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Study on Economic Partnership Projects
in Developing Countries in FY2016
Study on Reinforcement Project of Blood Service in the
Republic of Uzbekistan
February 2017
Prepared for:
Ministry of Economy, Trade and Industry
Prepared by:
Shimizu Corporation
Reproduction Prohibited
Stu
dy
on E
con
om
ic Partn
ership
Pro
jects in D
evelo
pin
g C
ou
ntries in
FY
2016
Stu
dy
on R
einfo
rcemen
t Pro
ject of B
loo
d S
ervice
in th
e Rep
ublic o
f Uzb
ekistan
Feb
ruary
2017
Min
istry o
f Eco
nom
y, Trad
e and In
du
stry
P
repared
by
:
Sh
imiz C
otp
oratio
n
Preface
This report summarizes the results of the “FY2016 Project for Promotion of Overseas Deployment of
High-Quality Infrastructure Systems (Investigation of Yen-Loan-Financed Private-Sector Infrastructure Project
Formation),” which was entrusted to Shimizu Corporation by the Ministry of Economy, Trade and Industry
(METI).
This study “Republic of Uzbekistan: Study on Reinforcement Project of Blood Service in the Republic of
Uzbekistan” was conducted to verify the feasibility of a project aiming to improve Uzbekistan’s blood services by
developing a new plasma product factory in its capital, Tashkent City, upgrading test equipment of blood centers
located in 4 major cities, including Tashkent City, and providing operational support and technology support for
those facilities at a cost of approx. 8.05 billion JPY.
We hope that this report will help the above project to be realized and serve as a reference for the stakeholders
in Japan.
February 2017
Shimizu Corporation
Project Map
Project sites across the country
Gray-shaded stations (1, 4, and 8) are target sites of the project.
Source: A map image from Google Maps was modified by the study team
Provincial Blood Station
(1) Nukus Provincial Blood Station Karakalpakstan Nukus City
(2) Urgench Provincial Blood Station Khorezm Urgench City
(3) Fergana Provincial Blood Station Ferghana City
(4) Andizhan Provincial Blood Station Andijan City
(5) Namangan Provincial Blood Station Namangan City
(6) Bukhara Provincial Blood Station Bukhara City
(7) Navoi Provincial Blood Station Navoiy City
(8) Samarkand Provincial Blood Station Samarkand City
(9) Jizzax Provincial Blood Station Djizakh City
(10) SyrDarya Provincial Blood Station Syrdarya City
(11) Kalush Provincial Blood Station Kashkadarya Karshi City
(12) Termez Provincial Blood Station Surkhandarya Termez City
(1)
(2)
(3)
(11)
(12)
(8)
(7) (6)
(4)
(5)
(9)
(10)
100 km
Project sites across Tashkent Province
Plasma product factory
(1) Within the premise of the Republican Blood
Transfusion Center in Tashkent City Existing plasma product factory
Blood transfusion stations in Tashkent Province
(1)
Tashkent City
Republican Blood Transfusion Center
(2) Blood transfusion station in the 2-clinic of Tashkent Medical Academy
(3) Blood transfusion station in the 3-clinic of Tashkent Medical Academy
(4) Blood transfusion station in the Republican Scientific Center of Surgery
(5) Blood transfusion station in the Republican Scientific Center of Emergency
(6) PNN Blood Product Center
(7) Chirchik Chirchik Blood Transfusion Station
The gray-shaded station (1) is a target site of the project.
Source: A map image from Google Maps was modified by the study team
(4)
(1)
(2)
(3)
(5)
(6)
2 km
(7)
5 km
Tashkent
Tashkent
Chirchik
Abbreviations
Abb. Complete designations
B/C Benefit per Cost
BCP Business Continuity Plan
CLEIA Chemiluminesent Enzyme Immunoassay
EIA Environmental Impact Assessment
ELISA Enzyme-Linked ImmunoSorbent Assay
E/N Exchange of Notes
FIRR Financial Internal Rate of Return
F/S Feasibility Study
GDP Gross Domestic Product
GMP Good Manufacturing Practice
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HIV Human Immunodeficiency Virus
IU International Unit
JB Japan Blood Products Organization
JBIC Japan Bank for International Cooperation
JETRO Japan External Trade Organization
JICA Japan International Cooperation Agency
JPY Japanese Yen
L/A Loan Agreement
ME Medical Equipment
METI Ministry of Economy, Trade and Industry
MOH Ministry of Health
NAT Nucleic acid Amplification Test
NPV Net Present Value
ODA Official Development Assistance
QA Quality Assurance
QC Quality Control
SanPiN Sanitary Norms and Regulations
STEP Special Terms for Economic Partnership
USD United States Dollar
UPS Uninterruptible Power Supply
WHO World Health Organization
Contents
Preface
Project Map
Abbreviations
Contents
Executive Summary
Chapter 1 Overview of the Host Country and Sector
(1) Economic and Financial Circumstances of the Counterpart Country ............................................ 1-1
........................................................................................ 1-1 1) General Background of Uzbekistan
2) Uzbek Economic and Financial Circumstances ..................................................................... 1-2
................................................................................................. 1-6 (2) Overview of Project Target Sector
1) Overview of Blood Services in Uzbekistan ............................................................................ 1-7
2) Status of blood donation ......................................................................................................... 1-9
3) Status of plasma derivative production ................................................................................ 1-10
4) Conditions of Major Institutes ............................................................................................... 1-11
5) Issues Related to Blood Services .......................................................................................... 1-16
6) Overview and Comparison of Current Status of Blood Services in Japan ........................... 1-17
(3) Conditions of Target Areas ........................................................................................................ 1-21
Chapter 2 Study Methodology
.................................................................................................................................. 2-1 (1) Study Details
1) Study Items ............................................................................................................................. 2-1
2) Study Targets .......................................................................................................................... 2-2
........................................................................................... 2-2 (2) Study Methodology and Organization
1) Study Methodology ................................................................................................................ 2-2
2) Study Organization ................................................................................................................. 2-3
............................................................................................................................... 2-5 (3) Study Schedule
51) Overall Schedule .................................................................................................................... 2-
5 2) Field Studies ........................................................................................................................... 2-
Chapter 3 Justification, Objectives and Technical Feasibility of the Project
............................................................................................ 3-1 (1) Project Background and Significance
1) Project Background ................................................................................................................ 3-1
2) Project Significance ................................................................................................................ 3-1
................................................................ 3-3 (2) Basic Policies and the Determination of Project Details
(3) Project Overview........................................................................................................................... 3-4
1) Improvement of blood services: securing of raw material plasma required for
4production of sufficient blood products .................................................................................. 3-
52) Improvement of blood services: increased blood safety ......................................................... 3-
63) Increase of safe and secure plasma derivatives production .................................................... 3-
4) Operational Support for Human Resource Development, Training and Equipment
10Maintenance etc. ................................................................................................................... 3-
-115) Project Cost Estimate ............................................................................................................ 3
(4) Necessary Evaluation of the Project ............................................................................................ 3-12
121) Demand Forecast .................................................................................................................. 3-
122) Consideration of Division of Roles for Implementing of the Project ................................... 3-
123) Evaluation of Technological Practices for Plasma Derivative Production ........................... 3-
13 4) Acquisition of Approval and Licenses Required for Plasma Product Factory Construction 3-
Chapter 4 Evaluation of Environmental and Social Impacts
............................................................. 4-1 (1) Analysis of Current Environmental and Social Situations
.............................................. 4-11) Current Status of the Land for a New Plasma Product Factory
............................................................................................. 4-12) Current Status of Blood Centers
................................................................................ 4-2 (2) Positive Environmental Impact of the Project
2(3) Environmental and Social Impact of the Project ........................................................................... 4-
.............................................................................. 4-21) Impact on Ambient Natural Environment
............................................................................................... 4-22) Impact on Social Environment
(4) Overview of Environmental and Social Impact Related Laws and Regulations of
.............................................................. 4-4 the Host Country and Actions Required for Compliance
......................... 4-4 1) Uzbek Laws and Regulations Related to Environmental and Social Impact
(5) Necessary Actions of the Host Country for Realization of the Project .......................................... 4-4
Chapter 5 Financial and Economic Evaluation
..................................................................................................................... 5-1 (1) Project Cost Estimate
1) New Plasma Product Factory ................................................................................................. 5-1
2) Blood Centers ......................................................................................................................... 5-1
3) Total Project Cost ................................................................................................................... 5-2
............................................. 5-2 (2) Summary of Preliminary Financial and Economic Analysis Results
1) Financial Analysis .................................................................................................................. 5-2
2) Economic Analysis ................................................................................................................ 5-11
Chapter 6 Planned Project Schedule ...................................................................................................... 6-1
............................................................................................................................ 6-1 (1) Overall Schedule
1) Split of Project Scope ............................................................................................................. 6-1
2) Implementation Schedule ....................................................................................................... 6-1
Chapter 7 Implementing Organization ................................................................................................... 7-1
...................................................... 7-1 (1) Overview of Implementing Organization in the Host Country
............................................................................... 7-11) Overview of Implementing Organization
...................................................................................... 7-12) Chart of Implementing Organization
............................................................. 7-2 (2) Host Country’s Organization for Project Implementation
.......................................................................................... 7-21) Supervising Organization (MOH)
2) Implementing Organization (Republican Blood Transfusion Center) .................................... 7-2
Chapter 8 Technical Advantages of Japanese Companies ..................................................................... 8-1
(1) The International Competitiveness of Japanese Companies and the Possibility of
................................................................................... 8-1 Winning Contracts in the Proposed Project
............................................................................................................. 8-1 1) Entire Blood Services
............................................ 8-1 2) Provision of Facilities and Equipment by Japanese Companies
3) Expectations of the Host Country Government ...................................................................... 8-1
..................................................................... 8-1 (2) Japanese Materials and Equipment, and their Prices
................................................................................................. 8-1 1) New Plasma Product Factory
......................................................................................................................... 8-4 2) Blood Centers
.................................................. 8-4 (3) Measures Required to Help Japanese Companies Win Contracts
........................ 8-4 1) Provision of Maintenance and Technological Support in Yen-Loan Package
2) Evaluation of STEP Conditions .............................................................................................. 8-5
Executive Summary
S-1
(1) Project Background and Significance
WHO recommends countries to domestically produce blood products for transfusion and plasma derivatives in
domestic formulation plants from human blood collected domestically. Following these recommendations,
Uzbekistan has been striving to establish self-sufficiency in their blood product supply. In June 2015, the country
formulated the “Complex Plan for Improvement of Blood Services in Republic of Uzbekistan” for the deliberation
of appropriate measures. According to the plan, the country’s population is expected to reach 40 million by 2035,
and this will necessitate (1) 4,000L albumin, (2) 240,000 doses of immune globulin, and (3) 8,200 doses of
cryoprecipitate per year.
Although Uzbekistan has developed and operated blood centers and a plasma product factory under supervision of
MOH, many of them were constructed in the 1970’s and are not sufficient in both quality and quantity. For
example, Uzbek production capacity of albumin is as small as 600L annually, which falls far short of the 3,000L
of the annual required amount for today’s population of 30 million. The shortfall is currently filled by imports and
this may possibly lead to an unstable supply depending on the country’s financial circumstances and the climates
of exporting countries.
In 2015, MOH of Uzbekistan contacted stakeholders in Japan and explored possibilities of improving and
rebuilding of existing old and aged blood-service facilities and poor plasma derivative production functions of the
country with support from Japanese government. An Uzbek presidential order (No.4639) regarding economic
corporation campaign was then issued by then President Karimov in the subsequent year 2016, which dictated the
promotion of construction of a new plasma product factory with the support of Japan as part of the
aforementioned complex plan for blood services improvement. This study was conducted in order to verify the
project scope, targets, and scale for a feasibility study of the project.
(2) Principles of Project Contents Determination
In line with the reference from MOH of Uzbekistan and the Presidential Order of the former President Karimov,
the objectives of this project are: to ensure blood products for transfusion and plasma derivatives are supplied to
more Uzbek patients in need through an improvement of its blood services and development of a plasma product
factory; and to reduce the country’s financial burden by reducing the imports of expensive blood products.
In order to achieve the objectives, present issues in Uzbekistan were revealed and the following policies were set
through preliminary studies. Integrated support provided through the project include not only facilities, equipment
and devices etc. on the hardware side, but also Japanese-style operation procedures, maintenance and human
resource development practices on the software side.
Basic policies of the project
1． Improvement of blood services: securing of raw material plasma required for the production of adequate
blood products
To secure donated blood required for producing the target amount of plasma derivatives, support for the
introduction of essential equipment and guidance and instructions on the promotion of blood donation
and processing of increased amounts of donated blood will be provided.
2． Improvement of blood services: increased blood safety
Support for the introduction of essential equipment to reduce the risk of infection through transfusion
and improve blood product safety, and training for new procedures associated with new equipment will
be provided.
3． Increase of safe plasma derivatives production
Construction of a new plasma product factory, introduction of modern equipment, and production
expansion of safe plasma derivatives conforming to international standards will be conducted. After
completion of a new factory, reagents and consumables will be provided with support for equipment
maintenance until factory operations are fully under way.
4． Operational support for human resource development, training and equipment maintenance etc. at the
plasma product factory
Besides hardware assistance (facilities and equipment), Japanese-style management and know-how will be
introduced to improve production efficiency and quality.
S-2
(3) Project Overview
1) Improvement of blood services: securing of raw material plasma required for production of sufficient blood
products
Possible measures to increase the number of non-remunerated blood donors and to process an increased volume of
donated blood are as follows.
a) Activities to promote blood donations
In order to increase the volume of donated blood, national efforts and increased awareness of blood donations
among the nationals are critical. Listed below are the possible measures to achieve this.
1. Activities to promote blood donations through education institutions
2. Distribution of information materials in video, poster and other formats to various strata of the country
3. Media promotion activities
b) Blood collection, testing, production and supply
Equipment and manpower to process an increased volume of donated blood will be necessary in the future.
1. Blood collection: bloodmobiles, donation rooms and whole blood collection devices
2. Testing: blood cell counters, full-auto blood grouping equipment and infection testers (NAT, etc.)
3. Production (blood products for transfusion): automated production equipment
4. Supply: cooling containers
The proposed project will provide support on the introduction of equipment associated with the above items, as
well as guidance on blood donation promotion activities and human resource development etc. on the software
side. The support on the software side will be provided for 4 years from equipment introduction, and support
measures to enable Uzbek bodies to independently promote blood donations and manage their blood service
operations will also be implemented during the period.
2) Improvement of blood services: increased blood safety
To secure fresh frozen plasma from which to produce blood products for transfusion and plasma derivatives with
low risk of HBV, HCV and HIV infection, infection testing equipment including NAT will be introduced. The
proposed project will also distribute reagents and consumables required for testing equipment for 4 years
beginning from the introduction of equipment.
3) Increase of safe and secure plasma derivatives production
A new plasma product factory will be constructed in the premises of the existing blood center and new production
equipment will be procured and installed in the new factory. The building will be two stories, with a gross floor
area of approximately 3,600m2. It will be located behind the blood center building and a linked corridor will be
provided to connect with the blood center building. The room layout will be arranged based on circulation
planning for the efficient production flow from the reception and storage of fresh frozen plasma (raw material), to
production, testing, packing and shipment. Production processes will be performed in clean rooms, which are
classified into primary through tertiary zones depending on their cleanliness levels. A pharmaceutical water plant,
a generator room and a boiler room will also be included in the new factory building.
4) Operational Support for Human Resource Development, Training and Equipment Maintenance etc.
a) Improvement of blood services: securing of required volume of raw material plasma
To solicit for new donors and further cooperation from past donors, guidance on promotional activities through
education institutions and various media. The proposed project will proceed with nation-wide promotional
activities in cooperation with the Uzbekistan Red Crescent, which has already conducted blood donation
promotional activities in Uzbekistan.
Along with the deployment of new blood collection devices and analysis equipment at blood centers, guidance on
test management and new procedures will also be necessary.
These support, guidance and human resource development activities will be conducted for 4 years, during which a
technology transfer and the establishment of training systems etc. are expected to be completed.
b) Improvement of blood services: increased blood safety
In order to reduce the risk of transfusion-transmissible diseases and improve the blood safety, not only hardware
support, e.g., deployment of testing equipment such as NAT, but also software support for management and
S-3
human resource development practices are important. In blood collection practices, management of blood
collection standards, interviews, and donors (identity check) is critical, while sample storage and look-back
studies are after blood collection. Guidance by Japanese experts on these matters is included in the project scope.
c) Plasma product factory
As the new factory will adopt a mass-production system with new production equipment, it will be necessary to
define staff organization and a division of roles, and implement training measures to familiarize staff with new
procedures. Compliance with internationally accepted standards, i.e., GMP (Good Manufacturing Practices), is
also essential to ensure exportable quality of plasma derivatives. Thus, experts will be dispatched from Japan to
develop human resources and provide guidance on maintenance systems, facility operations and production
practices for 4 years after completion of the new factory.
5) Project Cost Estimate
As shown in the following table, 26,248,703 USD for reinforcement of blood services, 42,327,335 USD for
construction of a new plasma product factory, and 68,576,038 USD (approx. 8.05 billion JPY) for total project
cost are estimated.
Table S-1 Breakdown of Estimated Project Cost for Reinforcement of Blood Services
1 Main equipment items to be deployed to blood centers
- Bloodmobiles: 14 blood centers
- Donation rooms: 2 locations in Tashkent City
- Whole blood collection devices: 14 locations
- Automated blood grouping equipment: 4 locations
- Automated biochemical analyzers: 4 locations
- Automated hematology analyzers: 4 locations
- NAT (nucleic acid amplification tester): 4 locations
- Trucks and containers for transportation
15,066,849 USD
2 Reagents, consumables and equipment maintenance for 4 years after equipment
introduction
8,766,664 USD
3 Dispatch of Japanese experts (blood donation promotion, test management,
technological instruction, management guidance, human resource development
and training etc.)
4 years after equipment introduction: about 219 experts per month in total
2,415,190 USD
Total 26,248,703 USD
Source: Study team
Table S-2 Breakdown of Estimated Project Cost Plasma Product Factory Construction
1 Factory building construction work
Gross floor area: 3,600m2; RC structure; two-story
Including building equipment (boiler, compressor, generator, transformer,
A/C, piping and valves etc.)
19,800,000 USD
2 Plasma product factory
Various tanks, heat exchangers, pharmaceutical water equipment,
freeze-drying machines, centrifugal separators, autoclaves, serial dispensing
machines, control systems and instrumentation etc.
14,478,745 USD
S-4
3
Consumables and maintenance work for 4 years after completion
1,751,841 USD
4 Japanese expert dispatch (blood donation promotion, test management,
technological instruction, management guidance, human resource
development and training etc.)
4 years after completion: 84 experts per month in total
6,296,749 USD
Total 42,327,335 USD
1 USD = 117.382 JPY (as per JICA’s settlement rate for FY2016 (as of January 2017))
Source: Study team
3) Summary of Preliminary Financial and Economic Analysis Results
a) Financial analysis
Conditions for financial analysis were determined as follows:
Life of buildings and equipment shall be assumed to be 40 years and 20 years, respectively; equipment
shall be renewed after 20 years after implementation.
No salvage value for both buildings and equipment shall be considered.
The analysis period shall be 40 years.
1% of building price and 5% of equipment price shall be accounted as maintenance and management
expenses every year from the second year after the project implementation.
In addition to the above conditions, three cases of plasma derivative pricing were simulated and results were
compared.
Case 1: Benefits were calculated based on the local price of plasma derivatives at the time of this study. As
a result, the project would not run on an economic basis due to the low unit price.
Case 2: Benefit was calculated based on the latest price of plasma derivatives published by the Ministry of
Health, which is higher than that of Case 1. The project would be profitable based on the latest MOH price
for derivatives, with B/C rated as 1.508.
Case 3: On the assumption that production of plasma derivatives could not reach the target volume, the
benefit was calculated as 85% of the target production volume. The project would be sufficiently profitable
despite lower NPV and B/C.
