergency power generators.
The UPS for sensitive equipment will be considered with the equipment specification. The
capacity requirement of the UPS is estimated at 200 kVA. The Main supply runs from a medium
Voltage. It will be connected to the new transformer and generator.
6.7. Lightning Protection System

(Early Streamer Emitter - ESE)
The principal components of the lightening protection system, in accordance with local
regulations shall be:
 Air Terminations
 Down Conductors
29
 Earth Termination Network
 Bonding (to prevent side flashing)
 In addition, the following areas will be considered during the implementation
 Corrosion
 Inspection, Testing, Records and Maintenance
 Lightning protection system will need to be provide for minimum 1 standard active lightning
point.
 Active lightning rods. It should be an electrostatic active lightning rod with early streamer
warning (ESE). Absolutely not contain radioactive material.
 ΔL values, in accordance with local regulation of Tajikistan or NFC 17-102 standard.
 The lightning rod will be placed on a pole with a minimum length of 5 meters and a diameter
of at least 2”. If the lightning rod is higher than 7mt, it will be fastened with tension wires
from at least three points. The lightning rod will carry the lightning rod safely, it will be
durable and robust against all weather conditions and external factors.
6.8. Fire Alarm System

Addressable Fire detection system is provided
which consists of following:
a) Microprocessor / controller base Control
Panel
b) Addressable Smoke & Heat Detectors
c) Manual Break glass
d) Addressable sounders
Dual detectors having ability to detect both

heat and smoke are proposed. A single loop is
formed with the help of Fire Alarm Junction
Boxes and Fire Alarm Control Panel.
6.9. Telecommunication System

Telecommunication works consisted of video surveillance system (VSS), Data (Internet, TV and
Phone) and Nurse Call System.
 A schematic drawing above mentioned assembly is shown along with the layouts for each
floor (refer drawing # Nurse Call Button/ System page/2)
 Voice and data facility is also provided at each nurse station and in each Doctor and
treatment room.
 Cat VI twisted pair copper cable is used for wiring of data points.
6.10. Nurse Calling System

Nurse call system each bed is provided with a nurse call push button and a nurse call lead. An
over door indication light is provided above each door in corridor to serve the purpose of nurse
indication. Each nurse station is provided with a nurse call indication unit which is reserved for
the rooms falling under that particular nurse station.
30
7. Mechanical
7.1. HVAC system
All facilities located on the first, second and third floor must be equipped with a ventilation
system and necessary filters as per Tajik regulations.
A central air conditioning system VRF will be integrated in the above system.
7.1.1. Standard and Codes
 СНиП(BC) 41-01-2003' - "Heating, ventilation and air conditioning"
 СНиП(BC) 23-101-2004' - "Design thermal protection of buildings"
 СНиП(BC) 31-05-2003 - "Public Buildings and Structures"
 СНиП(BC) 3.05.01-85 - "Internal sanitary and technical systems"
7.1.2. Design Condition

For planning heating and cooling requirements, the following parameters have been considered:
 The internal room temperature to maintain is considered at an average of 18°C
 Clinically sensitive areas such like the OT area and ancillary rooms as well as Intensive
Care Units and NICU areas, temperature ranges will be maintained at 22°C as average
target temperature with possibility to increase to up to 27°C
 For delivery rooms and the whole delivery area, minimum temperature should be maintained
at 22°C (to avoid temperature shock for newborn babies).
 if pediatric surgery is being carried out with small children) and NICU / SBCU areas.
Humidity in the OT areas shall not exceed 50%.
“Mechanical Air Handling Units (AHUs) consume approx. 50% of the hospital's total energy
which is estimated at about 850 kVA, in addition to the high cost of regular maintenance
services. With such units in place, the occasional voltage fluctuations as well as city power
outages cause cooling system failures. In such situations, given the high-power demand,
running the generators becomes very costly (198 liters per hour at 80% load) “
Keeping the above situation in mind, the design considers a combination of the ERV (Energy
Recovery Ventilation) and VRF (Variable Refrigeration Flow) systems in the new building to
minimize the risks without affecting performance needs.
Discharge Airflow (full fresh air) in OT 1400m3/h (As per Tajik regulations for OTs)
Pressure Relationship to Adjacent Areas: Positive
Air filtration Standard F7, Maximum F9
Design Temperature (overall) 22°C ± 2°C
Airflow Average Discharge Velocity 127 L/s·m2
Humidity Shall not exceed 50%
Person-oriented rate 503/hP
 The OTs will be equipped with Medical Air Handling Units OHA51aH type, which provides
100% filtered air cooled or heated and will be under positive pressure.
 The ICUs and NICUs (including the insolation rooms) will be equipped with ERV and VRF
systems, which will be compatible for use with necessary filters
 LDR will be equipped with supply air as per Tajik regulations (СНиП (BC) 41-01-2003)
31
 The isolation rooms will be equipped with exhaust fans to create negative pressure and
avoid contamination of the outside air (extracted air needs to be filtered) before being
exhausted
 Variable Refrigerant System (VRF) Units for cooling has been considered for hospital
facilities
 All shower rooms and toilets will have exhaust fans separate from the main duct system
“The shop drawings (design and installation) will be provided by the contractor during the
implementation of protection system required for full and safe operation in all facilities”
All the above will help to achieve efficient climatic performance and comfortable room
environment. Smoke dampers, fire dampers, and combination of fire and smoke dampers will be
provided in accordance with the local code and in line with the Tajik Fire and Safety regulations.
32
7.2. Automation system
The HVAC Control System shall include control and supervision of each air handling unit (and
interconnected exhaust fans) individually, through automatic control panels strategically located
in different parts of the building and AHU control panel.
7.3. Heating System
The new hospital building will be connected to the heating source of the Dushanbe city grid.
Design Organization Department in Dushanbe has
confirmed that the additional loads can be tolerated
based on the existing capacities of the city heating
plant.
Panel convector radiator system with smart Automatic

