KUWAIT MEDICAL CENTRE

Location

The Proposed Medical Centre is located in northern region of Pakistan namely Gilgit-

Baltistan. Located in the high peaks of Karakorum and Himalayas range, it has remained cut off

from the outside world for centuries till the construction of KKH. This highway passes through a

winding route along Indus river in one of the most difficult and inhospitable terrain. The highway

goes straight to the Chinese border Khanjrab Pass. At 30 KM short of Gilgit it branches off with

the Indus river to east to Siachin and two districts of Ghanchey and Skardu. The region has

international borders with Chinese region of Xinjiang, Wakhan corridor of Afghanistan and an

active control line with India India held Kashmir.

Geopolitical Importance

The location of this area has a geopolitical importance as it provides future commercial

corridor for China that connects to Gawader port through road network of the country. Once

made operational this will facilitate the transportation of the Chinese products of the entire

western provinces to the international market that is not only economical in terms of

transportation cost but also has the added advantage of time saving. The proposed highway to

Tajkistan by crossing the Wakhan corridor the area will also open to the region for trade and

commerce Asian countries to the rest of the world.

The control line along the Chinese glacier and Kargil poses a constant threat of conflict

with India. The losses are caused to both sides more due to the weather than any clashes. If the

situation settles down and the land if route to Kargil is opened it will set off an immense activity

in the tourism industry as the tourists visiting these areas to see mountainous range in this

entire region will have a very convenient route of traveling through Pakistan to an India

destination and also from India to Pakistan and to their destination. This economic activity will

bring prosperity to the area.

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This area has also huge natural resources of minerals that include copper, gold, marble,

granite and semi-precious stones as well as potential of about 50-70 thousands MGW of hydro

power energy. The government of Pakistan is already working on mega hydro power projects of

Bhasha, Bunji and Astore. This has attracted the international attention of the investors and also

the other countries due to its natural resources and its strategic location.

History and the People

Gilgit-Baltistan consisted of small states and principalities under the suzerainty of Dogra

rule of Kashmir in 1947. In that year historic developments were taking place in British India and

the Muslims wanted a separate homeland. The local population which is 100% Muslims also

seized this opportunity and rose against the repressive Dogra rule and after a long struggle of

almost more than a year with very limited resources liberated the entire area and declared its

independence and later on joined Pakistan. The area technically is still part of State of Jammu

and Kashmir and is considered as a disputed territory and has no representation in the Pakistan

Parliament. The Government of Pakistan however has the de facto authority for the area and in

the year 2009 promulgated a Self Governance Order for the area that now has a Chief Minister

selected by the Gilgit-Baltistan directly elected Legislative Assembly. There has been substantial

enhancement in the powers of the local Government structure. The future of the area is linked

with the UN Resolution for holding free and fair plebiscite of the entire state of Jammu and

Kashmir. This has not happened and the people are now demanding the merger of the region as

a province with Pakistan.

Ethnically the people of Baltistan are a mix of Tibetant descent of Mongols and Arians

while the districts of Gilgit population are Arians. Multiple languages that include Balti, Shina,

Brushiski and Wakhi are spoken in the area. The total population based on 1998 census with

annual growth 3.2% is now ____. The entire population is Muslim with all the sects i.e. Sunni,

Shia, Ismaili, Ahle Hadis and Noor Bakhshia.

The region has a stunning landscape with very good weather in summers and

abundance of fruits but due to scarcity of cultivable land and has remaineds cut off from the rest

of the world due to the towering mountains around it, the population has for decades lived on

subsistence farming. The ravages of harsh winters add to their miseries and in the absence of

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education and health facilities they have suffered for a very long time. Even after independence

in 1947 the area was neglected and had very limited any facilities for education and health.

Marafie Foundation

The KKH however opened the area to the world in seventies. In the year 1986 the

members of the Marafie Foundation family visited Baltistan and touched by the abject poverty

and lack of health and education facilities started its philanthropic work in Baltistan. Its

activities have now been extended to districts of Astore and Gilgit. In order to serve the people

a Trust was created that works across the ethnic and religious divide for humanity at large. Its

vision is to work together for humanity. Its mission is to alleviate poverty through investment in

health, education and other community support projects. It emphasis is on providing health

facility and education and targeting female population because the Foundation feels the healthy

mothers is essential for any successful community. The Marafie Foundation Pakistan is

governed by a Board of Trustees of the locals with representation of Marafie family as Patron

Trustees. The Board lays down the policy guidelines and identifies the sectors that need

attention. First Chief Patron Trustee Mr. Abdul Fateh Marafie realized the need to compliment

and supplement efforts of the other players in the field for providing health and education

services. He therefore initiated a very close working relationship with the government and filled

in the gaps that were impeding their efforts due to shortage of resources. A very balanced and

calibrated relationship with the public sector was therefore built to obtain the optimum results

from limited resources. His novel approach produced impressive results and that has brought

about lasting positive change in the lives of people living in the project area. This change is now

being extended to the rest of the region. He was a pioneer of the Public-Private partnership

concept for the first time in Pakistan. Presently the present Chief is Abdul Ilah Marafie has

consolidated the achievements of the Foundation and has built solid relationships with all the

stakeholders. This with time has resulted in phenomenal development in education and health

sectors.

An over view of the achievements of the Marafie Foundation are given in the slides.

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Health Facilities Available in the Region

The entire region has a total ______ hospital and _______ dispensaries. All these

facilities are in public sector with the exception of some areas in and Ghizer where Aga

Khan Health Support Program has provided medical facilities of _______ hospitals and

_________ dispensaries/MCH Centres.

The health facilities available in the public sector available to the common man, is faced

with the endemic problems of resource constraints resulting in shortage of medical supplies and

medical equipment. Moreover there is acute shortage of specialists particularly the female

gynecologists. This has father aggravated the situation for the female population who are

traditionally neglected.