Table S-3 Financial Analysis Results
In 1,000 USD
Case 1 Case 2 Case 3
Operational cost
distribution All paid All paid All paid
Grant for staff
compensation, etc,
from MOH
Yes Yes Yes
Basis of plasma
derivative pricing
Local price at the time
of the first local study
Latest MOH
price
Latest MOH
price
NPV -45,319 64,941 45,368
B/C 0.659 1.500 1.350
FIRR − − −
Source: Study team
S-5
b) Economic analysis
There are the following four potential economic benefits of the proposed project.
Table S-4 Potential Economic Benefits of the Proposed Project
No. Type of benefit Measurement
1 Production of sufficient amount of plasma
derivatives will eliminate the importing cost
arising out of the heavy dependence on
imports. Domestic sales volume will also
increase.
・ Increase of produced plasma
derivatives
・ Decrease or elimination of
imports
2 Surplus plasma derivatives produced
domestically can be exported to neighboring
countries.
・ Exports of plasma derivatives
3 Deployment of bloodmobiles is expected to
lead to a significant increase in the amount of
donated blood.
・ Increase of donated blood
・ Increase of plasma derivative
production thanks the securing of
more plasma (a raw material of
plasma derivatives)
4 Transfused patients’ risk of infection will be
substantially reduced by introduction of
established blood test systems.
・ Reduction of risk of infection
Source: Study team
Increase of plasma derivatives and plasma described in No.1 and No.3 above is the effect of pricing relative to the
derivative production volume as discussed in relation to the financial analysis.
The benefit No.4 can only be accessed qualitatively based on the reduction of infection risk as data regarding
infection cases after dosing of plasma derivatives are not available.
The benefit No.2 is the potential benefit from the possibility of exporting plasma derivatives when domestic
demands are fully met. This benefit is examined below.
Conditions for estimating the economic benefit are the same as those in the financial analysis.
With the plasma derivative production volume expected to exceed the current imported albumin volume of 1,100L
by 2020, the annual imports amounting to approximately 100 million JPY will be eliminated and even income
from exporting can be expected. The required volume of plasma derivatives for the Uzbek population is indicated
in the table below based on WHO’s recommendation per 1 million.
Table S-5 WHO’s Recommended Volume of Plasma Derivatives (per 1 million)
WHO’s recommended volume (per 1 million population)
Derivatives 10% albumin (L) 10% immune globulin (dose)
1 dose = 3ml
Blood coagulation
factor VIII (unit)
Required
volume
100L 6000 doses 1,000,000 units
Source: WHO
Based on the above figures, the possible surplus and exports were calculated. The calculated profit from exporting
was considered as the income in Case 2. Then a cash flow table was developed and the NPV and B/C figures were
calculated. The results of this calculation were -28,805 USD for NPV and 0.777 for B/C; NPV is negative, but the
B/C value indicates that the export income would account for about 51% of the total income in Case 2. Thus, the
benefit from plasma derivative exporting is expected to deliver significant positive effects on the Uzbek economy.
S-6
3) Evaluation of Environmental and Social Impacts
With MOH’s approval already obtained, the premises of the Republican Blood Transfusion Center where there is
an existing plasma product factory was determined as a site for the new plasma product factory. For this project,
therefore, there will be no need for securing a new factory site and for the relocation or resettlement of the
existing commercial facilities or residents.
For the traffic of the construction vehicles and the bringing in of construction materials/equipment for the
implementing of the project, a part of the existing blood center operations must be limited during the construction
period. For the same reason, safety, anti-contamination, anti-noise and anti-vibration measures etc. are required in
and around the premise of the Republican Blood Transfusion Center in order to minimize the impact on the
environment.
Although any plasma product factory requires special attention for the disposal of wastes including effluents, there
are no specific standards regarding effluent treatment in Uzbekistan. Therefore, the currently-applied SanPiN
standards should also apply to the new factory. Appropriate measures against construction noise, etc. should also
be implemented.
For the blood centers’ part of this project, there will be no environmental and social impact because the project
scope is limited to the procurement of additional equipment to existing facilities.
(4) Technical Advantages of Japanese Companies
Plasma derivative production techniques to be introduced to Uzbekistan through the proposed project are
elementary techniques for which there are no significant differences in technical competencies among advanced
nations including Japan. Similarly, equipment used in the production processes and construction techniques for
clean rooms required for GMP compliance are very common among many countries and companies in Europe and
other parts of the world. In other words, Japan and Japanese companies have no particular advantages in this field.
On the other hand, Japan’s blood services are known for the world’s highest level of safety and quality. Also, in
Japan there is great public trust in blood services developed through blood donation campaigns promoted by local
administrations and private businesses, which has led to a high rate of blood donation. Thus, Japan’s strengths lie
in thorough quality control excellent enough to maintain this trust and consistent supply of highly efficient and
safe blood products to the public.
In other words, Japan’s strengths in blood services are comprised of the collective competencies of its entire blood
service system covering upstream processes, including blood collection, backed by excellent quality control
know-how and the professional ethics of experts.
It is not easy to point out the objective and quantitative measurements of the abstract competitiveness of Japan’s
techniques and know-how. However, including the transfer of such techniques and the know-how in the scope of
this project, it will likely increase the chance for Japanese companies to receive orders. Additionally, the smooth
transfer of techniques and know-how from Japanese technicians, the introduction of reliable equipment familiar to
them would be prioritized and this could also increase the chance of increasing the exposure of the products of
Japanese manufacturers.
Moreover, this project originates from the presidential order of the ex-President Karimov (No. 4639, issued on
April 19, 2016), in which a Japan-Uzbekistan project was envisioned as part of the economic cooperation between
the countries. The Uzbek deep trust in Japanese products and technical competencies built through past economic
activities between Japan and Uzbekistan must be the primary reason of designating Japan in the order statement.
Considering the background of project formation, Uzbekistan primarily seeks Japan’s participation in the project
and it is likely that Japan can take the initiative in this project when other conditions are met.
S-7
(5) Concrete Schedule before Project Realization and Possible Obstacles
1) Schedule before Project Realization
Expected implementation schedule is as follows. After completion of this study, Uzbekistan government will
proceed with its internal decision making processes and submit a request letter to the Japanese Government. Then,
a preparatory survey will be conducted by JICA before confirmation of the project. Following the execution of
E/N and L/A based on the survey results, a consultant to support the implementation will be appointed and the
detailed design will be completed in about 7 months subsequently. Contractors for facility development and
equipment procurement will then be selected and equipment installation and operation instructions will be
provided upon completion of the construction after 18 months. Technical guidance, human resource training and
consumable supplies will also be provided in 4 years and then the project will be completed.
Figure S-1 Implementation Schedule
Source: Study team
2) Potential Risks
Based on the findings of this study, the following matters require continued study and analysis, in which an
unexpectedly long time or a review of the project scope may be needed. Thus, there are the potential risks that
may prevent project realization. Further studies based on sufficient consultation and agreement with relevant
international and domestic authorities and bodies are required to realize the project.
Impact of new president’s mid- and long-term investigation plan and economic and financial policies on this
project
Evaluation of needs and market conditions of export counterparts in relation to surplus exporting
Incorporation of long-term follow-up services into a yen-loan package
Verification of STEP yen-loan conditions
Human resource and operational budget planning on Uzbek side
Recruiting and dispatching appropriate operation instructors in both quality and quantity
Active acceptance of technical guidance on Uzbek side
Study completed
Internal request for decision in Uzbek Government
JICA preparatory survey
E/N and L/A execution
Consultant selection
Consultancy contract execution
Detailed design and bid documentation
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Equipment delivery (plasma product factory)
Equipment installation, plant installation arrangement
and delivery (production facilities)
Equipment procurement bidding (Tashkent City and
regional blood centers)
Equipment production (Tashkent City and regional
blood centers)
Equipment delivery, installation, operational
instructions and handover (Tashkent City and
regional blood centers)
Equipment installation and operational instructions
(production facilities, Tashkent City and regional
blood centers)
Staff training (production facilities, Tashkent City
and regional blood centers)
Defect liability period
Year1 Year2 Year3 Year4 Year5 Year5
S-8
(6) Maps of Project Sites in the Study Target Country
Figure S-2 Project Sites across the Country
Gray-shaded stations (1, 4, and 8) are target sites of the project.
Source: A map image from Google Maps was modified by the study team
Provincial Blood Station
(1) Nukus Provincial Blood Station Karakalpakstan Nukus City
(2) Urgench Provincial Blood Station Khorezm Urgench City
(3) Fergana Provincial Blood Station Ferghana City
(4) Andizhan Provincial Blood Station Andijan City
(5) Namangan Provincial Blood Station Namangan City
(6) Bukhara Provincial Blood Station Bukhara City
(7) Navoi Provincial Blood Station Navoiy City
(8) Samarkand Provincial Blood Station Samarkand City
(9) Jizzax Provincial Blood Station Djizakh City
(10) SyrDarya Provincial Blood Station Syrdarya City
(11) Kalush Provincial Blood Station Kashkadarya Karshi City
(12) Termez Provincial Blood Station Surkhandarya Termez City
(1)
(2)
(3)
(11)
(12)
(8)
(7) (6)
(4)
(5)
(9)
(10)
100 km
S-9
Figure S-3 Project Sites across Tashkent Province
Plasma product factory
(1) Within the premise of the Republican Blood
Transfusion Center in Tashkent City Existing plasma product factory
Blood transfusion stations in Tashkent Province
(1)
Tashkent City
Republican Blood Transfusion Center
(2) Blood transfusion station in the 2-clinic of Tashkent Medical Academy
(3) Blood transfusion station in the 3-clinic of Tashkent Medical Academy
(4) Blood transfusion station in the Republican Scientific Center of Surgery
(5) Blood transfusion station in the Republican Scientific Center of
Emergency
(6) PNN Blood Center
(7) Chirchik Chirchik Blood Transfusion Station
The gray-shaded station (1) is a target site of the project.
Source: A map image from Google Maps was modified by the study team
(4)
(1)
(2)
(3)
(5)
(6)
2 km
(7)
5 km Tashkent
Chirchik
Tashkent
Chapter 1 Overview of the Host Country and Sector
1-1
(1) Economic and Financial Circumstances of the Counterpart Country
1) General Background of Uzbekistan
Uzbekistan is a republic with a land area of about 447,400km2 and population of about 31.29 million
1. Its capital
is Tashkent City, located in the northeastern part of the country. The country consists of Tashkent City, 12
provinces and the Republic of Karakalpakstan.
Figure 1-1 Map of Uzbekistan
Source: Aflo Mall map image
a) Natural environment
Uzbekistan has a continental climate, in which temperature largely varies daily and yearly; temperature reaches
around 40℃ in summer and reach around -10℃ in winter. Its annual precipitation is 206 mm/year, which is
much lower than Japan’s 1,718 mm/year)2. The air is especially dry in summer.
Located over the Asia-Europe seismic zone, Uzbekistan is prone to earthquakes. In 1966, a great earthquake
centered in its capital Tashkent occurred and recently an earthquake near Fergana Province killed many Uzbek in
2011.
b) Geopolitical position
As Uzbek neighboring countries (Kazakhstan, Kirghiz, Tadzhikistan, Turkmenistan, and Afghanistan) are all
landlocked countries, Uzbekistan is a doubly landlocked country, from which you have to cross over at least two
borders to reach an ocean. The climates of neighboring countries are critical in promoting external trade, and the
direction of Afghanistan, which is in a poor security situation, is, especially, a concern of Uzbekistan.
c) Culture, ethnicity and history etc.
In the 7th century, the country was started to be Islamized along the invasion of Arab forces into Central Asia and
now the dominant religion in the country is Islamism (Sunni). Major ethnic groups in Uzbekistan are Uzbek
(78.4%), Russian (4.6%), Tajik (4.8%) and Tartar (1.2%)3. The national language is Uzbek while Russian is also
spoken in some parts of the country. The first ethnic group acting in the land before the 7th century was the Irani.
1 Source: World Bank (2015)
2 Source: 2008 Land Infrastructure and Transport White Paper
3 Source: Basic Data, Ministry of Foreign Affairs of Japan (as of December 28, 2016)
Uzbekistan
Turkmenista
n
Uzbekistan
Tajikistan
Kyrgyzstan
Afghanistan Iran
Kazakhstan
1-2
After the Islamization in the 7th century, the land went through Mongolian rule starting from the 13th century and
Russian rule from the 19th century, and upon the downfall of the Soviet Union in December 1991, the country
became independent as the Republic of Uzbekistan.
d) Political situation
Since the independence from the Soviet Union in December 1991, the former President Islom Karimov has long
governed Uzbekistan. The former President Karimov established the government base with a focus on political
stability and economic policies toward progressive transition to a market economy. The Uzbek Congress is
bicameral with upper and lower houses. Uzbekistan bans Islamic extremist activities in the country and is
especially cautious about movements of Islamic guerrillas near its borders with Afghanistan, Kirghiz, and
Tadzhikistan.
After the sudden passing of President Karimov in September 2016, the upper and lower houses named then Prime
Minister Mirziyoyev as Acting President. In December of the same year a presidential election was conducted and
the Acting President Mirziyoyev, who won the election, assumed the presidency. As the new President Mirziyoyev
has handled the government by following the policies of the former president, no significant political turbulence
or economic impact is expected, at least for the present.
e) Demographics
As shown in the following chart, the Uzbek population has increased annually and it crossed the mark of 31
million in 2015. The population growth is expected to continue at least for the near future and it is expected to
reach 40 million by 2035.
Figure 1-2 Changes in Uzbek Population
Source: World Bank, World Development Indicators (2016)
2) Uzbek Economic and Financial Circumstances
a) National economy
Changes in Uzbek real GDP growth rate are shown in Figure 1-3. A high growth rate has been maintained for the
10-year period from 2005, with steady growth in total nominal GDP and nominal GDP per capita.
1-3
Figure 1-3 Uzbek Real GDP Growth Rate (2005-2015)
Source: IMF, World Economic Outlook (April 2016)
Figure 1-4 Uzbek Total Nominal GDP and Nominal GDP per Capita
Source: IMF, World Economic Outlook (April 2016)
b) External trade and economic balance
Described in this subsection is the breakdown of Uzbek imports/exports by countries and the country’s
relationship with Japan. As Uzbekistan has maintained a close relationship with Russia since its independence,
Russia is the biggest trade counterpart of the country.
China is also one of its major trade counterparts. In the Uzbek-China summit in 2012, the relationship between the
countries was raised to a strategic partnership and China has actively invested in infrastructure projects in
Uzbekistan. Thus, imports of iron and steel, cement, and construction equipment etc. from China are expected to
grow further.
On the other hand, Japan accounts for only 0.5% of its exports and over 1% of its imports.
(%)
(US
D)
(Bil
lio
n U
SD
)
Nominal GDP
Nominal GDP per capita
1-4
Figure 1-5 Uzbek Exports by Countries
(In %)
Source: Uzbek imports statistics, JETRO (by countries and regions) (2016)
Figure 1-6 Uzbek Imports by Countries
(In %)
Source: Uzbek imports statistics, JETRO (by countries and regions) (2016)
Table 1-1 Major Indicators of Uzbek Trading
Indicators Values
Exports 6,553.4 (in million USD)
Exports to Japan 2.5 (in million USD)
Imports 11,858.5 (in million USD)
Imports from Japan 278.6 (in million USD)
Current account balance (b.p.) 93 (in million USD) *Estimate
Current account balance (b.p., property) 2,040.6 (in million USD) *Estimate
Exchange rate against USD 2,568 (UZS)
Source: Basic economic indexes, JETRO (2015)
Russia
Kazakhstan
China Turkey
Afghanistan
Others
Others
Germany
Kazakhstan Korea
China
Russia
1-5
Figure 1-7 Major Export Items of Uzbekistan
(In %)
Source: Uzbek imports statistics, JETRO (by items) (2016)
Figure 1-8 Major Import Items from Japan to Uzbekistan
(In %)
Source: Uzbek exports statistics, JETRO (by items) (2016)
c) Financial situation
Changes in Uzbek revenue, expenditure and the fiscal balance are shown in Figure 1-9. Both revenue and
expenditure have increased annually and the fiscal balance surplus has been maintained. This trend is expected to
continue. Thus, Uzbekistan is a country with a stable growth potential.
Energy
products
Service
Cotton fiber
Iron & steel Non-ferrous
metals
Machinery &
equipment
Food
products
Chemicals & plastic products
Others
Machinery &
equipment
Chemicals & plastic products
Food
products
Iron & steel
Non-ferrous
metals
Energy
products
Service
Others
1-6
Figure 1-9 Changes in Uzbek Revenue, Expenditure and Fiscal Balance (2005-2015)
Note: the values for 2015 are estimates
Source: IMF, World Economic Outlook (April 2016)
(2) Overview of Project Target Sector
The target sector of this project is blood services, which refer to an entire system of producing blood products for
disease treatment from human blood collected from sources such as blood donors and supplying them to the
public. Blood products include blood products for transfusion (blood components) and plasma derivatives.
Generally, organizations and bodies relevant to blood services are engaged in the collection of raw materials
(human blood), production of blood products and supply of raw materials and products etc.
Figure 1-10 Images of Blood Products
Source: Japan Association of Blood Preparations and Japan Red Cross websites, and
Japan Blood Products Organization’s booklet (2015)
(Bil
lion U
ZS
)
Revenue
Expenditure
Fiscal balance
Blood
Plasma Platelets Blood cells
Albumin products
Antithrombin III products
Immune globulin products
Tissue additives
Whole blood
products
Plasma derivatives
Blood component preparation
Blood coagulation factor products
Other plasma derivatives
Plasma derivatives
Plasma Platelets Blood cells
Whole blood
1-7
1) Overview of Blood Services in Uzbekistan
In Uzbekistan, the Ministry of Health of Uzbekistan (hereinafter “MOH”) controls all blood service operations.
The Uzbek blood services are composed of the Republican Blood Transfusion Center (having both blood center
functionality and plasma derivative production capabilities) located in Tashkent City, 17 blood transfusion stations
across the country and 185 blood banks within medical institutes across the country. The 17 blood transfusion
stations include several national medical centers under direct control of MOH (the Republican Scientific
Specialized Center of Surgery, the Republican Scientific Center of Emergency, the 2-clinic of Tashkent Medical
Academy, and the 3-clinic of Tashkent Medical Academy), which have superior capabilities to other general blood
banks. In addition to these, there is an institute called Scientific Production Enterprise in Tashkent City, which
independently collects blood, manufactures and supplies plasma derivatives.
Figure 1-11, provided by MOH, shows the relationships among bodies and institutes involved in Uzbek blood
services. As shown in the figure, the blood services are composed of the relevant organizations with the
Republican Blood Transfusion Center playing a central role.
Figure 1-11 Structure of Blood Services
Note: The blood transfusion functions of the Republican Specialized Center for Obstetrics and Gynecology and
the Tashkent Pediatric Medical Institute have not been used since 2012.
Source: material provided by MOH translated by the study team
1-8
Table 1-2 shows the total number of workers engaged in Uzbek blood services, disclosed by MOH. According to
the information, approximately 1,700 workers are engaged in the operations of organizations associated with
blood services across the country.
Table 1-2 Workers Engaged in Uzbek Blood Services
Job types Count
a) Clerks 58
b) Technologists 38
Physicians 381
Nurses 1,028
Pharmacists 1
Medical technologists ‐
Others 225
c) Researchers ‐
d) Others ‐
Total 1,731
Source: Material provided by MOH translated by the study team
The figure below illustrates an overall picture of the blood services in Uzbekistan revealed through a local study.
Functions of Uzbek blood services are distributed among related bodies, whose functions vary. Also, the raw
material blood is not only collected from donors as is generally done in Japan, but through a unique system of
“family donors,” which is not seen in Japan.
Supplies of blood products for transfusion are controlled by the blood centers and medical institutes, and there are
some distinct rules of blood product supply; for example, the amount of blood products transfused is limited based
on the amount of blood donated by the patients. Further, as the shortfall of plasma derivatives is filled by imports
and imported plasma derivatives are also available in the market, there are actually multiple supply channels of
imported plasma derivatives in Uzbekistan.