thermostatic valve will be used to achieve better
energy efficiency. It smartly controls the room
temperature.
Low level convector radiator will be installed where this

is necessary for tall windows on second and third
floor.
7.4. Medical Gas System

7.4.1. Oxygen Generator
The design is executed in accordance with the current norms, rules, instructions and state
standards and provides in the process of operation of the fulfillment of environmental and fire
safety norms in compliance with the stipulated design and technical solutions.
 SNiP III-31-74 Technological equipment. Basic provisions.

 SNiP II-9-70 Hospitals and polyclinics. Design standards.
 U 374-004-74 Guidelines for design and installation of gaseous oxygen pipelines.
 SP 158,13330,20147 Buildings and premises of medical organizations. Design rules.
 SNi P III-36-76
The oxygen generators are new generation stations that allows on-site production of oxygen.
This helps hospitals to supply oxygen from their own automated system independently. These
systems are generally combined with cylinder systems for instant back up.
The oxygen Generators will deliver oxygen in a purity up to 96% independent from the
consumption. The system consists of two air compressors (+ back up), dryers, O2 generator,
active carbon tower, tanks and filters.
33
7.4.2. Manifold System
Automatic Changeover Manifold has been considered to provide a continuous supply of Oxygen
in the new building. The manifold shall consist of two banks of cylinders located on each side of
the pressure control assembly. These pressured gases will be used in Operation Theatres,
Intensive Care Units, Neonatal Care Units, Emergency Rooms and Patient Rooms in the new
building only. The Automatic Changeover Manifold will be in compliance with
 HTM 02-01
 MDD 93/42/EEC
 EN ISO 7396-1
7.4.3. Medical Air Plant
The design of Medical Air Plant shall comply with
 ISO 13485 Quality Management System
 MDD 93/42/EEC.
The estimated capacity requirement is 2x117 m3/h – 10 bars (1working, 1 backup)
34
7.5. Patient Transfer Lift System
The design of Lift System shall comply with
 GOST 22845-85. Electric passenger and goods lifts. Arrangement for assembly, assembly
and acceptance.
 GOST 8823-85. Electric goods lift. Basic parameters and dimensions.
 GOST 22011-95. Passenger and goods lift. Specifications.
Load capacity, kg 1000
Total 4 elevators in the annex building, 2x1000 kg elevators will be installed between 3 floors
including the basement. 2x 480 kg elevators will be installed on the first and second floors
Lifts with regenerative converters have been considered for the new building at the time of
planning in light of the scope to energy savings. Should the availability of the lifts with
regenerative converter be an issue for the works contractor selected for works execution,
provisions have been kept to install the usual lifts available.
35
8. PLUMBING
8.1. Standard and Codes
 BC(TJK) 2.04.01-85 "Internal water supply and sewerage of buildings"
 ГОСТ 21.205-93 "Sanitary-technical systems"
 Designed for thread rolling ГОСТ (regional states standards) 3262-90
8.2. Pumping Units
Water Pumps: HYDRO MPC-E 2 CRIE10-12 component with vibration dampers
Q=10m³/hour, N=50m, N=4.5

kW (1-working, 1-standby)
Drainage Pump: AP 50.V.50 15.3

Q=5m3/h, H=9,5 m
P1/P2=2,15/1,50kW,
I=3A, U=400V
(1 working, 1 standby)
Fire hydrant pumping station Q=9m³/hour, N=50m, N=4.5kW