Marafie Foundation has been supporting these facilities by providing medical supplies,

budgetary support and purchase of equipment.

The problems of the health sector are summarized below:-

Financial Constraints

The local Government of Gilgit Baltistan has very limited budget and out of this

allocation it is not possible for it to meet the financial requirement of these hospitals with the

result there is always a shortage of medical supplies, staff particularly for

Maintenance/cleanliness and availability of required specialists particularly the female

Gynecologists.

Poor Quality of Services

This resulted in poor quality of services for treatment of the patients.

Absence of any credible and quality diagnostic facilities

Quality-Diagnostic Services are just not available as the hospitals do not have necessary

equipment nor the consumable goods/kit required for running such facilities.

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Non-availability of female gynecologist

Due to non-availability of female doctors and nurses staff the female population

suffered most with very high rate of mortality during child birth and of the infants.

Absence of specialist

Since there are no specialists in some of the important disciplines, serious medical cases

go unattended like plastic surgery and pediatrics and cancer.

Kuwait Medical Centre

In order to address these problems and fill a serious gap in the health services structure

in Baltistan and also in the entire region including 4 districts of Gilgit, Marafie Foundation has

taken up construction of State of the Art Hospital of 300 bed hospital with all the required

facilities. This was necessary because the existing facilities are insufficient with serious

inadequacy in the health services as well as quality of services available.

In order to integrate public sector and forge public-private partnership we approached

the government of Gilgit-Baltistan. After a lot of persuasion the local government has provided

a piece of land at a central location in Skardu town measuring about 30,000 square meters free

of cost. The market value of this land is Rs.100 million.

After taking over the possession of the land Marafie Foundation has completed the

following steps:-

i) Detailed topographic survey of the land.

ii) Preparation of a master plan by engaging a professional company of Architects.

iii) Extensive consultation with a team of doctors who provide voluntary services to

the Marafie Foundation.

iv) Appointment of a doctor as consultant to coordinate with the architects.

In the first phase of this project the main block and the services building with

wards for 100 patients and the essential residential accommodation for the members of

the staff will be taken in hand and completed within three years.

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The main block has the State of the Art diagnostic facilities that broadly include

radiology, blood bank and laboratory. The hospital in addition to the indoor treatment

of the patients will provide the quality and credible diagnostic facilities which are

practically not available in the entire region.

Staffing

There will be a permanent staff of the doctors and specialists who will be

dealing with cases of gynecology, pediatrics, medical specialists and general surgeons.

For other specialties regular specialists will come in rotation from Lahore and Islamabad

for ten months except for two winter months i.e. December and January. The

treatment by the doctors coming on rotation will be holding medical camps and will

provide the much needed treatment in high specialties at the door steps of the people

of the region.

Area to be served

The catchment area for the population will not be confined to the Baltistan but

also be available to the other four districts of Gilgit as upcoming up-gradation and

improvement of the road of Skardu the journey to Skardu by road will be only three

hours. It will save the people of the entire region from traveling to Islamabad from far

flung cities for treatment. Even now in medical camps of high specialties the patients

from Gilgit and Chilas are being treated.

Governance

The hospital will be run under the Management Board comprising the

following:-

i) Chairman and four members to be nominated by the Marafie

Foundation.

ii) Four members to be nominated by the Government of Gilgit-Baltistan

by designation.

iii) Two members to be nominated for fixed period from the civil society by

consensus between both the stakeholders i.e. Marafie Foundation and

Gilgit-Baltistan government.

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This Board will oversee the working of this hospital, lay down the broad policy

guidelines, approve the budget, appoint the auditors and approve the annual audit

report by external auditors.

Management of the hospital and arrangement of the funding would however be

the sole responsibility of the Marafie Foundation through this Board.

Sustainability

The challenge for this hospital is to sustain the operation and ensure quality services to

the population of the entire region who are faced with common problems of lack of facilities in

the health sector and travelling to Islamabad is difficult and very expensive.

In order to sustain it regular flow of income need to be ensured and matched with the

requirement of free treatment to the poorest of the poor through cross subsidy.

In order to generate the resources the following frame work has been determined:-

i) The patients visiting the hospital will make full payment of the charges to be

determined by the Management Board keeping in view the actual cost and

minor addition of some profit for cross subsidy for the poor.

ii) The hospital will also seek donations from philanthropists and funding from

Zakat and Baitul Mal.

iii) Government grants.

iv) Budget allocation for hospital will however be ensured by the Management

Board. Even the poorest of the poor will make payment for the treatment.

Marafie Foundation will however fund the treatment charges from the profit of

the hospital and donation/allocation from other sources. This will be done

through an independent committee outside the management structure of the

hospital.

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Financial Layout for 1 st phase

The first phase will that include the full facilities of diagnostic, operation theatres,

emergency, physicians block, ancillary services and residential accommodation for the essential

staff with 100 beds ward will cost approximately US $ 7 million.

The cost of equipment including transportation and ancillary services will be US $ 300

million. Operational expenses for one year will be US $ 500,000.

Source of Funding for the project

Present donors will continue their support for the project.

Seek donation from multinational and other business entities as part of their corporate

social responsibility.

Seek support from the donors who are investing in the NGO sector in Pakistan.

Government grants and funding support.

Equipment from international donors (DRI). They have already committed the provisions

of hospital beds and instruments

New donors from Kuwait.

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