Figure 1-12 Overview of Blood Services in Uzbekistan
Source: Study team
1-9
2) Status of blood donation
Blood is a fundamental basis for blood services and is collected by MOH in Uzbekistan through donations by the
public. As shown in the figure below, the number of blood donors has increased annually, but about 60% of the
total is accounted for by “family donors” (i.e., donations for family members) and only the remaining 40% is
non-remunerated blood donation from the general public. There are cases of remunerated blood donations, but
such cases are limited to the collection of rare blood types and the ratio to total blood donation is minimal.
Figure 1-13 Changes in the Number of Blood Donors in Uzbekistan
Source: prepared by the study team based on material received from MOH
(Changes in Blood Donors in 2009-2015)
In principle, people donate blood at the Republican Blood Transfusion Center, blood transfusion stations in each
province and blood banks under the stations. As shown in the figure below, Tashkent City, which has the largest
population in the country, produces the largest number of blood donors among other provinces.
Figure 1-14 Number of Donors in Uzbekistan by Provinces and National Hospitals
Source: prepared by the study team based on material received from MOH
(Changes in Blood Donors in 2009-2015)
remunerated blood donations
non-remunerated blood donation
family donors
Total of all other Provinces
Tashkent City
1-10
3) Status of plasma derivative production
a) Status of plasma derivative supply
In the production and supply of plasma derivatives in Uzbekistan, the existing plasma product factory of the
Republican Blood Transfusion Center in Tashkent City, which produces albumin and immune globulin for I.M.,
has played a central role. Besides the center, albumin is also produced by the Scientific Production Enterprise in
Tashkent City, as well as the Republican Scientific Specialized Center of Surgery, and Andizhan Blood
Transfusion Station, etc. Besides those MOH institutes, Uzbekistan Railways and the Blood Transfusion Center of
the Uzbekistan Ministry of Defense also produce a small amount of albumin.
The following tables show the changes in production volume disclosed by MOH. Annual production volume of
albumin is about 600-700L and that of immune globulin for I.M. was reduced by half between 2012 and 2015. In
the past, albumin was produced in the Bukhara Blood Transfusion Station and the blood transfusion center of the
second clinic of Tashkent Medical Academy etc., too. However, they ceased production with the intention of
MOH to integrate all the plasma derivative production functions into the factory in the Republican Blood
Transfusion Center.
Table 1-3 Changes in Plasma Derivative Production Volume by Institutes
Source: material provided by MOH translated by the study team
The present production volume is not enough to satisfy the national demand and the shortfall is filled by imports
as indicated in Table 1-4. For immune globulin for I.V. and factor-III products, which cannot be produced
domestically, the country fully depends on imports. Its major import trading partners are pharmaceutical makers in
Russia and Eastern Europe and the annual import amount the country has paid for is reported to be several
hundred million JPY. This is why Uzbek MOH considers it an urgent task to meet domestic demands by
enhancing production capacity of the plasma product factory to replace imports.
1-11
Table 1-4 Changes in Blood Product Imports
Source: The Pharm Committee, MOH
4) Conditions of Major Institutes
a) Republican Blood Transfusion Center
1. Facility overview
The Republican Blood Transfusion Center is a leading institute of Uzbek blood services. On its premise, the
institute has a blood center with blood collection, testing, production (blood products for transfusion), product
storage and supply capacities and a plasma product factory.
There are separate areas for blood collection, production, supply and testing on the ground floor of the blood
center, and the main inspection areas and administrative department on its second floor. The center is one of the
facilities that received financial support from ADB4
since 2004, and its apheresis devices, refrigerators and test
equipment etc. were introduced with the support of ADB.
Figure 1-15 Front and Entrance of the Republican Blood Transfusion Center
Source: Study team
4 A maternal and child health project was implemented with support of ADB from 2004 through 2011. For blood
services, equipment and training etc. were also provided by ADB. For more information, refer to Chapter 9.
1-12
2. Functions of the Republican Blood Transfusion Center (the blood center section)
Its blood collection area has a waiting space for donors, and provides functions for reception (application
forms and interview sheets are provided; PC-based reception), preliminary testing (blood type and
hemoglobin level), interviews by a doctor and blood collection (14 beds and 2 apheresis devices). The
production area is equipped with centrifugal separators, blood separators, freezers and refrigerators.
Red blood cells, plasma and albumin are stored in the supply area. Hospital staff will come to take the
products when a hospital needs any blood products (as per the contract between the center and the hospital).
In its testing area, virological, serological and immunological tests are conducted. Thanks to a system
introduced by ADB, data obtained by the testing department are input to a PC application and centrally
managed by the center. However, such data are not automatically shared with other centers and MOH via the
Internet and are delivered to MOH in a physical storage devices.
While donors and donated blood bags are basically managed by barcodes, hand-written ledgers and records
are also made besides electronic records in a computer.
X-ray radiation to blood products for transfusion is conducted only when requested.
2 bloodmobiles and 2 equipment carriers (station wagons) are available. Blood collection teams are
dispatched to provincial hospitals with blood banks, schools and private businesses etc. for blood collection.
In Tashkent Province, there are 42 hospitals under control of the center and 10 out of the hospitals are
engaged in the blood collection service.
The bloodmobiles have 2 beds each. However, these vehicles are antiquated and they possess no equipment
or functions other than the installed beds.
A blood collection team normally consists of a driver, 4 nurses and a doctor.
The number of donors outside the center is about 100 per day. It is 20 to 30 per location and generally a team
visits 3 locations daily. For blood campaign at schools, the center’s representative promotes the campaign to
schools in advance. The number of employees at the Republican Blood Transfusion Center is as follows.
Table 1-5 Number of Employees at the Republican Blood Transfusion Center
Job types Count
Clerks 12
Physicians 48
Nurses 99
Pharmacists 1
Medical technologists 1
Others 50
Total 211
Source: MOH
3. The conditions of equipment introduced to the Republican Blood Transfusion Center (blood center section)
The main existing equipment items in the Republican Blood Transfusion Center (blood center section) are listed in
the table below. Equipment introduced with support of ADB is also listed.
Table 1-6 Main Existing Equipment Items in the Republican Blood Transfusion Center (blood center section)
Blood collection dept.
1 Single-channel hemoglobin determination equipment with
consumables
2 Plasma apheresis device
3 Blood collection bed
Testing dept.
1 Immunohematological analyzer with reagents
2 Centrifugal separator for experiments
3 Binocular immersion microscope
Production dept.
1 Manual plasma extractor
2 Automatic tube sealer
Supply dept.
1 Plasma freezer
2 Refrigerator
3 Plasma refrigerator for blood center
1-13
Source: answer to inquiry
Unlike the plasma product factory described below, the center has no dedicated facility maintenance personnel
and asks manufacturers to repair equipment failures, which impedes the center’s operational efficiency.
The mode of training on the operation of the facility’s equipment is basically OJT; generally senior staff members
teach new staff about how to operate by following the respective manuals.
b) Plasma product factory
1. Facility overview
The facility is a two-story annex building located within the premises of the Republican Blood Transfusion Center
and the production processes are conducted on the ground floor and the second floor (mezzanine floor). There are
a freeze-drying room on the ground floor and fractionation and dispensing rooms on the second floor.
As there are large cracks on the production site floor, little attention has been paid to hygiene and the production
environment is not sufficiently controlled to ensure product quality. Most of the equipment was manufactured in
the 1980s to 1990s and are seemingly antiquated and have past their service life. It is reported that equipment
failure occurs frequently. Further, when any one machine within the production line fails, then the entire
production line must stop until the failed machine is restored.
22 staff members are working for the production dept., including an engineer and 6 technologists in the factory.
Those technical staff fix any failure of the production machines as far as possible. However, they have to ask
equipment manufacturers for repair in case of any failure outside their capabilities, and this further drags down the
production efficiency of the factory.
2. Plasma derivative production flow
In this facility, precipitate is extracted from frozen plasma after melting by using Cohn’s cold ethanol fractionation
process and the precipitate is freeze-dried to remove ethanol. The resultant freeze-dried powder is dissolved. After
adjusting the concentration, the solution is sterilized and filtrated and then poured into a glass bottle in bulk. After
being poured into a bottle, albumin goes through a virus inactivation process at 60℃ for 10 hours (bottle
pasteurization).
3. Production site quality control
In Japan, there are strict standards regarding the quality of blood products for transfusion and plasma derivatives
and every lot of such products are subject to a national test. In Uzbekistan, however, only an extraction test is
conducted about once a year for to grant national production approval. Blood product production in Uzbekistan is
said to be conducted as per applicable pharmacopoeia, official standards regarding products and raw material
plasma (FS-Uz-42-1016:2015 Plasma Fractionation Method) and quality standards for process management and
final products (FS-Uz-41-0175: 2016 Albumin 5%/10%/20% Products, FS-42-Uz-0906-2011 Antistaphylococcal
Immune Globulin Products, FS-42-Uz-0020-2011 Human Immune Globulin, etc.).
4. Human resource development conditions
The mode of training for the facility staff is basically OJT; generally senior staff members teach new staff about
their operations by following the internal operation manuals. The production processes are mostly manual and no
systematic training and education have been conducted. Thus, there is a concern of varied product quality
depending on the skill levels of production staff.
5. Conditions of introduced equipment (manufacturer, model and year of introduction)
Existing equipment items in the factory are listed in the table below. As mentioned above, most of the equipment
items were manufactured in the 1980s and 1990s. In consideration of the fact that the amortization period of
manufacturing machinery is generally 5-10 years, most of the machines in the factory are past their service life.
1-14
Table 1-7 Main Equipment Items Available in the Existing Plasma Product Factory
Source: MOH
c) Samarkand Blood Transfusion Station
This blood transfusion station covers the entire Samarkand Province. As with the case of the Republican Blood
Transfusion Center, it received support from ADB for renewing some equipment and, consequently, its operational
efficiency, and safety and management of donated blood bags were reportedly improved.
There are 20 blood banks in the province and they are basically annexed to the respective district hospitals. The
blood banks are visited by mobile teams (blood collection team) from the station for blood collection.
Between 2014 and 2015, the number of blood donors in this region was significantly increased from 12,400 to
17,295 largely due to the blood donation promotion activities, and so was the number of non-remunerated blood
donors. In the past, the region suffered a shortage of donated blood and of blood products. Today, in contrast,
internal demands of the province can be satisfied thanks to the increased blood donation, and the blood transfusion
station even transfers surplus raw material plasma to the Republican Blood Transfusion Center.
In the past, the station had production facilities for plasma derivatives (albumin and globulin), but production at
this station was ceased in 2006. Since then, the station has transferred raw material plasma collected in the
province to the Republican Blood Transfusion Center and received plasma derivatives from the center.
The facility adopts the common processes of the country’s other blood transfusion stations: entrance, reception
1-15
(based on a system introduced with the support of ADB; identity check by passport), testing (blood cell count and
blood type), interview and blood collection. There are 4 beds and 2 apheresis devices in the blood collection area.
For blood products for transfusion, collected blood goes through separation, testing (virological, serological and
immunological tests, etc.) and supply processes at this station.
It was explained that medical wastes are incinerated in an incinerator in the premise and there is no specialized
medical waste disposer.
d) Navoi Blood Transfusion Station
As the station’s building is a former kindergarten building renovated 6 years ago, the interior and exterior appear
relatively new. The functions of the facility are the same as those of the Samarkand Blood Transfusion Station.
The station is also equipped with minimal required equipment for the production of blood products for transfusion,
including equipment introduced with the support of ADB. There are 6 beds in the blood collection area. The
station has no bloodmobile.
In Navoi Province, there are 8 blood banks besides the station, all of which are annexed to a hospital. Each
hospital also introduced refrigerators for blood product storage with the support of ADB. The blood banks in the
province can receive blood products for transfusion from the station depending on the amount of blood the banks
provided to the station.
Plasma derivatives are also not produced at the station. The station sends raw material plasma to the Republican
Blood Transfusion Center and receives plasma derivatives in exchange. It was explained that they send raw
material plasma in cold containers along with refrigerants.
e) Nukus Blood Transfusion Station
This station is a central blood center of the Republic of Karakalpakstan and also the only station with testing and
production capacities in the autonomous republic. Although hospitals in the autonomous republic had testing and
production capacities in the past, such functions were integrated into the central facilities in response to guidance
from the central government in 2012.
In the Republic of Karakalpakstan, there are 25 blood banks in 25 hospitals, which are visited by mobile teams of
the station for blood collection. The blood banks serve as blood collection sites and their functions are limited to
gathering donors and storing blood products for transfusion.
The station receives about 35 blood donors per day, which adds up to about 5,500 blood donors annually. Also, it
collects blood from about 4,500 blood donors outside the station; 80% of them are from blood banks and the
remaining 20% is from schools and private companies. A breakdown of donors is: non-remunerated blood donors
(25-30%), family donors (70-75%) and zero remunerated blood donors. Six beds for blood collection and 2
apheresis devices are available.
The station has no bloodmobiles, and only 2 vans to carry blood collection teams and their equipment. As the
fartherest blood bank is located 230km away, cold containers are used for transportation. It was explained that a
mobile team is dispatched to each blood bank on a weekly basis.
Functions of the station are mostly the same as those of other regional blood transfusion stations and a functional
flow of processes (reception, preliminary testing, interview, blood collection, production, testing and storage) has
been established. It also received the support of ADB for equipment upgrades, i.e., electronic reception and
barcode management systems.
While being under control of the MOH of the Republic of Karakalpakstan, the station is under the supervision of
the Republican Blood Transfusion Center regarding operations and implementation of the blood services. Thus,
the station has monthly teleconferences for reporting and consultation with the center.
f) Chirchik Blood Transfusion Station
This station is the provincial blood center of Tashkent and located in Chirchik, Tashkent. It was located in a
different place until 2004 when it was moved to its present location, a renovated building formerly used as a
kindergarten building.
This station dispatches blood collection teams to 16 hospitals within the Tashkent Province for blood collection. It
performs no production and testing operations and the blood it collects is sent to the Republican Blood
1-16
Transfusion Center for production and testing etc. It possesses no bloodmobiles.
Blood products for transfusion are provided by the Republican Blood Transfusion Center to the station, which in
turn supplies them to 6 medical institutes in Chirchik and 16 hospitals in Chirchik and neighboring
cities/provinces. Blood bags used in this facility are purchased within the budget of the city of Chirchik, Tashkent.
5) Issues Related to Blood Services
From the findings of the local study, several issues in Uzbek blood services were identified. For the purpose of
this study, consideration is given to those issues for the realization of projects that take advantage of support from
Japan.
Due to the small number of blood donors and high ratio of family donors among them (about 60%), a
sustainable and stable blood supply (including plasma for production of plasma derivatives) has not been
realized.
The number of mobile blood collection units, such as bloodmobiles, is insufficient, and there are no
permanent donation rooms.
The supply of platelets is extremely low, except in Tashkent, and only a small amount of platelets is
imported.
Safety measures commonly implemented in Japan have not been implemented in Uzbekistan: donors’ blood
sample storage; diversion of the initially drawn blood to prevent skin bacteria from being mixed in; reduction
of leukocytes to prevent side effects; and an FFP inventory hold for look-back studies.
An absence of a nucleic acid amplification test (NAT5) poses a risk of infected blood getting past testing.
Products that require temperature control are shipped with cold containers only. This poses a risk in quality
control.
Even equipment introduced with the support of ADB is not fully utilized due to the difficulties of procuring
consumables and insufficient maintenance.
The plasma product factory is very old with antiquated machines. Moreover, pre-modern production
techniques are used.
There are no clean rooms available and the hygiene and process management of blood products are poor.
The absence of nucleic acid amplification tests (NAT) poses a risk of infected plasma getting past testing.
Frozen plasma that requires temperature control is shipped with cold containers only. This poses a risk in
quality control.
Patients have to personally purchase expensive imported products if hospitals lack drug stock. This is an
inconsistency with the country's policy to provide the people with free health care.
The country has to depend on imported plasma derivatives, which results in payments of a large amount of
foreign currency every year.
While MOH’s GMP was amended in 2015, the facility does not satisfy the amended GMP. There are 4
domestic companies complying with the present GMP.
5
To prevent virus infection via blood products, donated blood must go through virus testing. The
antigen/antibody test (a virus test) is to detect antigens/antibodies produced in blood after infection, and cannot
detect infection for some time after infection (the window period). On the other hand, NAT amplifies the part of
nucleic acids (DNA or RNA) consisting of viruses 100,000,000x in order to detect viruses. Therefore, NAT is
highly sensitive and specific and can minimize the window period for precision testing. The table below compares
the window periods of the antigen/antibody test and the NAT.
Virus type Antigen/antibody NAT
Hepatitis B virus HBsAg test
Approx. 59 days
NAT (HBV DNA) 1
Approx. 34 days
Hepatitis C virus Anti-HCV test
Approx. 82 days
NAT (HCV RNA)
Approx. 23 days
Human immunodeficiency virus
(AIDS virus)
Anti-HIV-1 and
anti-HIV-2 test
Approx. 22 days
NAT (HIV RNA)
Approx. 11 days
1-17
6) Overview and Comparison of Current Status of Blood Services in Japan
a) Overview of Current Status of Blood Services in Japan
The Japan Red Cross’s blood center operations and supply of blood products for transfusion, and production of
plasma derivatives by private businesses are the main pillars of blood services in Japan. The figure illustrates the
overall picture.
Figure 1-16 Overall Picture of Blood Services in Japan
Source: Japan Red Cross’ booklet
b) Facilities Associated with Blood Services in Japan
The purpose of this study is to reveal the feasibility of forming projects for transferring Japanese technology and
know-how to Uzbekistan. Therefore, an overview of a representative blood center and plasma product factory is
described in this section for comparison.
1-18
1. Japanese Red Cross Hokkaido Block Blood Center / Hokkaido Red Cross Blood Center
Figure 1-17 Overview of Japanese Red Cross Hokkaido Block Blood Center /
Hokkaido Red Cross Blood Center
Source: Japan Red Cross website
Facility overview
This is one of the 7 block centers across Japan, engaged in testing and production (separation) of blood
donated by 270,000 donors annually from branch and field stations across Hokkaido. It also provides
other services such as umbilical cord blood storage.
Facility features
Its blood collection department gives consideration to amenities and privacy to attract more donors.
Its testing department operates multiple test devices to handle tests on blood from 800 donors per day.
Individual NAT is conducted. However, machines used for NAT are not made in Japan.
Biochemical and hematological tests, which are not necessary for production of blood products, are
conducted as a service for blood donors. Test results are sent to donors who wish to receive results.
Frozen samples are retained for 11 years to ensure traceability.
Its production department promotes mechanization for some part of their operations. They produce
700-1000 doses of blood products for transfusion on average per year.
While some processes had to be done in a bioclean room in the past, no bioclean room is needed as
machines that do not require sterile environments were introduced.
Machines used by the production department are all made in Japan for ease of after-sales services.
Transportation of blood and frozen plasma between centers is outsourced to a specialized contractor (Air
Water Inc.). Specialized custom-ordered vehicles are used.
Private power generators and UPS are used against power failures.
2. Chitose Plant, Japan Blood Products Organization
Figure 1-18 Chitose Plant, Japan Blood Products Organization
Source: Japan Blood Products Organization website
Hakodate
Tomakomai
Tomakomai
Obihiro
Kushiro
Kitami
Asahikawa
Wakkanai
Muroran
Atsubetsu
Hokkaido Block Blood Center /
Hokkaido Red Cross Blood Center
1-19
Facility overview
This facility was built in 1983 as a plant of the Japan Red Cross, and transferred to Japan Blood
Products Organization in 2012.
It produces plasma derivatives from raw material plasma purchased from the Japan Red Cross.
Freezers are automated mechanical cold storages constantly kept under -30°C.
Cohn’s cold ethanol fractionation process is employed. A variety of plasma derivatives is produced from
single raw materials by repeating the fractionation process.
Facility features
All production processes are connected by piping so that raw material and products are not exposed to
ambient air.
The dispensing process is conducted in a clean room.
A private alcohol processing facility is available within the premises to reuse alcohol.
There is also a private effluent treatment facility.