(1-working, 1-standby)
8.3. HDG Water Tank
Corrosion-resistant steel water tank V=85m3 (Galvanized)
Location: Basement Floor.
Used for water supply and firefighting system, the capacity of 85m3 was calculated according to
Tajik code.
8.4. Decentralized Hot Water Supply (Boiler Type)
The hot water supply will be through decentralized electric water heaters put in individual
rooms / functional areas in line with capacity needs. Key reasons behind this consideration are
explained below.
 Lesser chances of heating energy loss due to shorter water lines + correct water amount +
smaller tanks enabling quicker heating of water = Energy-efficient, lesser wastage of water
due to heating energy lost in circulation
 Not working when hot water is not required in the particular functional area thus making it
more energy efficient
 A malfunction in any one unit will not affect the entire hospital
 Water temperature can be set as per user needs in an individual functional area / unit.
The centralized hot water supply was not planned for the following reasons:
 Higher chances of heating energy loss in preparation, circulation and distribution especially
due to long water lines + large water tanks + Excessively high-water temperature = Energy
and higher water wastage due to heating energy lost in circulation
 Works continuously due to ongoing demand for hot water in different sections of the hospital
leading to higher energy requirement
 Lack of maintenance or any malfunction will lead to the shutdown of the hot water supply for
the entire hospital.
 The temperature requirement can to set to a fixed figure only at the central point
36
For hygienic reasons, the water boiler will be concealed type and installed in an easily
accessible cupboard.
8.5. Firefighting System

Fire hydrant pumping station Q=9m³/hour, N=50m, N=4.5kW
(1-working, 1-standby)
The automatic fire pumps will be powered by electricity and connected to the insulated water
tank in the basement (technical floor of new building) and will be connected through metal pipes
to the fire cabins on each floor.
The water storage tank will be used for both supply to the hospital and fire-fighting purposes. It
will be monitored for high and low water level. The capacity of the tank is calculated based on
regular water usage in the new building (estimated at approximately 350 liters/patient/day) +
additional water to have in reserve in case of fire according the Tajikistan fire regulation –
 Rules of the state supervision of fire safety of PGNPB - P-1-10
 BC RT 21-01-2007 "Fire safety of buildings and structures "
Fire extinguishers of different sizes will be used, the locations and distances will be selected
according to national regulations.
* Automatic Sprinkler System not considered separately in this project.

8.6. Waste Water Treatment
The individual sanitary service line of the new building will be attached to the City's sewer
system, thereby allowing the discharge of sewage waste stream to the sewer collection main.
The sewage will be treated at the district central treatment unit in Dushanbe city.
*The waste water treatment unit will not be required for the new building.
** The sewage discharge from the annex building is estimated at 32m3/day at this stage.
8.7. Clean Water Treatment System (Softener)

The new building's clean water supply line will be connected to the city's water system.
Drinking water is treated at the district central processing unit in Dushanbe before being sent to
the hospital.
37
The hospital complex is already connected to the main clean water supply line of the city. As
confirmed by the planning department, the supply line to the hospital has enough flow rate and
pressure to supply water to the new building also.
* Softener system not considered separately in this project.