Private power generators and UPS are used against power failures.
c) Comparison of Japanese and Uzbek Blood Services
Blood services of the countries are compared in tables below in terms of implementation system, donors, donated
blood/blood products, and test items/methods.
Table 1-8 Blood Donation Implementation System
Uzbekistan Japan
Responsible organization National and local governments Japan Red Cross (JRC)
Blood donation campaign Red Crescent, national and local
governments
National and local governments,
JRC
No. of blood centers National blood centers: 1 JRC block blood centers: 7
Municipal blood transfusion stations:
15
JRC local blood centers: 47
Blood transfusion stations in national
hospitals: 4
Blood transfusion stations in
municipal hospitals: 185
Blood collection sites National and local blood centers, and
blood transfusion stations in national
hospitals
JRC local blood centers
Bloodmobiles: 2 Bloodmobiles: 292
Donation rooms: 0 Donation rooms: 129
No. of workers 1,731 6,432
Source: Study team
1-20
Table 1-9 Donor Comparison Table
Uzbekistan Japan
No. of donors per year 156,000 (2015) 4.88 million (2015)
Donor ratio 0.5% 3.9%
Collection categories
Whole blood 96.5% 72%
Platelet apheresis 3.4% 16%
Plasma apheresis 0.004% 12%
Donor types
Family donors 60% 0
Non-remunerated donation 40% 100%
Remunerated donation Few (for raw material for special
immune globulin only)
Source: Study team
Table 1-10 Donation and Production Comparison Table
Uzbekistan Japan
Donation types 500mL 200mL, 400mL
Transfusion conditions Family or relatives must donate blood
and obtain a certificate.
Otherwise, patients have to buy blood.
Transfused free of charge in case of
emergency.
Blood supply Hospitals have to pick up blood at a
blood center
Blood centers deliver blood to
hospitals
Blood product prices When there is no blood donor for a
patient
NHI standards
Whole blood 242,000 UZS (about 8,228 JPY) 16,320 JPY (before leukocyte
reduction radiation)
Red blood cells 250,700 UZS (about 8,524 JPY) 16,805 JPY (before leukocyte
reduction radiation)
Plasma 260,400 UZS (about 8,854 JPY) 17,912 JPY (before leukocyte
reduction radiation)
Source: Study team
Table 1-11 Test Items and Method Comparison Table
Uzbekistan Japan
Blood typing ABO, Rh ABO, Rh, Irregular antibody,
HLA (not all)
Infection test ELISA (=EIA)
Enzyme-linked immunosorbent assay
CLEIA
Chemiluminesent enzyme
immunoassay
Infection test items Syphilis, HBsAg,
anti-HCV,
anti-HIV-1, anti-HIV-2,
brucellosis,
malaria,
S-GPT (ALT)
Syphilis, HBsAg, anti-HBs,
anti-HBc,
anti-HCV,
anti-HIV-1, anti-HIV-2,
anti-HTLV-1, human parvovirus
B19,
S-GPT (ALT)
NAT Not performed HBV, HCV, HIV
Testing service for donors Not performed Biochemical test
Hematological test
Source: Study team
1-21
Table 1-12 Comparison Table for Plasma Derivatives
Uzbekistan Japan
Producers Blood centers, hospitals - 3 private operators
Plasma volume distributed
annually
4,000L (estimate for 2016) 965,000L (2016)
Pooled plasma NAT Not performed HIV, HBV, HCV
Virus inactivation/removal
treatment
Alcohol fractionation, pasteurization Alcohol fractionation,
pasteurization, S/D processing,
dry heating, virus removal film,
etc.
Main plasma derivatives Albumin
Globulin for I.M.
Specialized immune globulin
(cryoprecipitate: produced at blood
collection sites)
- Globulin for I.V. and I.M.
- Specialized immune globulin
- Albumin
- Blood coagulation factors VIII
and IX products
- Antithrombin III products
- Fibrinogen, etc.
GMP compliance No experience of GMP-compliant
production
Compliant
Source: Study team
(3) Conditions of Target Areas
The table below indicates information of all Uzbek areas including target areas of this project. Tashkent City,
Andizhan Province, Samarkand Province and the Republic of Karakalpakstan are the target areas of this project,
but the project aims to spread its benefits to the entire country starting from those areas.
Table 1-13 Basic Data of Project Target Areas
Name Population
(in 1,000)
Area No.of
districts
Capital city
Tashkent City 2,393.2 -
Andizhan Province 2,910.5 4,200 14 Andizhan
Bukhara Province 1,815.2 39,400 11 Bukhara
Fergana Province 3,505.3 6,800 16 Fergana
Jizzax Province 1,276.1 20,500 12 Jizzax
Namangan Province 2,603.4 7,900 11 Namangan
Navoi Province 927.9 110,800 8 Navoi
Qashqadaryo Province 3,025.6 28,400 14 Kalush
Samarkand Province 3,583.9 16,400 14 Samarkand
Syr Darya Province 790.6 5,100 9 Gulistan
Surxondaryo Province 2,411.5 20,800 14 Termez
Tashkent Province 2,794.1 15,300 15 Tashkent
Khorazm Province 1,746.9 6,300 10 Urgench
Republic of Karakalpakstan 1,791.1 165,600 15 Nukus
Source: uzstat
The following map shows the provisional division of blocks under consideration for this project. A suitable
division is sought where the positive impact of the project on the target areas will reach the neighboring provinces.
1-22
Figure 1-19 Proposed Division of Blocks for this Project
Source: Study team
8 Qashqadaryo Province
9 Samarkand Province
10 Syr Darya Province
11 Surxondaryo Province
12 Tashkent Province
13 Khorazm Province
14 Republic of Karakalpakstan
1 Tashkent City
2 Andizhan Province
3 Bukhara Province
4 Fergana Province
5 Jizzax Province
6 Namangan Province
7 Navoi Province
Chapter 2 Study Methodology
2-1
(1) Study Details
1) Study Items
In this study, the following matters were investigated.
a) Specific matters regarding the plasma derivative market
Current market situation
Annual volume of blood or plasma collected
Number of patients suffering related diseases (by treatment type)
Supply sources (import situation)
Healthcare insurance system
Medical expense per capita
b) Specific matters regarding the regional blood transfusion stations and the Republican Blood Transfusion Center
Blood collection department (number of donors, equipment, procedures and workforce, etc.)
Testing department (number of tests, equipment, procedures and workforce, etc.)
Production department (number of doses produced, equipment, procedures and workforce, etc.)
Supply department (number of doses supplied, equipment, procedures and workforce, etc.)
Logistics department
Initial building study and building equipment conditions
Equipment maintenance, facility operation and maintenance conditions
c) Confirmation of opinions of implementing organization based on current plan
Confirmation of current plan, proposed project scope and consistency with other projects
Confirmation of implementing organization and their opinions on implementation of the proposed project
d) Study on the current system and operation situations of existing facilities
Study on the overall picture of today’s Uzbek blood product production and supply systems and on the
operating status of existing related facilities
System scheme
Status of production approval by the national government (processes and targets)
Organizational chart and workforce of the production site
Production flow
Presence/absence of production manuals, change procedures to be followed in the event of any change in
production methods, records thereof, and inspection frequency
Presence/absence of factory audits by national government, and frequency of such audits (if any)
Presence/absence of pre-shipment inspections by the national government
Current factory operations (number of workers, and organization, etc.)
e) Approval and license systems related to construction
Study of approval and licensing systems regarding construction and verification of basic laws and regulations
Study of approval and licensing matters related to construction work, material and equipment importing and
installation, etc.
f) Proceedings for project approval within the host country’s government
Check of approval procedures, competent bodies and applicable laws and regulations regarding the yen-loan
project implementation (information gathering from relevant authorities)
g) Evaluation of project implementation scheme
Assessment of any implementation scheme and system of similar operations in the host country
Verification of responsibilities, supervision and organization to implement the project
Operations, organizational structure, financial status and staff organization of all implementing
organization(s) (including their statutory positioning)
Responsibilities, supervision and organization of implementing organization for this project
Organization and capabilities of the implementing organization regarding safety, quality control and
scheduling etc. for the project
Implementing organization experience in implementing similar projects
h) Evaluation of human resource development planning
2-2
Verification of staffing and development status etc. in relation to the existing system
Evaluation of human resource development planning in view of renovation/establishment of systems and
centers (as necessary)
i) Evaluation of operational, maintenance and management schemes
Verification of operations, maintenance and management schemes for systems and centers, and obtaining
organizational and financial resources
j) Evaluation of overall project planning
Planning of facility size, construction methods, plans, fundamental infrastructure development, and
equipment list etc. based on a consideration of the project scope
Verification of renewable energy utilization and BCP etc.
k) Evaluation of total project cost
Calculation of project cost estimate based on consideration of project planning
l) Financial and economic evaluation
Evaluation of profitability of the project based on the calculated estimate of project costs
m) Evaluation of procurement circumstances
Study of the local conditions of customary construction work bidding and contracting, local consultants, local
contractors and suppliers etc.
Close investigation of precautions for project implementation
n) Evaluation of operations and effect indicators
Setting of effect indicators for project monitoring and evaluation (for quantitative effects [operation and
effect indicators] and qualitative effects)
Confirmation of environmental and social considerations
Evaluation of environmental impact
Confirmation of the baseline environmental and social conditions (land use and natural environment etc.)
Confirmation of environmental and social consideration systems and organizations of the host country
Environmental and social matters to be considered in relation to implementation of the project, and
confirmation of their methods of evaluation
Impact projection
Study on social considerations
Check for critical impact factors
o) Proposal of collaboration with other projects
Proposal of possible collaboration with blood supply system support programs implemented in the host
country by other countries or international bodies
p) Evaluation of utilization of Japanese technology
Inquiring with relevant companies that are already conducting or interested in business in the host country
Evaluating the potential to introduce Japanese technologies and identifying Japanese products that may be
introduced
Evaluation of benefits for Japan
2) Study Targets
The study target facilities include the existing plasma product factory annexed to the Republican Blood
Transfusion Center, blood centers and regional blood transfusion stations.
(2) Study Methodology and Organization
1) Study Methodology
For preparation of the study report in line with the study items listed above, a literature review in Japan and a field
study in the host country were conducted. During the study period, interim reporting was provided accordingly to
METI, the host country government, the Japan External Trade Organization (JETRO), and the Japan External
Trade Organization (JICA), etc.
2-3
2) Study Organization
The organization of this study is as illustrated in the figure below.
a) Study management organization
Figure 2-1 Study Management Organization Chart
Kazuyuki Inoue
President & Representative Director
Shimizu Corporation
Kazuo Nakamoto Senior Managing
Officer
Head of International Division
Hajime Kamiosako
Deputy Chief,
International Division
Masanobu Suzuki
Sales Manager,
International Division
Source: Study team
2-4
b) Study implementation organization
Figure 2-2 Study Organization Chart
Source: Study team
Shimizu Corporation International Division Shimizu Corporation International Division Japan Blood Products Organization
General Manager Manager Director
Masanobu Suzuki Kuniaki Kume Hirokazu Ito
Assigned work：Project Manager Assigned work：Project Manager support 1 Assigned work：Blood Service Planning 3
Japan Blood Products Organization
Shimizu Corporation International Division Corporate Planning Section
Manager Takehiko Iijima
Tatsuya Sugimoto Assigned work：Blood Service Planning (Controller)
Assigned work：Project Manager support 2
Shimizu Corporation Tashkent Office
Representative
Takashi Iwata Japan Blood Products Organization
Assigned work：Environmental and Social Analysis Corporate Planning Section
Shimizu Corporation International Division Momoko Otaki
Assistant Manager Assigned work：Blood Service Planning Support 1
Kenji Mizuno
Assigned work：Project Manager support 3
Shimizu Corporation Tashkent Office
Dmitriy Maslov(Mr) Japan Blood Products Organization, Chitose Plant
Assigned work: Support of local actiuvities Production Dept. I, Production Sec. II,
Hitoshi Otsuka
Shimizu Corporation International Division Assigned work：Blood Service Planning Support 2
Design Group
Designer
Shimizu Corporation Tashkent Office Haruhiko Tsuchiya
Naira Turakhanova(Ms) Assigned work：Project Manager support 4
Assigned work: Support of local actiuvities Japan Blood Products Organization, Chitose Plant
Production Dept. I, Bulk Processing&Filling Sec.
Katsuya Iwama
Assigned work：Blood Service Planning Support 3
Japan Blood Products Organization, Chitose Plant
Chitose Plant Manager
Shinichiro Hase
Assigned work：Blood Service Planning 1 Japan Blood Products Organization, Kyoto Plant
Administration Dept., Engineering Sec.
Hideki Yoshii
Assigned work：Blood Service Planning Support 4
Japan Blood Products Organization, Kyoto Plant
Fractionation Dep, Fractionation Sec.Ⅲ
Teruaki Minamoto
Assigned work：Blood Service Planning Support 5
Japanese Red Cross Society Blood Service Head Quarter Japanese Red Cross Society Blood Service Head Quarter
Management and Planning Department Management and Planning Department
Yoshiaki Numata Manager Yuki Matsuyama
Assigned work：Blood Service Planning 2 Assigned work：Blood Services Planning Support
Marubeni Corporation Transport & Infrastructure Project Marubeni Corporation Tashkent Liaison Office
Department, Manager Head of Representative
Yuichiro Urai Yasuaki Fujii
Assigned work：Financial & Economic Analysis Support 1 Assigned work: Support of local actiuvities
Marubeni Corporation Transport & Infrastructure Project
Department, Manager International Total Engineering Corporation
Yuichiro Urai C&E Division, Global Business Group
Assigned work：Financial & Economic Analysis Supporet2 Executive Officer, Jun TAKAHASHI
Assigned work：Survey Support 1
International Total Engineering Corporation International Total Engineering Corporation
Presidential Aide C&E Division, Global Business Group
Senior Managing Director, Masaki KOMATSU Assistant Manager, Nobuki KAWASAKI
Assigned work：Healthcare/Medical Environment Survey Assigned work：Survey Support 2
International Total Engineering Corporation
International Total Engineering Corporation C&E Division, Global Business Group
C&E Division, Global Business Group Assistant Manager, Nagaharu YOKOMORI
Executive Officer, Kenji ISHIDA Assigned work：Survey Support 3
Assigned work：Healthcare/Medical Environment
Survey Support
International Total Engineering Corporation
C&E Division, Global Business Group
Chief, Masaki HORI
Assigned work：Survey Support 4
2-5
(3) Study Schedule
1) Overall Schedule
Table 2-1 Overall Schedule
Source: Study team
2) Field Studies
a) Field tour of blood-product related facilities in Hokkaido
1. Purpose
Before field studies, a field tour of blood service-related facilities of the Japan Red Cross and the Japan Blood
Products Organization was conducted with the aim of creating common knowledge of the overall picture of
Japanese blood service systems, and assessing their present situation as the basis for evaluating the possibilities of
the introduction of Japanese technologies.
2. Visitation schedule
The schedule of the visits was as follows.
Table 2-2 Schedule of the Field Tour of Blood Product-Related Facilities in Hokkaido (September 8-9, 2016)
Morning Afternoon
8th
(Thu)
Haneda - New Chitose Airport (JB,
JRC)
Preliminary arrangement and
preparation for the visits
9th
(Fri)
Haneda - New Chitose Airport (Shimizu
Corp. Marubeni, ITEC)
Japanese Red Cross Hokkaido Block Blood Center, Hokkaido Red Cross
Blood Center
Chitose Factory, Japan Blood Products
Organization
New Chitose Airport - Haneda
Source: Study team
September October Novemnber December January February
Exchange of Contract
Progress Meeting
Draft Submissoiopn
Follow-up in Uzbekistan
Final Meeting
Report Submission
2017Items
Preparation Work
First Field Study
Preparing Documents
Second Field Study
Finalization
2016
2-6
3. Primary outcomes
Because the subject of the project is blood services, a highly-specialized field, the study team established a shared
understanding of the project’s overall picture and Japan’s engagement. Also, the possibility of introducing the
technology and products of Japan were discussed and evaluated in the face of the practical introduction and
operational status of the facilities.
b) First field study
1. Purpose
The first field study was conducted with the aim of comprehending the current status and issues of the Uzbek
blood services and collecting information regarding the systems of the ODA project formation.
2. Study schedule
Table 2-3 Schedule of Field Study in October 2016
Morning Afternoon
2nd (Sun) Narita - Incheon - Tashkent
3rd (Mon) ●Embassy of Japan
●JICA
●WHO
◎MLIT’s Conference on
Infrastructure
●MOH
4th (Tue) ●MOH, Medical Facility Design
Bureau
●Institute of Hematology (hospital)
●Republican Blood Transfusion
Center
5th (Wed) ●Republican Blood Transfusion
Center
Blood center, the 2-clinic of
Tashkent Medical Academy
●Blood center, the Republican
Blood Transfusion Center
●JETRO
6th (Thu) Tashkent - Samarkand
◎Samarkand blood center
●Republican Blood Transfusion
Center
●Private design firm
●Accounting firm
7th (Fri) Samarkand - Navoi
◎Navoi blood center
●Republican Blood Transfusion
Center
●Private hospital
Navoi - Samarkand
8th (Sat) Samarkand - Tashkent
9th (Sun) ●Team meeting
10th (Mon) Tashkent - Nukus
◎MOH of Republic of
Karakalpakstan
●Nukus blood center
●Equipment manufacturer agent
●Republican Blood Transfusion
Center
Nukus - Tashkent
11th (Tue) ●Tashkent province blood center ●Republican Institute of Virology ◎Tashkent PNN center
●ADB
12th (Wed) ●Municipal hospital
●Ministry of Economy
●Equipment manufacturer agent
13th (Thu) ●MOH ●Uzbekistan Red Crescent
◎Private company (dairy product
plant)
14th (Fri) ●Private company (pharmaceutical
plant)
●JICA
●Embassy of Japan (courtesy call
on the ambassador) Tashkent -
15th (Sat) - Incheon - Narita
The ◎ mark signifies separate activities.
2-7
Source: Study team
(3) Main outcomes
By visiting the relevant facilities in Uzbekistan and having talks with local stakeholders, the study team
established a shared understanding of the present situation and issues of Uzbek blood services. Also, the team
consulted with authorities including MOH and implementing organization and confirmed the project scope and
their opinions.
The results of discussions and evaluations were eventually compiled in a Minutes of Meeting (MOM) and agreed
between the MOH representative and the study team leader.
Figure 2-3 Primary Contents of the MOM
Source: Study team
c) Second field study
1. Purpose
The second field study trip was conducted to present the study progress, to explain the proposal from Japan and
the estimate amount.
2. Study schedule
Table 2-4 Schedule of Field Study in December 2016
Morning Afternoon
13th (Tue) Narita - Incheon - (Kume, Tuchiya) - Tashkent
14th (Wed) ●Jurabek pharmaceutical plant
9:00-11:00
(Numata) - Tashkent
●JETRO 15:00-16:30
15th (Thu) ●Embassy of Japan 9:30-10:30
●Study team meeting 11:00-12:00
●Republican Blood Transfusion Center
14:00-16:30
16th (Fri) ●MOH 10:00-11:30 ●Study team meeting, material preparation
17th (Sat) ●Study team meeting, material preparation
13:00-17:00
18th (Sun) ●Study team meeting, material preparation
13:00-17:00
(Ito) - Tashkent
19th (Mon) ●Republican Blood Transfusion Center
10:00-11:00
●Study team material preparation
●Ministry of Finance 16:00-17:00
20th (Tue) ●Presentation to MOH 10:00-11:30 ●Embassy of Japan 15:00-16:00
Tashkent -
21th (Wed) - Incheon - Narita
<MOM Contents>
- Mutual confirmation of goals
10% albumin: 4,000L/year
10% immune globulin: 240,000 doses/year
Cryoprecipitate: 8,232 units/year (40 million units of blood coagulation factor
VIII)
*WHO’s recommended figures
- Confirmation of scope
Construction of a GMP-compliant, sustainable plasma derivative plant
Enhancement of blood collection, testing, production, storage and supply functions
of each blood center
Support in technological training for workers at the plasma derivative plant and
blood centers
2-8
Source: Study team
3. Primary outcomes
The study team presented a proposal developed in Japan after the first field study to MOH and the counterpart, the
Republican Blood Transfusion Center, and discussed the proposal with the Ministry of Finance, which is the
authority that grants approval for yen-loan projects.
The team also discussed with the Embassy of Japan and JETRO whether the political movement following the
sudden death of President Karimov and the start of a new presidential administration could impact the project.
d) Follow-up in Uzbekistan
1. Purpose
After the second field study, the Uzbek office of the study team followed up with local stakeholders including
MOH. They also reported results to and discussed with the Embassy of Japan and Uzbek office of JICA etc. as
necessary.
2. Main discussions with Uzbek stakeholders
January 10, 2017: Explanation of the proposal and consultation with Abdunomon Sidikov, General Director
Dept. of External Economic Activities
January 10, 2017: Explanation of the proposal and consultation with Rustam Yoldashev, Director of
Republican Blood Center and other stakeholders
January 20 and 26, 2017: Explanation of the proposal and consultation with Jamshed Jabriyev, Rustam
Yoldashev, and other stakeholders
February 3, 2017: Explanation of final proposal and consultation with Shukhrat, Vice Minister of MOH,
Jamshed Jabriyev, Rustam Yoldashev, and other stakeholders
Chapter 3 Justification, Objectives and Technical
Feasibility of the Project
3-1
(1) Project Background and Significance
1) Project Background
WHO recommends countries domestically produce blood products for transfusion and plasma derivatives in
domestic formulation plants from human blood collected domestically. Following this recommendation,
Uzbekistan has been striving to establish self-sufficiency in their blood product supply. In June 2015, the country
formulated the “Complex Plan for Improvement of Blood Services in Republic of Uzbekistan” to deliberate
appropriate measures. According to the plan, the country’s population is expected to reach 40 million by 2035, and
this will necessitate (1) 4,000L albumin6, (2) 240,000 doses of immune globulin, and (3) 8,200 doses of
cryoprecipitate.
Although Uzbekistan has developed and operated blood centers and a plasma product factory under the
supervision of MOH, many of them were constructed in the 1970s and blood products produced in those facilities
are not sufficient in both quality and quantity. For example, Uzbek production capacity of albumin is as small as
600L annually, which falls far short of 3,000L, the annual required amount for today’s 30-million population. The
shortfall is currently filled by imports and this may possibly lead to a supply shortage depending on the country’s
financial circumstances and the climates of exporting countries.
In 2015, MOH of Uzbekistan contacted stakeholders in Japan and explored the possibility of improving and
rebuilding existing antiquated and deteriorated blood-service facilities and poor plasma derivative production
functions of the country with support from the Japanese government. An Uzbek presidential order (No.4639)
regarding an economic cooperation campaign was then issued by then President Karimov in the subsequent year
2016, which dictated the promotion of construction of a new plasma product factory with the support of Japan as
part of the aforementioned complex plan for blood service improvements. This study was conducted in order to
verify a project scope, targets, and scale for a feasibility study of the project.
2) Project Significance
a) Project scope and targets
The purpose of this project is to renew aged plasma derivative production functions in order to help the country to
domestically satisfy its internal demands for plasma derivatives. The target facility is located within the
Republican Blood Transfusion Center in the country’s capital Tashkent.
Through preliminary studies it has been found that the supply of raw material plasma would be far short of the
required volume after the plasma product factory is rebuilt. Therefore, the proposed project will also commit to
securing a stable supply of plasma and improving safety through infection control measures etc.
b) Analysis of current situations and future prospects
Due to the absolute shortage of current plasma derivative production capacity, the country has relied on imports.
While the country’s population as of 2015 is 31.29 million, it is expected to grow to 40 million by 2035, which,
according to the WHO’s recommendation, will require 4,000L of albumin, 240,000 doses for immune globulin for
I.M. and 40 million units of blood coagulation factor VIII7 per year.
More importantly, the volume of donated blood (the raw material) is not sufficient, and the present ratio of blood
donors in the country’s population, which is as low as 0.5% (n = 156,264 in 2015), should be increased to at least
the WHO’s recommended ratio of 1.0%. (Refer to Figure 3-1 and Figure 3-2.)
6 WHO recommends reserves of 100L per one million people per year.
7 The Complex Plan for Improvement of Blood Services in the Republic of Uzbekistan set a goal to increase
cryoprecipitate production; but, cryoprecipitate has been replaced by blood coagulation factor VIII in following with global healthcare trends. Therefore, this project deals with blood coagulation factor VIII instead of
cryoprecipitate pursuant to an agreement with MOH.
3-2
Figure 3-1 Changes in the Number of Blood Donors in Uzbekistan
Source: Study team, based on MOH materials
Figure 3-2 Changes in Donated Blood and Plasma Volumes
Source: Study team, based on MOH materials
c) Expected effects and impact of the project
If the self-sufficiency in the blood product supply in Uzbekistan is achieved through the proposed project, the
supply of blood products would be stable and, consequently, there would be improvements to the treatment of
Uzbek patients needing blood products. Also, the import cost burden on the country’s finances would be reduced
and these positive influences would reach citizens who presently have to buy expensive imported medicines.
In addition, as discussed in Chapter 1, Uzbek blood services have faced many issues, and a considerable portion
of such issues are related to safety. The proposed project will aim to improve these safety issues as much as
possible. Specifically, the risk of transfusion-transmissible diseases can be mitigated through the new
development of an efficient, GMP-compliant, and safety-conscious plasma product factory and through the
introduction of NAT.
d) Probable scenario without project implementation and its consequences
Granting that this project will not be implemented and the current situation will remain unchanged, the limited
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
180,000
2009 2010 2011 2012 2013 2014 2015
Donation number
person
year
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2009 2010 2011 2012 2013 2014 2015
Blood amount（L)
Fresh frozen plasma
distributed to hospitals（L)
Plasma processed for
medicines（L)
Liter
year
3-3
size and quality of the country’s production capacity will result in continued dependence on imported plasma
derivatives. Also, the present facilities are not enough to ensure the stable supply and safety of blood products and
may possibly result in pharmaceutical accidents in the future. Thus, expected benefits from the implementation of
this project will be significant for Uzbek nationals.
(2) Basic Policies and the Determination of Project Details
In line with the reference from MOH of Uzbekistan and the Presidential Order of the former President Karimov,
the objectives of this project are: to ensure blood products for transfusion and plasma derivatives are supplied to
more Uzbek patients in need through an improvement of its blood services and development of a plasma product
factory; and to reduce the country’s financial burden by reducing the imports of expensive blood products.
In order to achieve the objectives, present issues in Uzbekistan were revealed and the following policies were set
through preliminary studies. Integrated support provided through the project include not only facilities, equipment
and devices etc. on the hardware side, but also Japanese-style operation procedures, maintenance and human
resource development practices on the software side.
Basic policies of the project
1． Improvement of blood services: securing of raw material plasma required for the production of adequate
blood products
To secure donated blood required for producing the target amount of plasma derivatives, support for the
introduction of essential equipment and guidance and instructions on the promotion of blood donation
and processing of increased amounts of donated blood will be provided.
2． Improvement of blood services: increased blood safety
Support for the introduction of essential equipment to reduce the risk of infection through transfusion
and improve blood product safety, and training for new procedures associated with new equipment will
be provided.
3． Increase of safe plasma derivatives production
Construction of a new plasma product factory, introduction of modern equipment, and production
expansion of safe plasma derivatives conforming to international standards will be conducted. After
completion of a new factory, reagents and consumables will be provided with support for equipment
maintenance until factory operations are fully under way.
4． Operational support for human resource development, training and equipment maintenance etc. at the
plasma product factory
Besides hardware assistance (facilities and equipment), Japanese-style management and know-how will
be introduced to improve production efficiency and quality.
3-4
(3) Project Overview
1) Improvement of blood services: securing of raw material plasma required for production of sufficient blood
products
The Uzbek population is expected to reach 40 million by 2035. To achieve WHO’s recommendation of 1.0%
donor ratio in the population, the Uzbek blood service sector will need 400,000 donors by 2035. In other words, a
2.7-fold increase of today’s number of blood donors (approx. 150,000) must be achieved. (Refer to Figure 3-3
Target Growth of Donors.)
The volume of plasma for plasma derivatives production from 400,000 donors is approximately 75,000L; 46,000L
and 29,000L of which are used for blood products for transfusion and plasma derivatives, respectively. (Refer to
Figure 3-4 Projected Increase of Blood Donation and Plasma for Derivatives Production.)
Figure 3-3 Target Growth of Donors
Source: Study team
Figure 3-4 Projected Increase of Blood Donation and Plasma for Derivatives Production
Source: Study team
Possible measures to increase the number of non-remunerated blood donors and to process an increased volume of
donated blood are as follows:
a) Activities to promote blood donations
In order to increase the volume of donated blood, national efforts and increased awareness of blood donations
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
1年後 5年後 11年後 18年後
献血者数
(人）
Person
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
1年後 5年後 11年後 18年後
献血量
(L)
分画製剤用
血漿（L)
Liter
Numbers of donors
Year 1 Year 5 Year 11 Year 18
Amount of Blood
Donation (L)
Amount of Plasma for
Derivatives Production (L)
Year 1 Year 5 Year 11 Year 18
3-5
among the nationals are critical. Listed below are the possible measures to achieve this.
1. Activities to promote blood donations through education institutions
2. Distribution of information materials in video, poster and other formats to various strata of the country
3. Media promotion activities
b) Blood collection, testing, production and supply
Equipment and manpower to process an increased volume of donated blood will be necessary in the future.
1. Blood collection: bloodmobiles, donation rooms and whole blood collection devices
2. Testing: blood cell counters, full-auto blood grouping equipment and infection testers (NAT, etc.)
3. Production (blood products for transfusion): automated production equipment
4. Supply: cooling containers
The proposed project will provide support on the introduction of equipment associated with the above items, as
well as guidance on blood donation promotion activities and human resource development etc. on the software
side. The support on the software side will be provided for 4 years from equipment introduction, and support
measures to enable Uzbek bodies to independently promote blood donations and manage their blood service
operations will also be implemented during the period.
Target facilities are the Republican Blood Transfusion Center in Tashkent City, which is the primary target of this
project, and regional blood transfusion stations: the Andizhan Blood Transfusion Station, the Samarkand Blood
Transfusion Station, and Nukus Blood Transfusion Station (the Republic of Karakalpakstan). Through the project,
the regional facilities are expected to serve as the regional basis to provide technical support to blood centers in
neighboring provinces.
Figure 3-5 Bloodmobile (image) Figure 3-6 Donation room (image)
Source: Japan Red Cross website Source: Japan Red Cross website
2) Improvement of blood services: increased blood safety
To secure fresh frozen plasma from which to produce blood products for transfusion and plasma derivatives with
low risk of HBV, HCV and HIV infection, infection testing equipment including NAT will be introduced. The
proposed project will also distribute reagents and consumables required for testing equipment for 4 years
beginning from the introduction of equipment.
Figure 3-7 NAT
Source: manufacturer’s website
3-6
3) Increase of safe and secure plasma derivatives production
A new plasma product factory will be constructed in the premises of the existing blood center and new production
equipment will be procured and installed in the new factory. The building will be two stories, with a gross floor
area of approximately 3,600m2. It will be located behind the blood center building and a linked corridor will be
provided to connect with the blood center building. The room layout will be arranged based on circulation
planning for the efficient production flow from the reception and storage of fresh frozen plasma (raw material), to
production, testing, packing and shipment. Production processes will be performed in clean rooms, which are
classified into primary through tertiary zones depending on their cleanliness levels. A pharmaceutical water plant,
a generator room and a boiler room will also be included in the new factory building.
a) Land for a new factory
The land for the new plasma product factory is located in the premises of the Republican Blood Transfusion
Center, Tashkent City, which is in the southern part of greater Tashkent. It is 3km away from the Tashkent
International Airport and a cemetery for Japanese nationals is located in adjacent land.
The land is currently a forested land behind the Republican Blood Transfusion Center. (See the photos below.)
Figure 3-8 Front of Figure 3-9 Entrance of
the Republican Blood Transfusion Center the Republican Blood Transfusion Center
Source: Pictures taken by the study team (October 2016)
Figure 3-10 Construction Land behind the Republican Blood Transfusion Center
Source: Picture taken by the study team (October 2016)
3-7
b) Construction plan of the plasma product factory
Table 3-1 Outline of New Plasma Product Factory
Building area 1,800m2
Gross floor area 3,600m2
Structure 2-story RC
Finishing of main
building parts
Floor: epoxy coating
Dust-proof painting (machine rooms)
PVC tiles (office rooms)
Walls: heat-insulating sandwich panels
Gypsum boards, etc.
Ceiling: heat-insulating sandwich panels
Gypsum boards, rock-wool, acoustic boards, etc.
Clean room
specifications Class 100,000 to 1,000
Source: Study team
Figure 3-11 New Factory Layout (draft)
Source: Study team
Existing blood center
building
New plasma derivative plant
Parking lot
Entrance
Property border
3-8
Figure 3-12 Plasma Product Factory 1st
Floor Plan
Figure 3-13 Plasma Product Factory West Elevation
Source: Study team
3-9
c) Equipment introduction plan for the plasma product factory
Main rooms and equipment items of the plasma product factory are listed below.
Table 3-2 Main Equipment Items for Plasma Product Factory
Room Equipment Maker Description (usage, etc.)
CIP room
Boiler room,
etc.
Brine room
Reagent water
room
Freeze-dry
room
Bulk
pasteurization
room
Centrifugal
separator room
Fractionation
room
Autoclave
Bottle-washing
room,
dispensing
room
Chemical test
room
Microbial test
room
Chemical test
room
Chemical test
room
Microbial
test/growth test
room
Quality test
room
QC cleaning
room
Source: Study team
3-10
4) Operational Support for Human Resource Development, Training and Equipment Maintenance etc.
a) Improvement of blood services: securing of required volume of raw material plasma
To solicit for new donors and further cooperation from past donors, guidance on promotional activities through
education institutions and various media. The proposed project will proceed with nation-wide promotional
activities in cooperation with the Uzbekistan Red Crescent, which has already conducted blood donation
promotional activities in Uzbekistan.
Along with the deployment of new blood collection devices and analysis equipment at blood centers, guidance on
test management and new procedures will also be necessary.
These support, guidance and human resource development activities will be conducted for 4 years, during which a
technology transfer and the establishment of training systems etc. are expected to be completed.
b) Improvement of blood services: increased blood safety
Above all, improvement of blood safety requires ‘voluntary and non-remunerated donation of blood.’ So, WHO
has set a goal of making the ratio of ‘voluntary and non-remunerated blood donation’ 100% in each country by
2020. However, the ratio in Uzbekistan is still as low as 40% as of 2015. Transition from ‘blood donation for
family’ to ‘voluntary and non-remunerated blood donation’ is essential for Uzbek blood services.
In order to reduce the risk of transfusion-transmissible diseases and improve the blood safety, not only hardware
support, e.g., deployment of testing equipment such as NAT, but also software support for management and
human resource development practices are important. In blood collection practices, management of blood
collection standards, interviews, and donors (identity check) is critical, while sample storage and look-back
studies are after blood collection. Guidance by Japanese experts on these matters is included in the project scope.
c) Plasma product factory
As the new factory will adopt a mass-production system with new production equipment, it will be necessary to
define staff organization and a division of roles, and implement training measures to familiarize staff with new
procedures. Compliance with internationally accepted standards, i.e., GMP (Good Manufacturing Practices), is
also essential to ensure exportable quality of plasma derivatives. Thus, experts will be dispatched from Japan to
develop human resources and provide guidance on maintenance systems, facility operations and production
practices for 4 years after completion of the new factory.
3-11
5) Project Cost Estimate
As shown in the following table, 26,248,703 USD for reinforcement of blood services, 42,327,335 USD for
construction of a new plasma product factory, and 68,576,038 USD (approx. 8.05 billion JPY) for total project
cost are estimated.
Table 3-3 Breakdown of Estimated Project Cost for Reinforcement of Blood Services
1 Main equipment items to be deployed to blood centers
- Bloodmobiles: 14 blood centers
- Donation rooms: 2 locations in Tashkent City
- Whole blood collection devices: 14 locations
- Automated blood grouping equipment: 4 locations
- Automated biochemical analyzers: 4 locations
- Automated hematology analyzers: 4 locations
- NAT (nucleic acid amplification tester): 4 locations
- Trucks and containers for transportation
15,066,849 USD
2 Reagents, consumables and equipment maintenance for 4 years after equipment
introduction
8,766,664 USD
3 Dispatch of Japanese experts (blood donation promotion, test management,
technological instruction, management guidance, human resource development
and training etc.)
4 years after equipment introduction: about 219 experts per month in total
2,415,190 USD
Total 26,248,703 USD
Source: Study team
Table 3-4 Breakdown of Estimated Project Cost Plasma Product Factory Construction
1 Factory building construction work
Gross floor area: 3,600m2; RC structure; two-story
Including building equipment (boiler, compressor, generator, transformer,
A/C, piping and valves etc.)
19,800,000 USD
2 Plasma product factory
Various tanks, heat exchangers, pharmaceutical water equipment,
freeze-drying machines, centrifugal separators, autoclaves, serial dispensing
machines, control systems and instrumentation etc.
14,478,745 USD
3
Consumables and maintenance work for 4 years after completion
1,751,841 USD
4 Japanese expert dispatch (blood donation promotion, test management,
technological instruction, management guidance, human resource
development and training etc.)
4 years after completion: 84 experts per month in total
6,296,749 USD
Total 42,327,335 USD
1 USD = 117.382 JPY (as per JICA’s settlement rate for FY2016 (as of January 2017))
Source: Study team
3-12
(4) Necessary Evaluation of the Project
1) Demand Forecast
As mentioned earlier, WHO has defined recommended production volume of plasma derivatives (the target
products of this project) relative to national population. For this project the recommendation of WHO
recommendation can be assumed to be fulfilled as a demand. In interviews with local medical institutes using
blood products, representatives of the institutes explained how they suffer shortages of blood products; it was
indicated that currently they can administer blood products only to patients with an urgent need for such products,
and in many cases expensive imported products have to be used. Thus, a stable source of blood products is
imperative in the country.
On the other hand, a qualitative assessment of the issues above is necessary for the future. While MOH looks to
export surplus products to neighboring countries, additional studies are required to verify blood product demands
and the distribution situations of neighboring countries and administrative commitment to blood services in each
country, so as to provide a more accurate demand forecast, and further elaborate the project scope.
2) Consideration of Division of Roles for Implementing of the Project
An appropriate division of roles among Uzbek and Japanese stakeholders is an enabling factor of the proposed
project. On the Japanese side, there must be selection of the appropriate entities in charge of new factory
development, equipment procurement and introduction, and operational and technological guidance etc.
Matters requiring further evaluation regarding roles to be taken by Uzbek stakeholders include recruitment of
human resources and the constant securing of an operating budget. While local human resources and a budget
were evaluated in this study, further studies are required from mid- and long-term perspectives.
As of writing of this report, the project scope is expected to be divided as shown in the figure below.
Table 3-14 Division of Project Scope
Source: MOH
3) Evaluation of Technological Practices for Plasma Derivative Production
Technologies to be introduced through production facilities and equipment in this project are not particularly
advanced but commonly-adopted across the world, especially in developed countries. Therefore, no special
considerations are required in terms of technology.
3-13
On the other hand, blood services in Japan are highly recognized for their safely and efficiency; and their
experience, know-how and human resource development techniques etc. are the particular strengths of Japan.
However, blood services in Japan are operated by a small number of entities and human resources with sufficient
experience and know-how are relatively limited in comparison with other sectors. Therefore, there is a need for
preliminary arrangements to supply the appropriate human resources, especially for operational guidance, and to
continuously maintain the quality of guidance.
In regards to the dispatching of experts, coordination among involved organizations is required for the future; for
example, consultants may have to take a mediator role among blood service providers and derivative product
manufacturers to obtain their cooperation. Thus, detailed studies on burden sharing (including on-site staff
training in Japan) and associated risks are required.