8.8. Sewerage System
Wastewater disposal is envisaged by gravity flow into the internal network with discharge into
the sewerage collector. Internal network from sanitary devices is laid under the ceiling of the
basement and above the floor of floors from polyethylene pipes D=150-100-50 mm.
ГОСТ (regional state standards) 22689.3-2001.
38
9. Cost Estimate
The latest cost estimation is the outcome of the detailed design developed based on the
approved preliminary design. The details are provided below.
The cost estimates were verified on site and take into account
 Market prices for major inputs for civil work
 Other necessary aspects such as MGPS, firefighting, HVAC, water
supply/purification/storage systems, generators, stabilizer, UPS and transformer.
 Geological survey results.
 The price increase margin (PIM)/ cost escalation per year of Approx. 3% has been
calculated and added to the cost of civil works.
9.1. Summary of Confidential Cost Estimates
Total Cost
№ № Work Item/ Description
Estimate /Euro
1 2 4 5
No. 1 ESTIMATE CALCULATION
General construction works (Architectural
1 № 1-1 1.025.282
part)
2 № 1-2 General construction works (Structural part) 1.224.485
3 № 1-3 Medical gas system 335.295
4 № 1-4 Water supply and sewerage system 155.645
5 № 1-5 Heating and ventilation system 721.675
6 № 1-6 Internal power supply 177.876
7 № 1-7 Fire alarm system 13.207
8 № 1-8 Notification system 5.161
9 № 1-9 Telephony 2.079
1 Television
№ 1-10 2.963
0
11 № 1-11 Internet 42.998
1 Video surveillance
№ 1-12 11.865
2
1 Nurse call button
№ 1-13 15.932
3
1 Installation of elevators
№ 1-14 124.559
4
1 Waste collection facilities
№ 1-15 3.684
5
1 Facilities for diesel generator
№ 1-16 2.431
6
TOTAL NUMBER 1: 3.865.138
No. 2 OBJECT ESTIMATE CALCULATION
1 External power supply
№ 2-1 226.403
7
39
1 Lighting of the territory
№ 2-2 10.447
8
1 General construction works of Transformers
№ 2-3 29.319
9
2 Installation-transformer equipment
№ 2-4 74.311
0
2 Facade lighting
№ 2-5 8.548
1
TOTAL NUMBER 2: 349.028
OBJECT ESTIMATE CALCULATION No. 3
2 External communication networks
№ 3-1 7.924
2
OBJECT ESTIMATE CALCULATION No. 4
2
№ 4-1 External water supply and sewerage systems 8.419
3
2 External heating systems
№ 4-2 22.492
4
2 Road surface
№ 5-1 71.632
5
2 Landscaping of the territory
№ 5-2 4.022
6
2 № 5-3 Small architectural forms
1.254
7
TOTAL 4.329.908
9.2. Cost Estimate per Sqm
Item Total Sqm Final Cost Cost Per Sqm

Estimate
1 Total Construction Area 4430 4.094.908,00 924 EUR
Annex building
2 Total Construction Area 182 120.000,00 660 EUR
Secondary Structure
(Medical Gas Room, Waste
Disposal Structure, Generator
and Transformer room)
3 Bridge Connection 182 115.000,00 630 EUR
9.3. Final Cost Estimate (Overall-Civil Work)
1 Annex Building
EUR 4.329.908,00
2 Secondary Building
3 Project Contingency (civil work) 15% EUR 649.486,20
40
Total EUR 4.979.394,20
*Preliminary cost estimate including 15% contingency was 5.144.479 EUR
41

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February, 2024

Final Design Report

BMZ No.: 2014 68 321

II. Confidential Cost Estimate (BoQ)

ADB Asian Development Bank

2.2. The Site

The proposed site plan for the annex building.

Functional Area Original Request Preliminary Final Design

Level l / First Floor

3.3. Design Parameters Considered

4.3. Building Program (SRP) Summary

Total Area - Main Structures:

Total Gross Area 4256 4430 +174

Total Area - Secondary Structures:

4.5. Floor Layout of Annex Building (Plans, Sections, and Elevations)

The agreed changes as mentioned above has ensured the following:

1 Window/wall area ratio is on the North Facade (Axes 13-1) %20.49

Cleanliness, sanitation and ease of maintenance

Security and safety

Wall thickness: Brick masonry 250mm +

4.7.2. Partition Wall

(1) ICU and NICU:

(2) ICU Isolation Room

Floors and floor insulation with

River Washed Round Stone Ballast HVAC Equipment Screen Cladding

4.7.9. Suspended ceiling

The construction site is characterized by the following data:

5.2. General Condition

5.6. Reinforced Concrete Slabs

The adopted technical solutions meet the requirements:

6.3. Design Consideration & Parameters for Electrical Works

6.5. Grounding System

6.6. Emergency Power Supply

6.7. Lightning Protection System

6.8. Fire Alarm System

Dual detectors having ability to detect both

6.9. Telecommunication System

6.10. Nurse Calling System

7.1.2. Design Condition

Panel convector radiator system with smart Automatic

Low level convector radiator will be installed where this

7.4. Medical Gas System

 SNiP III-31-74 Technological equipment. Basic provisions.

Load capacity, kg 1000

Q=10m³/hour, N=50m, N=4.5

Drainage Pump: AP 50.V.50 15.3

Fire hydrant pumping station Q=9m³/hour, N=50m, N=4.5kW

8.5. Firefighting System

* Automatic Sprinkler System not considered separately in this project.

8.7. Clean Water Treatment System (Softener)

* Softener system not considered separately in this project.

ГОСТ (regional state standards) 22689.3-2001.

9.2. Cost Estimate per Sqm

Item Total Sqm Final Cost Cost Per Sqm

9.3. Final Cost Estimate (Overall-Civil Work)

*Preliminary cost estimate including 15% contingency was 5.144.479 EUR

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