4) Acquisition of Approval and Licenses Required for Plasma Product Factory Construction
For construction of the plasma product factory, the relevant approval and licenses must be obtained pursuant to
Uzbek rules. MOH’s internal organization called the “Design Institute” possesses experts in design, electric works,
fire prevention, healthcare and medication etc., and grants such approvals and licenses, and there is mandatory
conformance with the conditions required by the organization. The State Committee’s approval and the approval
of fire protection applications and environmental measures will also be required. Information regarding all
required approvals must be gathered in the future.
As of this study, the following items regarding specific design approvals and licenses to be obtained from the
Design Institute were confirmed.
The offset distance between the property border and a building must be at least 20-25m.
The offset distance between buildings must be at least 15m. However, a link corridor between buildings is
allowed.
The offset distance from a transformer must be at least 25m.
Spaces (roads) of sufficient width to allow a fire-fighting vehicle to enter must be made available around a
building. Windows must be at a height of 5-8m from the ground to allow a fire ladder to reach.
Infrastructural lines, such as electric lines and piping, must not be routed beneath the building.
Public infrastructural facilities will be provided after demands for electricity, gas, water, sewage and hot
water etc. are calculated and submitted.
Dual line power reception system and an emergency generator are already available on the land.
Clean rooms required by GMP shall be fire-proof and classified into appropriate zones.
The city planning law and building standard law are stipulated based on standards called SNIP. Also,
construction rules such as KMK and hygiene regulations called SanPin shall be observed.
Building and land planning drawings at a 1:500 scale shall be submitted during the application process.
Other required approvals and licenses related to the construction work are listed in the table below. For
implementation of the project, the following approvals and licenses shall be obtained.
Table 3-5 Approvals and Licenses Related to Construction Work
Approval/license type Office in charge Administrative bodies
in charge
1 Issuance of “land use permit” Property and Land Registration
Office
Property and Land
Registration Office
2 Acquisition of “land use permit” Property and Land Registration
Office
Property and Land
Registration Office
3 Acquisition of “design license” National Design and Construction
Committee
National Design and
Construction
Committee
4 Approval of “environmental
impact assessment”
National Nature Conservation
Committee
5 “Design approval” National Design and Construction
Committee
6
“Approval of hygiene and
anti-disease measures” upon
design approval
National Hygiene and Plague
Office MOH
3-14
7
“Fire-fighting and
fire-prevention approval” upon
design approval
National Fire Prevention Office Ministry of Internal
Affairs
8 “Utility connection approval” Municipal electric company Uzbekenergo (national
company)
Municipal waterworks department Tashkent City
Municipal gas company Tashkent City
Municipal heat supply company Tashkent City
9 “Construction permit” National Design and Construction
Committee
Source: MOH
Chapter 4 Evaluation of Environmental and Social Impacts
4-1
(1) Analysis of Current Environmental and Social Situations
1) Current Status of the Land for a New Plasma Product Factory
With the approval of MOH already being obtained, the premises of the Republican Blood Transfusion Center,
where there is an existing plasma product factory, was determined as a site for the new plasma product factory.
For this project, therefore, there will be no need to secure a new factory site nor for the relocation or resettlement
of existing commercial facilities or residents. A part of the existing blood center operations must be limited during
the construction period due to construction vehicle traffic and the bringing in of construction materials/equipment
to implement the project. For the same reason, safety, anti-contamination, anti-noise and anti-vibration measures,
etc. are required in and around the premises of the Republican Blood Transfusion Center in order to minimize the
impact on the environment.
As far as revealed by the field studies, the sewers are used for both general wastewater and sewage, which are
discharged to a public sewage system via septic tanks. Discharge of industrial waste water into the public water
system is pursuant to the Presidential Order No.11, dated February 3, 2010, and there are not national standards
regarding waste water quality in Uzbekistan. Therefore, effluent generated in medicine production such as waste
alcohol from the plasma product factory is discharged to the public sewage system after inactivation under the
supervision of Tashkent City pharmaceutical officers, as per the SpanPiN standards that have been applied since
the Soviet era.
The table below is the SanPiN Standard 0317-15 regarding waste disposal, in which medical wastes are classified
into Class G, the 4th highest class among the 5 hazard classes. As it is allowed to discharge effluent from
medicine production to the public sewage system after disinfection, and there are no national standards regarding
waste water disposal, the means of waste fluid disposal currently used in the existing factory can satisfy the
administrative requirements at the new factory, too.
Table 4-1 Waste Hazard Classification of the SanPiN Standard 0317-15
No. Hazard class Description of the waste composition
1. Class A
Non-hazardous
Non-hazardous wastes, which have no contact with body liquids of patients or with
patients with transmissible diseases; non-toxic wastes: food wastes of all hospital
departments except the infections department; furniture, inventory and
non-working diagnostic equipment not containing toxic elements, non-infected
paper, construction waste, etc.
2. Class B
hazardous
Hazardous (risky) wastes: potentially infected wastes; materials and tools polluted
with body liquids of patients, pathology wastes, wastes from infection departments
including food wastes, wastes of microbiological laboratories working with
microbes of group 3 and 4; biological wastes of vivaries
3. Class V
extremely
hazardous
All materials contacting with patients with extremely dangerous infections; wastes
from microbiological laboratories working with microbes of group 1 and 2;
tuberculosis departments wastes; wastes from patients with anaerobic infection
4. Class G
wastes close to
industrial wastes
Expired medicines; wastes of medicines and diagnostic reagents; disinfection
chemicals, cytostatics and other chemical preparations; mercury containing articles,
instruments and equipment
5. Class D
radioactive wastes
All kinds of wastes containing radioactive components with content of
radionuclides exceeds admissible levels established by radiation safety rules
Source: MOH
2) Current Status of Blood Centers
It was confirmed that no specialized medical waste disposal mechanism is used at the Samarkand Blood Center
and solid medical wastes are incinerated in a private incinerator in the center’s premises.
As incineration may cause significant smoke pollution to neighboring residents and commercial facilities,
countermeasures such as the use of low-emission fuel should be considered. While SanPiN-compliant disinfection process for solid medical wastes was not observed during the field tour, the disinfection of Class G solid medical
wastes will be necessary for the project site as is being done in Tashkent City.
4-2
(2) Positive Environmental Impact of the Project
This project does not intend to develop an energy infrastructure and there will be no positive environmental
impact, such as reduction of pollutants or greenhouse gas emissions.
(3) Environmental and Social Impact of the Project
1) Impact on Ambient Natural Environment
The site is located in an urban area and an old factory building already exists in the site. Around the site there are
no ecosystem, cultural heritages, and minority ethnic/indigenous groups that will be adversely affected by factory
construction and the production of plasma derivatives. No factors conflicting with the natural environment or
specific issues that may lead to social and environmental impact were found during the field tour.
After construction of the plasma product factory, medical waste fluid will be discharged as it is today, but
compliance with the SanPiN standards can be secured through the discharging to the public sewage system after
inactivation treatment. As waste alcohol generated through an alcohol distillation process is also treated in the
same way, there will be unlikely any significant impact on the surrounding natural environment arising out of
waste fluid treatment.
Thus, the potential environmental impact from implementing the project can be concluded as follows.
a) Noise and vibration
Countermeasures against noise and vibration arising out of the construction work on the plasma product factory
will be implemented to minimize the impact on neighboring residents and commercial facilities. For example,
low-noise pile drivers and heavy machinery will be used, where noise and vibration from bolting and ground
excavation are expected.
Noise and vibration produced from certain equipment, such as the vibration of production equipment and the
noise of sirens of emergency vehicles coming in and out of the blood center, require appropriate considerations;
for example, installation positions and operating time should be adjusted to reduce negative impacts.
b) Sewage treatment
As mentioned above, effluent generated in medicine production such as waste alcohol from the plasma product
factory should be appropriately discharged to the public sewage system after inactivation treatment pursuant to the
Presidential Order No.11 and the SpanPiN standards to minimize negative impact on the environment.
c) Dust and smoke
Periodic inspection and maintenance of construction vehicles and machines are necessary to reduce air pollution
during the construction period. Water spraying on the construction site is also required to minimize dust
dispersion.
For smoke exhaust, the existing factory also disposes of solid medical wastes in an incinerator within the blood
center’s premise. However, the new factory should use fuel that generates less smoke to minimize negative impact
on the environment.
d) Wastes
Wastes from the plasma product factory operations and the blood center must be divided into general wastes and
medical wastes. Thus, pursuant to the SanPiN standards, medical wastes must undergo an appropriate disinfection
treatment by disinfectant solution, pressurized steam or microwaves etc. to minimize the negative impact on the
environment.
e) Soil contamination
Measures to avoid soil and groundwater contamination caused by construction waste water and leaching etc. must
be employed. Any hazardous waste fluid generated during construction, such as waste oil and oil paint, must be
contained in reservoir tanks to prevent them from being mixed or penetrating into ground soil, and such fluid must
be carried out of the site for disposal.
2) Impact on Social Environment
A land for the new plasma product factory is secured within the premise of the Republican Blood Transfusion
4-3
Center where there is currently an old factory. Therefore, there will be no need for movement of residential areas.
Also, the proposed plasma product factory is relatively small in size, and no significant modification of a land
form or geological structure around the site is expected for construction.
An environmental impact of construction work of the factory (noise, vibration, dust, exhaust gas, sewage, wastes
etc.) can be mitigated or eliminated by appropriate measures. The table below lists response measures for each
item of the environmental impact checklist. Particularly, appropriate measures to reduce noise, vibration, water
contamination, dust, exhaust gas and wastes etc. in construction work must be implemented to minimize impact
on nearby areas.
There will be no fresh impact on blood services because blood services are not a business new to the country.
Table 4-2 Environmental Impact Checklist
CategoryEnvironmental
ItemMain Check Items
Yes: Y
No: N
Confirmation of Environmental Considerations
(Reasons, Mitigation Measures)
1 Permits and
Explanation(1) EIA and
Environmental
Permits
(a) Have EIA reports been already prepared in official process?
(b) Have EIA reports been approved by authorities of the host country's government?
(c) Have EIA reports been unconditionally approved? If conditions are imposed on the
approval of EIA reports, are the conditions satisfied?
(d) In addition to the above approvals, have other required environmental permits been
obtained from the appropriate regulatory authorities of the host country's government?
(a)N
(b)N
(c)N
(d)N
(a)Not yet prepared, need to make an EIA report at prior to execution of a project
(b)Not yet authorized, neeed to get authorizatuon of government prior to execution of a
project
(c)EIA report not yet prepared, need further investigation
(d)Permit not yet obtained, need further investigation
(2) Explanation to
the Local
Stakeholders
(a) Have contents of the project and the potential impacts been adequately explained to the
Local stakeholders based on appropriate procedures, including information disclosure? Is
understanding obtained from the Local stakeholders?
(b) Have the comment from the stakeholders (such as local residents) been reflected to the
project design?
(a)N
(b)N
(a)Not necessary, since plant is planned to build in exisiting premises of MOH
(b)Not necessary, since plant is planned to build in exisiting premises of MOH
(3) Examination of
Alternatives
(a) Have alternative plans of the project been examined with social and environmental
considerations?
(a)N (a) No alternative plans necessary
2 Pollution
Control
(1)Air Quality
a) Do air pollutants, (such as sulfur oxides (SOx), nitrogen oxides (NOx), and soot and dust)
emitted from the proposed infrastructure facilities and ancillary facilities comply with the
country's emission standards and ambient air quality standards? Are any mitigating measures
taken?
(b) Are electric and heat source at accommodation used fuel which emission factor is low
(a)Y
(b)N/A
(a)Local Emission Standard（Comply to SanPiN Standard）
(b)No accommodation facility
(2)Water Quality
(a) Do effluents or leachates from various facilities, such as infrastructure facilities and the
ancillary facilities comply with the country's effluent standards and ambient water quality
standards?
(a)Y (a)Local Emission Standard（Comply to SanPiN Standard）
(3)Wastes(a) Are wastes from the infrastructure facilities and ancillary facilities properly treated and
disposed of in accordance with the country's regulations?
(a)Y (a)Local Emission Standard（Comply to SanPiN Standard）
(4)Soil
Contamination
(a) Are adequate measures taken to prevent contamination of soil and groundwater by the
effluents or leachates from the infrastructure facilities and the ancillary facilities?
(a)Y (a) Discharged to the public sewage system after inactivation treatment
(5)Noise and
Vibration
(a) Do noise and vibrations comply with the country's standards? (a)Y (a)Noise may occur during construction stage, but not after starting operation of a factory
(6)Subsidence(a) In the case of extraction of a large volume of groundwater, is there a possibility that the
extraction of groundwater will cause subsidence?
(a)N/A (a)Not planned to use groundwater
(7)Odor (a) Are there any odor sources? Are adequate odor control measures taken? (a)N (a)Should be no odor sources
3 Natural
Environment(1) Protected
Areas
(a) Is the project site or discharge area located in protected areas designated by the country's
laws or international treaties and conventions? Is there a possibility that the project will affect
the protected areas?
(a)N/A (a)It is not a protected area
(2) Ecosystem
(a) Does the project site encompass primeval forests, tropical rain forests, ecologically
valuable habitats (e.g., coral reefs, mangroves, or tidal flats)?
(b) Does the project site encompass the protected habitats of endangered species designated
by the country's laws or international treaties and conventions?
(c) Is there a possibility that changes in localized micro-meteorological conditions, such as
solar radiation, temperature, and humidity due to a large-scale timber harvesting will affect the
surrounding vegetation?
(d) Is there a possibility that the amount of water (e.g., surface water, groundwater) used by
the project will adversely affect aquatic environments, such as rivers? Are adequate measures
taken to reduce the impacts on aquatic environments, such as aquatic organisms?
(a)N
(b)N
(c)N/A
(d)N/A
(a)Not included
(b)Not included
©No planned to use groundwatwer
(d)Not plannedf to use surface water, groundwater
(3) Hydrology(a) Is there a possibility that hydrologic changes due to the project will adversely affect
surface water and groundwater flows?。
(a)N (a)Discharged to the public sewage system after inactivation treatment(comply to SanPin
Standard)
(4) Topography
and Geology
(a) Is there a possibility the project will cause large-scale alteration of the topographic features
and geologic structures in the project site and
surrounding areas?
(a)N/A (a)
4 Social
Environment
(1) Resettlement
(a) Is involuntary resettlement caused by project implementation? If involuntary resettlement
is caused, are efforts made to minimize the impacts caused by the resettlement?
(b) Is adequate explanation on compensation and resettlement assistance given to affected
people prior to resettlement?
(c) Is the resettlement plan, including compensation with full replacement costs, restoration of
livelihoods and living standards developed based on socioeconomic studies on resettlement?
(d) Is the compensations going to be paid prior to the resettlement?
(e) Is the compensation policies prepared in document?
(f) Does the resettlement plan pay particular attention to vulnerable groups or people,
including women, children, the elderly, people below the poverty line, ethnic minorities, and
indigenous peoples?
(g) Are agreements with the affected people obtained prior to resettlement?
(h) Is the organizational framework established to properly implement resettlement? Are the
capacity and budget secured to implement the plan?
(i) Are any plans developed to monitor the impacts of resettlement?
(j) Is the grievance redress mechanism established?
(a)N/A
(b)N/A
(c)N/A
(d)N/A
(e)N/A
(f)N/A
(g)N/A
(h)N/A
(i)N/A
(j)N/A
(a)Not necessary, since,plant is planned to build in exisiting premises of MOH
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
(j)
(2) Living and
Livelihood
(a) Is there a possibility that the project will adversely affect the living
conditions of inhabitants? Are adequate measures considered to reduce
the impacts, if necessary?
(a)N (a)There will be no affect to the living conditions of inhabitants, since the project will be
executed with in existing premises of MOH
(3) Heritage
(a) Is there a possibility that the project will damage the local
archeological, historical, cultural, and religious heritage? Are adequate
measures considered to protect these sites in accordance with the
country's laws?
(a)N (a)There will be no affect to the the local archeological, historical, cultural, and religious
heritage, since the project will be executed with in existing premises of MOH
(4) Landscape
(a) Is there a possibility that the project will adversely affect the local
landscape? Are necessary measures taken?
(b) Is there a possibility that landscape is spoiled by construction of highrise
buildings such as huge hotels?
(a)N
(b)N
(a)No affect to the local landscape, since project will be executed inside existing premises of
MOH
(b)No affect to the landscape, since the height of planned building is limited
(5) Ethnic
Minorities and
Indigenous Peoples
(a) Are considerations given to reduce impacts on the culture and lifestyle
of ethnic minorities and indigenous peoples?
(b) Are all of the rights of ethnic minorities and indigenous peoples in
relation to land and resources respected?
(a)N/A
(b)N/A
(a)No imapct due to a existing premises
(b)No affect to imapct ethnic minorities and indigenous peoplesdue, since project will be
executed with in existing premises of MOH
4-4
Source: Study team
(4) Overview of Environmental and Social Impact Related Laws and
Regulations of the Host Country and Actions Required for Compliance
1) Uzbek Laws and Regulations Related to Environmental and Social Impact
The key laws and regulations applicable to environmental and social impacts are the Presidential Order No.491,
dated December 31, 2001 (amended in 2005 and 2009), the Presidential Order No.11, dated February 3, 2010, and
the SanPiN standards. The Presidential Order No.491 formulated the Regulation on State Environmental Expertise
(SEE), which requires the implementation of Environmental Impact Assessment (EIA). Results of this assessment
are evaluated by governmental bodies in charge of SEE. The EIA procedure comprises 3 steps, and EIA
documentation is required for each step.
As shown in Table 4-1, the SanPiN standards define 5 hazard class of wastes. Medical wastes of the plasma
product factory, such as waste alcohol, are classified into Class B and required to discharge after inactivation
treatment.
(5) Necessary Actions of the Host Country for Realization of the Project
Prior to implementing the project, an EIA must be conducted in accordance with the Regulation on State
Environmental Expertise (SEE). Medical waste disposal and sewage treatment etc. in compliance with local
environmental standards, SanPiN standards, must be performed during the project period.
4 Social
Environment
(6) Working
Conditions
(a) Is the project proponent not violating any laws and ordinances associated with the working
conditions of the country which the project proponent should observe in the project?
(b) Are tangible safety considerations in place for individuals involved in the project, such as
the installation of safety equipment which prevents industrial accidents, and management of
hazardous materials?
(c) Are intangible measures being planned and implemented for individuals involved in the
project, such as the establishment of a safety and health program, and safety training
(including traffic safety and public health) for workers etc.?
(d) Are appropriate measures taken to ensure that security guards involved in the project not
to violate safety of other individuals involved, or local residents?
(a)Y
(b)Y
(c)Y
(d)Y
(a)Necessary action to be taken during project constructon and training procedure
(b)Necessary action to be taken during project constructon and training procedure
(c)Necessary measures should be implemented during project constructon and training
procedure
(d)Necessary measures should be implemented during project constructon and training
procedure
5 Others
(1) Impacts during
Construction
(a) Are adequate measures considered to reduce impacts during construction (e.g., noise,
vibrations, turbid water, dust, exhaust gases, and wastes)?
(b) If construction activities adversely affect the natural environment
(ecosystem), are adequate measures considered to reduce impacts?
(c) If construction activities adversely affect the social environment, are
adequate measures considered to reduce impacts?
(a)Y
(b)N
(c)N
(a)All adequate measures related to noise, vibrations, turbid water, dust, exhaust gases, and
wastesconsidered should be considered to reduce impacts during construction
(b)There will be no constrcution activities which will affect the natural environment
(c)There will be no constrcution activities which will affect the natural environment, while we
will take a proper measures to reduce noise, vibrations, turbid water, dust, exhaust gases, and
wastes, during construction stage
(2) Monitoring
(a) Does the proponent develop and implement monitoring program for the environmental
items that are considered to have potential impacts?
(b) What are the items, methods and frequencies of the monitoring program?
(c) Does the proponent establish an adequate monitoring framework (organization, personnel,
equipment, and adequate budget to sustain the monitoring framework)?
(d) Are any regulatory requirements pertaining to the monitoring report system identified,
such as the format and frequency of reports from the proponent to the regulatory authorities?
(a)Y
(b)N
(c)N
(d)N
6 Note
Reference to
Checklist of Other
Sectors
(a) Where necessary, pertinent items described in the Roads, Railways and Bridges checklist
should also be checked (e.g., projects including access roads to the infrastructure facilities).
(b) For projects, such as installation of telecommunication cables, power line towers, and
submarine cables, where necessary, pertinent items described in the Power Transmission and
Distribution Lines checklists should also be checked.
(a)N/A
(b)N/A
(a)
(b)
Note on Using
Environmental
Checklist
(a) If necessary, the impacts to transboundary or global issues should be confirmed (e.g., the
project includes factors that may cause problems, such as transboundary waste treatment, acid
rain, destruction of the ozone layer, or global warming).
(a)N/A (a)
1) Regarding the term “Country's Standards” mentioned in the above table, in the event that environmental standards in the country where the project is located diverge significantly from international standards,appropriate environmental
considerations are required to be made. In cases where local environmental regulations are yet to be established in some areas, considerations should be made based on comparisons with appropriate standards of other countries (including Japan's
experience).
2) Environmental checklist provides general environmental items to be checked. It may be necessary to add or delete an item taking into account the characteristics of the project and the particular circumstances of the country and locality in
which the project is located.
Chapter 5 Financial and Economic Evaluation
5-1
(1) Project Cost Estimate
1) New Plasma Product Factory
a) Land condemnation cost
The land for the new plasma product factory is a part of the premises of the Republican Blood Transfusion Center,
owned by MOH. Therefore, there will be no cost for land condemnation.
b) Factory construction material and equipment cost
The total estimated cost for factory construction, equipment, operation and maintenance management, and training
is 42,327,335 USD (approx. 4.97 billion JPY) as shown in Table 5-1 below.
Table 5-1 Project Cost for Plasma Product Factory Construction
NO Description Project cost (in
USD)
1 Factory building construction work
Gross floor area: 3,600m2; RC structure; two-story
Including building equipment (boiler, compressor, generator, transformer,
A/C, piping and valves, etc.)
19,800,000 USD
2 Plasma product factory
Various tanks, heat exchangers, pharmaceutical water equipment,
freeze-drying machines, centrifugal separators, autoclaves, serial dispensing
machines, control systems and instrumentation etc.
14,478,745 USD
3
Consumables and maintenance work for 4 years after completion
1,751,841 USD
4 Dispatching of Japanese experts (blood donation promotion, test
management, technological instruction, management guidance, human
resource development and training etc.)
4 years after completion: 84 experts per month in total
6,296,749 USD
Total 42,327,335 USD
1 USD = 117.382 JPY (as per JICA’s settlement rate for FY2016 (as of January 2017))
Source: Study team
c) Consulting fees and general management costs etc.
Consulting fees and general management costs etc. shall be included in the construction cost.
2) Blood Centers
a) Land condemnation cost
The project scope in relation to the existing Republican Blood Transfusion Center is the introduction of
bloodmobiles and test equipment and the center is MOH’s facility. Therefore, there will be not cost for land
condemnation. Similarly, the project scope for regional blood centers only involves the introduction of equipment
to existing facilities and there will be no cost for land condemnation.
b) Equipment cost
The total estimated cost of blood center equipment introduction including bloodmobiles, NAT equipment, test
equipment, operation and maintenance management, and training is 26,248,703 USD (approx. 3.08 billion JPY) as
shown in Table 5-2 below. The estimated cost includes the introduction and installation of test equipment and
donation rooms in the 3 regional cities.
5-2
Table 5-2 Project Cost for Blood Center Equipment Introduction
1 Main equipment items to be deployed to blood centers
- Bloodmobiles: 14 blood centers
- Donation rooms: 2 locations in Tashkent City
- Whole blood collection devices: 14 locations
- Automated blood grouping equipment: 4 locations
- Automated biochemical analyzers: 4 locations
- Automated hematology analyzers: 4 locations
- NAT (nucleic acid amplification tester): 4 locations
- Trucks and containers for transportation
15,066,849 USD
2 Reagents, consumables and equipment maintenance for 4 years after equipment
introduction
8,766,664 USD
3 Japanese expert dispatch (blood donation promotion, test management,
technological instruction, management guidance, human resource development
and training etc.)
4 years after equipment introduction: about 219 experts per month in total
2,415,190 USD
Total 26,248,703 USD
1 USD = 117.382 JPY (as per JICA’s settlement rate for FY2016 (as of January 2017))
Source: Study team
3) Total Project Cost
The total project cost is estimated to be 68,576,038 USD (approx. 8.05 billion JPY) as detailed in the Table 5-3
below.
Table 5-3 Total Project Cost
Item Project cost (in USD) Project cost (in JPY)
Project cost for plasma product
factory construction 42,327,335 4,968,467,237
Project cost for blood center
equipment introduction 26,248,703 3,081,125,256
Total project cost 68,576,038 8,049,592,493
Source: Study team
(2) Summary of Preliminary Financial and Economic Analysis Results
1) Financial Analysis
In this subsection, the feasibility of the proposed project is analyzed from a financial point of view. Specifically,
there is a comparison between the benefit expected to grow through the project (income from derivatives) and the
project cost (for construction, equipment, operations, maintenance and management etc.).
a) Performance metrics
3 metrics are used for this evaluation: net present value (NPV), benefit per cost (B/C) and financial internal rate of
return (FIRR).
b) Preconditions
Life of buildings and equipment shall be assumed to be 40 years and 20 years, respectively. Therefore,
equipment shall be renewed after 20 years from implementation. No salvage value of both buildings and
equipment shall be considered.
The analysis period shall be 40 years.
1% of facility price and 5% of equipment price shall be accounted as maintenance and management expenses
5-3
every year from the second year after the project implementation.
It shall be assumed that wages for facility staff are all borne by MOH. (MOH’s capital)
Use of STEP yen loan with an interest rate 0.1%, a 40-year redemption period and a 10-year deferment
period shall be assumed.
The blood derivative production volume shall be assumed to be as indicated in Table 5-4, based on which the
project benefits shall be calculated.
The following exchange rates shall be used.
1 USD = 117.382 JPY 1 UZS = 0.037020 JPY
(as per JICA’s settlement rate for FY2016 (as of January 2017))
5-4
Table 5-4 Expected Changes in Plasma Derivative Production Volume
Source: Study team
Passed
years
predicted
population
（million
person）
Plazma amount
(L)
Albumin amount
recommended value
for the population
（L)
10% Alubmin
product
volume(L)
10%
Immunoglobulin
(dose：3ml）
Factor Ⅷ
(unit)
1 32.21 3,000 3,221 750 37,500
2 32.64 4,000 3,264 1,000 50,000
3 33.07 6,000 3,307 1,500 75,000
4 33.51 9,000 3,351 2,250 112,500 1,000,000
5 33.94 13,000 3,394 3,250 162,500 2,437,500
6 34.37 19,000 3,437 4,750 237,500 3,562,500
7 34.80 22,000 3,480 5,500 275,000 4,125,000
8 35.24 24,000 3,524 6,000 300,000 4,500,000
9 35.67 25,000 3,567 6,250 312,500 4,687,500
10 36.10 25,933 3,610 6,483 324,164 4,862,453
11 36.54 26,244 3,654 6,561 328,051 4,920,771
12 36.97 26,555 3,697 6,639 331,939 4,979,088
13 37.40 26,866 3,740 6,717 335,827 5,037,406
14 37.84 27,177 3,784 6,794 339,715 5,095,724
15 38.27 27,488 3,827 6,872 343,603 5,154,041
16 38.70 27,799 3,870 6,950 347,491 5,212,359
17 39.13 28,110 3,913 7,028 351,378 5,270,677
18 40.00 28,732 4,000 7,183 359,154 5,387,312
19 40.43 29,043 4,043 7,261 363,042 5,445,629
20 40.87 29,354 4,087 7,339 366,930 5,503,947
21 41.30 29,665 4,130 7,416 370,818 5,562,265
22 41.73 29,976 4,173 7,494 374,705 5,620,582
23 42.17 30,287 4,217 7,572 378,593 5,678,900
24 42.60 30,598 4,260 7,650 382,481 5,737,218
25 43.03 30,910 4,303 7,727 386,369 5,795,535
26 43.46 31,221 4,346 7,805 390,257 5,853,853
27 43.90 31,532 4,390 7,883 394,145 5,912,171
28 44.33 31,843 4,433 7,961 398,033 5,970,488
29 44.76 32,154 4,476 8,038 401,920 6,028,806
30 45.20 32,465 4,520 8,116 405,808 6,087,124
31 45.63 32,776 4,563 8,194 409,696 6,145,441
32 46.06 33,087 4,606 8,272 413,584 6,203,759
33 46.50 33,398 4,650 8,349 417,472 6,262,077
34 46.93 33,709 4,693 8,427 421,360 6,320,394
35 47.36 34,020 4,736 8,505 425,247 6,378,712
36 47.79 34,331 4,779 8,583 429,135 6,437,030
37 48.23 34,642 4,823 8,660 433,023 6,495,347
38 48.66 34,953 4,866 8,738 436,911 6,553,665
39 49.09 35,264 4,909 8,816 440,799 6,611,982
40 49.53 35,575 4,953 8,894 444,687 6,670,300
41 49.96 35,886 4,996 8,971 448,575 6,728,618
Plasma fractionation formulation production volume
forecast
5-5
c) Benefit calculation
Table 5-5 below shows the recent sales volume and income of the Republican Blood Transfusion Center, disclosed
by MOH. Based on the data, domestic unit price for albumin and globulin is 50.43 USD/L (5,920 JPY/L) and 2.56
USD/L (300 JPY/L).
Table 5-5 Unit Price and Production Volume of Plasma Derivatives of the Existing Factory
Plasma derivative sales volume of the Republican Blood Transfusion Center (in L)
Item Unit 2015
Q4 2016 half-year
1 Albumin L 42.7 65.8
2 Anti-rhesus macaque immune globulin L 162 224
3 Blood coagulation factor VIII L 32 85
4 Anti-staphylococci immune globulin L 199 48
The Republican Blood Transfusion Center’s income from plasma derivatives (in 1,000 UZS)
Item Unit 2015
Q4 2016 half-year
1 Albumin 1,000 UZS 6828.2 10522.2
2 Anti-rhesus macaque immune globulin 1,000 UZS 1567.3 2167.2
3 Blood coagulation factor VIII 1,000 UZS 640.3 1700.7
4 Anti-staphylococci immune globulin 1,000 UZS 1323.3 319.2
Source: MOH
In regards to imported blood products the information indicated in Table 5-6 was disclosed by MOH through
interviews. As MOH looks to domestically distribute and export new blood products at similar prices in the future,
the prices for new blood products were used as the basis for to calculate benefits for the B/C analyses.
Table 5-6 New Product Price Table
10% albumin
(liter)
10% globulin
(dose) 1 dose = 3ml
Factor VIII
(unit)
MOH purchase price 626.15 USD 13.95 USD 0.37 USD
Price of equivalent Japanese
product for reference
46,230 JPY 1,551 JPY 64 JPY
Source: MOH
Operations, maintenance and management of the facilities and equipment will cost approximately 200 million JPY
as indicated in Table 5-7. The expected utility costs of the factory facilities are 22 to 100 million JPY as indicated
in Table 5-8.
Table 5-7 Estimated Maintenance and Management Costs of the Plasma Product Factory
Item Annual cost (in JPY) Remark
Facility and equipment
maintenance and
management cost
132,756,000
0.1% of facility price, and
0.5% of equipment price assumed
per year
Facility utility costs etc. 22,237,000 - 102,857,000
Variable depending on production
volume (See Table 5-9)
Total Approx. 155 - 235 million JPY
Source: Study team
5-6
Table 5-8 Facility Utility Costs, etc.
4,000L per year 25,000L per year
Item Unit price
(JPY) Usage Unit
Annual cost
(JPY) Usage Unit
Annual cost
(JPY)
1 Electricity 6.46 224,000 KWh 1,447,040 1,400,000 KWh 9,044,000
2 Gas 8.31 17,600 Nm3 146,256 110,000 Nm3 914,100
3 Water 6.08 1,280 m3 7,782 8,000 m3 48,640
4 Well water (city
water) 6.08 416 2,529 2,600 15,808
5 96% ethanol 2,327 3,570 L 8,307,390 19,525 L 45,434,675
6 53% ethanol 1,600 7,704 L 12,326,400 29,625 L 47,400,000
7
In-house
production of
purified water (UF
water)
624 L - 3,900 L -
8 Infectious waste 1,600 kg - 10,000 kg -
9 Industrial waste 4,800 kg - 30,000 kg -
Total cost per year 22,237,398 102,857,223
Source: Study team
Based on the preconditions described above, an analysis was conducted by three possible cases (Case 1, Case 2
and Case 3).
Case 1:
Benefits were calculated based on the expected production volume (Table 5-4) and the plasma derivative unit
price of the existing factory (Table 5-5). Calculation results are shown in the “Expected income/domestic price
(USD)” columns in Table 5-9 B/C Calculation Table.
5-7
Table 5-9 B/C Calculation Table
Source: Study team
Case 2:
As with the Case 1, benefits were calculated based on the expected production volume (Table 5-4) but with new
product prices disclosed by MOH (Table 5-6). Calculation results are shown in the “（US$）” columns in Table 5-9
B/C Calculation Table.
Case 3:
Benefit was calculated on the assumption of an 85% achievement rate of the intended production volume (Table
5-4) based on the conditions of Case 2.
The results of expense and benefit calculations for the cases above are shown in the cash flow tables in Table 5-11, 5-12 and 5-13.
d) Analysis results
For Case 1, benefits were calculated based on local prices of plasma derivatives as of the study. Due to the low
Passe
d
years
10%
Alubmin
product
volume(L)
10%
Immunoglob
ulin
(dose：
3ml）
Factor Ⅷ
(unit)albumin immunoglobulin factor No.8 Total albumin immunoglobulin factor No.8 Total
25 cc/litr 12.5 dose/litr 187.5 dose/litr $50.43 /litr $0.00768 /dose(3ml) $0.33 /unit $626.00 /litr $13.95 /dose(3ml) $0.37 /unit
1 750 37,500 $37,823 $288 $0 $38,111 $469,500 $523,125 $0 $992,625
2 1,000 50,000 $50,430 $384 $0 $50,814 $626,000 $697,500 $0 $1,323,500
3 1,500 75,000 $75,645 $576 $0 $76,221 $939,000 $1,046,250 $0 $1,985,250
4 2,250 112,500 1,000,000 $113,468 $864 $330,000 $444,332 $1,408,500 $1,569,375 $370,000 $3,347,875
5 3,250 162,500 2,437,500 $163,898 $1,248 $804,375 $969,521 $2,034,500 $2,266,875 $901,875 $5,203,250
6 4,750 237,500 3,562,500 $239,543 $1,824 $1,175,625 $1,416,992 $2,973,500 $3,313,125 $1,318,125 $7,604,750
7 5,500 275,000 4,125,000 $277,365 $2,112 $1,361,250 $1,640,727 $3,443,000 $3,836,250 $1,526,250 $8,805,500
8 6,000 300,000 4,500,000 $302,580 $2,304 $1,485,000 $1,789,884 $3,756,000 $4,185,000 $1,665,000 $9,606,000
9 6,250 312,500 4,687,500 $315,188 $2,400 $1,546,875 $1,864,463 $3,912,500 $4,359,375 $1,734,375 $10,006,250
10 6,483 324,164 4,862,453 $326,951 $2,490 $1,604,609 $1,934,050 $4,058,527 $4,522,081 $1,799,108 $10,379,716
11 6,561 328,051 4,920,771 $330,873 $2,519 $1,623,854 $1,957,246 $4,107,203 $4,576,317 $1,820,685 $10,504,205
12 6,639 331,939 4,979,088 $334,794 $2,549 $1,643,099 $1,980,442 $4,155,879 $4,630,552 $1,842,263 $10,628,694
13 6,717 335,827 5,037,406 $338,715 $2,579 $1,662,344 $2,003,638 $4,204,555 $4,684,787 $1,863,840 $10,753,182
14 6,794 339,715 5,095,724 $342,636 $2,609 $1,681,589 $2,026,834 $4,253,231 $4,739,023 $1,885,418 $10,877,671
15 6,872 343,603 5,154,041 $346,558 $2,639 $1,700,834 $2,050,030 $4,301,906 $4,793,258 $1,906,995 $11,002,160
16 6,950 347,491 5,212,359 $350,479 $2,669 $1,720,078 $2,073,226 $4,350,582 $4,847,494 $1,928,573 $11,126,649
17 7,028 351,378 5,270,677 $354,400 $2,699 $1,739,323 $2,096,422 $4,399,258 $4,901,729 $1,950,150 $11,251,137
18 7,183 359,154 5,387,312 $362,243 $2,758 $1,777,813 $2,142,814 $4,496,610 $5,010,200 $1,993,305 $11,500,115
19 7,261 363,042 5,445,629 $366,164 $2,788 $1,797,058 $2,166,010 $4,545,285 $5,064,435 $2,014,883 $11,624,604
20 7,339 366,930 5,503,947 $370,085 $2,818 $1,816,303 $2,189,206 $4,593,961 $5,118,671 $2,036,460 $11,749,092
21 7,416 370,818 5,562,265 $374,007 $2,848 $1,835,547 $2,212,402 $4,642,637 $5,172,906 $2,058,038 $11,873,581
22 7,494 374,705 5,620,582 $377,928 $2,878 $1,854,792 $2,235,598 $4,691,313 $5,227,142 $2,079,615 $11,998,070
23 7,572 378,593 5,678,900 $381,849 $2,908 $1,874,037 $2,258,794 $4,739,989 $5,281,377 $2,101,193 $12,122,559
24 7,650 382,481 5,737,218 $385,771 $2,937 $1,893,282 $2,281,990 $4,788,664 $5,335,612 $2,122,771 $12,247,047
25 7,727 386,369 5,795,535 $389,692 $2,967 $1,912,527 $2,305,186 $4,837,340 $5,389,848 $2,144,348 $12,371,536
26 7,805 390,257 5,853,853 $393,613 $2,997 $1,931,771 $2,328,382 $4,886,016 $5,444,083 $2,165,926 $12,496,025
27 7,883 394,145 5,912,171 $397,534 $3,027 $1,951,016 $2,351,578 $4,934,692 $5,498,319 $2,187,503 $12,620,514
28 7,961 398,033 5,970,488 $401,456 $3,057 $1,970,261 $2,374,774 $4,983,368 $5,552,554 $2,209,081 $12,745,002
29 8,038 401,920 6,028,806 $405,377 $3,087 $1,989,506 $2,397,970 $5,032,043 $5,606,790 $2,230,658 $12,869,491
30 8,116 405,808 6,087,124 $409,298 $3,117 $2,008,751 $2,421,166 $5,080,719 $5,661,025 $2,252,236 $12,993,980
31 8,194 409,696 6,145,441 $413,219 $3,146 $2,027,996 $2,444,362 $5,129,395 $5,715,260 $2,273,813 $13,118,469
32 8,272 413,584 6,203,759 $417,141 $3,176 $2,047,240 $2,467,558 $5,178,071 $5,769,496 $2,295,391 $13,242,957
33 8,349 417,472 6,262,077 $421,062 $3,206 $2,066,485 $2,490,753 $5,226,747 $5,823,731 $2,316,968 $13,367,446
34 8,427 421,360 6,320,394 $424,983 $3,236 $2,085,730 $2,513,949 $5,275,422 $5,877,967 $2,338,546 $13,491,935
35 8,505 425,247 6,378,712 $428,905 $3,266 $2,104,975 $2,537,145 $5,324,098 $5,932,202 $2,360,123 $13,616,424
36 8,583 429,135 6,437,030 $432,826 $3,296 $2,124,220 $2,560,341 $5,372,774 $5,986,437 $2,381,701 $13,740,912
37 8,660 433,023 6,495,347 $436,747 $3,326 $2,143,465 $2,583,537 $5,421,450 $6,040,673 $2,403,278 $13,865,401
38 8,738 436,911 6,553,665 $440,668 $3,355 $2,162,709 $2,606,733 $5,470,126 $6,094,908 $2,424,856 $13,989,890
39 8,816 440,799 6,611,982 $444,590 $3,385 $2,181,954 $2,629,929 $5,518,801 $6,149,144 $2,446,434 $14,114,379
40 8,894 444,687 6,670,300 $448,511 $3,415 $2,201,199 $2,653,125 $5,567,477 $6,203,379 $2,468,011 $14,238,867
41 8,971 448,575 6,728,618 $452,432 $3,445 $2,220,444 $2,676,321 $5,616,153 $6,257,615 $2,489,589 $14,363,356
Plasma fractionation formulation
production volume forecastExpected income/domestic price（USD) Expected income/new product price (USD)
5-8
product unit prices, NPV and B/C were calculated to be −45,319,000 USD and 0.659, respectively. Thus, the case is
not profitable.
For Case 2, benefits were calculated based on the latest price of plasma derivatives disclosed by the Ministry of
Health, which is higher than that of Case 1. The project would be sufficiently profitable based on the latest MOH
price for blood products, with NPV and B/C rated as 64,941,000USD and 1.50, respectively.
For Case 3, benefits were calculated with 85% of the target production volume on the assumption that the
production of plasma derivatives could not reach the target volume. As a result, NPV and B/C were calculated to
be 45,368,000 USD and 1.35, respectively, which are both lower than those of Case 2. However, the case is still
profitable and expected to produce sufficient income. FIRR could not be calculated as NPV, is constantly positive
in all the cases, and NPV becomes 0 in no instance.
Table 5-10 Financial Analysis Results
Unit: 1000 USD
Case1 Case2 Case3
Operational cost
distribution
All paid All paid All paid
Grant for staff
compensation, etc., from
MOH
Yes
130,000 USD per month
Yes
130,000 USD per month
Yes
130,000 USD per month
Pricing of plasma
derivatives
Local price at the time of
the first local study
Latest MOH price Latest MOH price
Target production volume As per Table 5-4 As per Table 5-4 85% of Table 5-4
NPV -45,319 64,941 45,368
B/C 0.659 1.500 1.350
FIRR − − −
Source: Study team
5-9
Table 5-11 Cash Flow Table for Case 1
Source: Study team
Table 5-12 Cash Flow Table for Case 2
Source: Study team
5-10
Table 5-13 Cash Flow Table for Case 3
Source: Study team
5-11
2) Economic Analysis
a) Consideration of economic costs and benefits
1. Concept of Benefits
There are the following four potential economic benefits of the proposed project.
Table 5-14 Potential Economic Benefits of the Proposed Project
No. Type of benefit Measurement
1 Production of sufficient amount of plasma
derivatives will eliminate the importing cost
arising out of the heavy dependence on
imports. The domestic sales volume will also
increase.
・ Increase of produced plasma
derivatives
・ Decrease or elimination of imports
2 Surplus plasma derivatives produced
domestically can be exported to neighboring
countries.
・ Exports of plasma derivatives
3 Deployment of bloodmobiles is expected to
lead to a significant increase in the amount of
donated blood.
・ Increase of donated blood
・ Increase of plasma derivative
production due to obtaining more
plasma (a raw material of plasma
derivatives)
4 Patients’ risk of infection will be substantially
reduced by the introduction of established
blood test systems.
・ Reduction of risk of infection
Source: Study team
Increase of plasma derivatives and plasma described in No.1 and No.3 above is the effect of pricing relative to the
derivative production volume as discussed in relation to the financial analysis.
The benefits of No.4 can only be accessed qualitatively based on a reduction of infection risk as data regarding
infection cases after dosing of plasma derivatives are not available.
The benefits of No.2 are the potential benefits from the possibility of exporting plasma derivatives when domestic
demands are fully met. This benefits are examined below.
2. Preconditions
Conditions for estimating the economic benefits are the same as those in the financial analysis.
With the plasma derivative production volume expected to exceed the current imported albumin volume of 1,100L
in 3 years after the completion of the new factory (Table 5-4), the annual imports amounting to approximately 100
million JPY will be eliminated and even income from exporting can be expected. The required volume of plasma
derivatives for the Uzbek population is indicated in the table below based on the WHO’s recommendation per 1
million.
Table 5-15 WHO’s Recommended Volume of Plasma Derivatives (per 1 million)
WHO’s recommended volume (per 1 million population)
Product
specifications
10% albumin
(liter)
10% immune globulin
(dose) 1 dose = 3ml
Factor VIII
(unit)
Required
volume
100L/1 million 6,000 dose/1 million 100,000 unit/1 million
Source: WHO
Expected surplus and export amount calculated based on the above preconditions are shown in Table 5-16. The
export prices were set to 90% of domestic sales price in order to achieve price competitiveness in the global
market relative to the present import prices.
5-12
Table 5-16 Expected Surplus and Export Amount
Source: Study team
In Case 4, income in Case 2 was replaced by the import profit calculated above. The cash flow table for Case 4 is
shown in Table 5-19. As shown in Table 5-17, results of this calculation were -29,409,000 USD for NPV and 0.773
for B/C; NPV is negative, but the B/C value indicates that the export income would account for about 51% of the
total income in Case 2. Thus, the benefit from plasma derivative exporting is expected to deliver significant
positive effects in Uzbekistan.
Table 5-17 Results of Economic Analysis
Unit: 1,000 USD
Case 4
Operational cost distribution All paid
Grant for staff compensation, etc., from MOH Yes
Pricing of plasma derivatives Latest MOH price
Expected benefit Blood product export
NPV -29,409
B/C 0.773
FIRR -
Source: Study team
Passed
years
predicted
population
（million
person）
Plazma amount
(L)
Albumin amount
recommended
value for the
population
（L)
10% Alubmin
product
volume(L)
10%
Immunoglobulin
(dose：3ml）
Factor Ⅷ
(unit)
10% Alubmin
Export
volume(L)
10%
Immunoglobulin
(dose：3ml）
Factor Ⅷ
(unit)
10%
Alubmin
(USD)
10%
Immunoglobulin
(USD)
Factor Ⅷ
(USD)
Total
（USD)
1 32.21 3,000 3,221 750 37,500
2 32.64 4,000 3,264 1,000 50,000
3 33.07 6,000 3,307 1,500 75,000
4 33.51 9,000 3,351 2,250 112,500 1,000,000
5 33.94 13,000 3,394 3,250 162,500 2,437,500
6 34.37 19,000 3,437 4,750 237,500 3,562,500 1,313 31,274 125,400 $739,865 $392,632 $41,719 $1,174,216
7 34.80 22,000 3,480 5,500 275,000 4,125,000 2,020 66,176 644,600 $1,138,115 $830,811 $214,452 $2,183,379
8 35.24 24,000 3,524 6,000 300,000 4,500,000 2,476 88,578 976,300 $1,395,482 $1,112,059 $324,806 $2,832,346
9 35.67 25,000 3,567 6,250 312,500 4,687,500 2,683 98,480 1,120,500 $1,511,964 $1,236,374 $372,780 $3,121,118
10 36.10 25,933 3,610 6,483 324,164 4,862,453 2,873 107,546 1,252,153 $1,619,019 $1,350,188 $416,579 $3,385,787
11 36.54 26,244 3,654 6,561 328,051 4,920,771 2,907 108,835 1,267,171 $1,638,437 $1,366,381 $421,576 $3,426,394
12 36.97 26,555 3,697 6,639 331,939 4,979,088 2,942 110,125 1,282,188 $1,657,855 $1,382,575 $426,572 $3,467,001
13 37.40 26,866 3,740 6,717 335,827 5,037,406 2,976 111,415 1,297,206 $1,677,272 $1,398,768 $431,568 $3,507,609
14 37.84 27,177 3,784 6,794 339,715 5,095,724 3,011 112,705 1,312,224 $1,696,690 $1,414,961 $436,564 $3,548,216
15 38.27 27,488 3,827 6,872 343,603 5,154,041 3,045 113,995 1,327,241 $1,716,108 $1,431,155 $441,561 $3,588,823
16 38.70 27,799 3,870 6,950 347,491 5,212,359 3,080 115,285 1,342,259 $1,735,525 $1,447,348 $446,557 $3,629,430
17 39.13 28,110 3,913 7,028 351,378 5,270,677 3,114 116,574 1,357,277 $1,754,943 $1,463,542 $451,553 $3,670,038
18 40.00 28,732 4,000 7,183 359,154 5,387,312 3,183 119,154 1,387,312 $1,793,778 $1,495,929 $461,546 $3,751,252
19 40.43 29,043 4,043 7,261 363,042 5,445,629 3,218 120,444 1,402,329 $1,813,196 $1,512,122 $466,542 $3,791,860
20 40.87 29,354 4,087 7,339 366,930 5,503,947 3,252 121,734 1,417,347 $1,832,614 $1,528,315 $471,538 $3,832,467
21 41.30 29,665 4,130 7,416 370,818 5,562,265 3,286 123,024 1,432,365 $1,852,031 $1,544,509 $476,534 $3,873,074
22 41.73 29,976 4,173 7,494 374,705 5,620,582 3,321 124,313 1,447,382 $1,871,449 $1,560,702 $481,530 $3,913,682
23 42.17 30,287 4,217 7,572 378,593 5,678,900 3,355 125,603 1,462,400 $1,890,867 $1,576,896 $486,527 $3,954,289
24 42.60 30,598 4,260 7,650 382,481 5,737,218 3,390 126,893 1,477,418 $1,910,284 $1,593,089 $491,523 $3,994,896
25 43.03 30,910 4,303 7,727 386,369 5,795,535 3,424 128,183 1,492,435 $1,929,702 $1,609,282 $496,519 $4,035,504
26 43.46 31,221 4,346 7,805 390,257 5,853,853 3,459 129,473 1,507,453 $1,949,120 $1,625,476 $501,515 $4,076,111
27 43.90 31,532 4,390 7,883 394,145 5,912,171 3,493 130,763 1,522,471 $1,968,537 $1,641,669 $506,512 $4,116,718
28 44.33 31,843 4,433 7,961 398,033 5,970,488 3,528 132,053 1,537,488 $1,987,955 $1,657,863 $511,508 $4,157,325
29 44.76 32,154 4,476 8,038 401,920 6,028,806 3,562 133,342 1,552,506 $2,007,372 $1,674,056 $516,504 $4,197,933
30 45.20 32,465 4,520 8,116 405,808 6,087,124 3,597 134,632 1,567,524 $2,026,790 $1,690,250 $521,500 $4,238,540
31 45.63 32,776 4,563 8,194 409,696 6,145,441 3,631 135,922 1,582,541 $2,046,208 $1,706,443 $526,497 $4,279,147
32 46.06 33,087 4,606 8,272 413,584 6,203,759 3,665 137,212 1,597,559 $2,065,625 $1,722,636 $531,493 $4,319,755
33 46.50 33,398 4,650 8,349 417,472 6,262,077 3,700 138,502 1,612,577 $2,085,043 $1,738,830 $536,489 $4,360,362
34 46.93 33,709 4,693 8,427 421,360 6,320,394 3,734 139,792 1,627,594 $2,104,461 $1,755,023 $541,485 $4,400,969
35 47.36 34,020 4,736 8,505 425,247 6,378,712 3,769 141,081 1,642,612 $2,123,878 $1,771,217 $546,481 $4,441,577
36 47.79 34,331 4,779 8,583 429,135 6,437,030 3,803 142,371 1,657,630 $2,143,296 $1,787,410 $551,478 $4,482,184
37 48.23 34,642 4,823 8,660 433,023 6,495,347 3,838 143,661 1,672,647 $2,162,714 $1,803,604 $556,474 $4,522,791
38 48.66 34,953 4,866 8,738 436,911 6,553,665 3,872 144,951 1,687,665 $2,182,131 $1,819,797 $561,470 $4,563,399
39 49.09 35,264 4,909 8,816 440,799 6,611,982 3,907 146,241 1,702,682 $2,201,549 $1,835,990 $566,466 $4,604,006
40 49.53 35,575 4,953 8,894 444,687 6,670,300 3,941 147,531 1,717,700 $2,220,967 $1,852,184 $571,463 $4,644,613
41 49.96 35,886 4,996 8,971 448,575 6,728,618 3,976 148,821 1,732,718 $2,240,384 $1,868,377 $576,459 $4,685,220
Plasma fractionation formulation production volume
forecastSurplus (Export) volume prediction Surplus (Export) value prediction
5-13
Table 5-18 Cash Flow Table for Case 4
Source: Study team
Chapter 6 Planned Project Schedule
6-1
(1) Overall Schedule
1) Split of Project Scope
The entire project is proposed to be STEP yen-loan based. The yen-loan project scope is split into the following 4
categories.
Table 6-1 Split of Project Scope
Project scope Project description Contractors
Consulting - Detailed design
- Bidding
- Procurement supervision
- Japanese consultant
Facility development - Facility design, construction and
delivery
- Guidance for facility operation
maintenance and management
- Defect warranty
- Japanese constructor
- Local general constructor
Equipment
procurement
- Equipment production, installation and
delivery
- Guidance on equipment operations
- Defect warranty
- Consumable supply (4 years)
- Japanese trading company etc.
Technical instructions - Technical instructions and human
resource training etc.
- Japanese consultant and blood
service implementing
organization
Source: Study team
2) Implementation Schedule
The expected implementation schedule based on the scope described above is shown in the table below. After
completion of this study, the Uzbekistan government will proceed with its internal decision making processes and
submit a request letter to the Japanese Government. A preparatory survey will then be conducted by JICA before
confirmation of the project. Following the execution of E/N and L/A based on the survey results, a consultant to
support the implementation will be appointed and a detailed design will subsequently be completed in about 7
months.
Contractors for facility development and equipment procurement will then be selected and equipment installation
and operation instructions will be provided upon completion of the construction after 18 months.
Technical guidance, human resource training and consumable supplies will also be provided for 4 years until the
project is completed.
6-2
Figure 6-1Implementation Schedule
Source: Study team
Study completed
Internal request for decision in Uzbek Government
JICA preparatory survey
E/N and L/A execution
Consultant selection
Consultancy contract execution
Detailed design and bid documentation
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Bidding for facility construction (plasma product
factory)
Equipment delivery (plasma product factory)
Equipment installation, plant installation arrangement
and delivery (production facilities)
Equipment procurement bidding (Tashkent City and
regional blood centers)
Equipment production (Tashkent City and regional
blood centers)
Equipment delivery, installation, operational
instructions and handover (Tashkent City and
regional blood centers)
Equipment installation and operational instructions
(production facilities, Tashkent City and regional
blood centers)
Staff training (production facilities, Tashkent City
and regional blood centers)
Defect liability period
Year1 Year2 Year3 Year4 Year5 Year5
Chapter 7 Implementing Organization
7-1
(1) Overview of Implementing Organization in the Host Country
1) Overview of Implementing Organization
MOH serves to plan, manage and adjust health-care systems in Uzbekistan, and also manage national health-care
institutions. In each province, there is also a health department that manages health-care institutions in the
province. In the Republic of Karakalpakstan, its independent MOH led by a minister governs health-care
administration in the autonomous republic.
In relation to blood services, the Republican Blood Transfusion Center is under the supervision of MOH, but the
blood transfusion station(s) in each province are managed by the provincial health department. However,
operations related to blood donation and production in each provincial blood center is governed and supervised by
the Republican Blood Transfusion Center.
2) Chart of Implementing Organization
a) Position of implementing organization in the national government
As shown in the chart below, MOH is under the supervision of deputy prime minister in charge of education,
health care, welfare and information, who reports to the prime minister and the president. The Republican Blood
Transfusion Center, the implementing organization of this project, is under the control of MOH and currently led
by the Director Rustam Yoldashev.
Figure 7-1 Position of Implementing Organization in the Uzbek Government
Source: MOH
b) MOH Organization Chart
The following figure shows the organization chart of MOH. MOH has 1 minister and 4 deputy ministers. Among
them, the Deputy Minister Hudaikulov is in charge of the blood services. There is also a department in charge of
ODA, which is led by Mr. Jabriev. The person responsible for practical operations of the proposed project will be
7-2
Director Yoldashev of the Republican Blood Center, who is responsible for the entire blood services of the
country.
The medical institutions and the Design Institute will also be involved in the development of medical facilities and
grant design approval etc.
Multiple republican medical centers with blood transfusion stations will also take part in the blood services.
Figure 7-2 MOH Organization Chart
Source: MOH
(2) Host Country’s Organization for Project Implementation
1) Supervising Organization (MOH)
As the project scope is, in principle, limited to the rebuilding of an existing facility and/or addition of functions,
there are no plans to change the above implementation organization. Therefore, the Uzbek MOH will serve as a
supervising organization during the project period while the Republican Blood Transfusion Center will be the
implementing organization of the project.
Within the supervising organization, MOH, as described above, the Blood Preparation Department will take
charge of the project and Mr. Alim Imatov will be the responsible official. As the proposed project is a yen-loan
project, the Investment Projects Coordination Department in charge of ODA investment will also be involved.
2) Implementing Organization (Republican Blood Transfusion Center)
On the implementing organization side, Director Yoldashev of the Republican Blood Transfusion Center will
assume responsibility for implementing the project. Operations after the development of the new factory
development and the introduction of equipment can be handled by the current staff of the Republican Blood
Transfusion Center and regional blood centers.
7-3
a) Plasma derivative factory
The following 23 specialists are expected, in total, to be required for operations of the new plasma derivative
factory.
Alcohol fractionation and bulk adjustment: 8
Filling and packing: 4
Facility management and procurement management: 6
Quality control: 5
QA: 2-3 (may be fulfilled by the quality control staff)
On the assumption that the 22 specialists currently working for the existing plasma derivative factory will
continue to work for the new factory, recruiting one additional staff member will meet the staff requirements.
However, thorough technical instruction and training are required in preparation for the introduction of
GMP-compliance practices and new equipment.
b) Blood centers (the Republican Blood Transfusion Center and 3 regional blood transfusion stations)
No significant facility extension is planned for blood centers and there will be no immediate need for a reinforcing
workforce following the project commencement. As discussed in relation to future outlook, however, installation
of new donation rooms and recruitment of new staff to cope with increased blood donations are expected to be
needed in the course of the efforts to increase the number of donors. In addition, it is desirable to standardize and
schematize new staff training as an attempt to achieve efficient human resource development.
Chapter 8 Technical Advantages of Japanese Companies
8-1
(1) The International Competitiveness of Japanese Companies and the
Possibility of Winning Contracts in the Proposed Project
1) Entire Blood Services
The plasma derivative production techniques to be introduced to Uzbekistan through the proposed project are
elementary techniques, for which there are no significant differences in technical competencies among advanced
nations including Japan. Similarly, equipment used in the production processes and construction techniques for
clean rooms are very common among many countries and companies in Europe and other parts of the world. In
other words, Japan and Japanese companies have no particular advantage in this field.
On the other hand, Japan’s blood services are known to have the world’s highest level of safety and quality. Also,
in Japan there is great public trust in the blood services developed through blood donation campaigns promoted by
local administrations and blood donation promoting organizations etc., which has led to a high rate of blood
donation. Thus, Japan’s strengths lie in its thorough quality control excellent enough to maintain this trust and its
consistent provision of highly efficient and safe blood products to the public.
In other words, Japan’s strengths in blood services are comprised of collective competencies of its entire blood
service system covering upstream processes including blood collection, backed by the excellent quality control
know-how and professional ethics of experts.
It is not easy to point out the objective and quantitative measurements of the competitiveness of Japan’s intangible
techniques and know-how. However, including the transfer of such techniques and know-how in the scope of this
project will likely increase the chance for Japanese companies to receive orders. Additionally, for the smooth
transfer of techniques and know-how from Japanese technicians, the introduction of reliable equipment familiar to
them would be prioritized and this could also increase the chance of introducing the products of Japanese
manufacturers.
2) Provision of Facilities and Equipment by Japanese Companies
The facilities and production equipment of the Japan Red Cross (the primary blood service operator of Japan) and
domestic plasma product factories are mostly supplied by Japanese manufacturers. In fact, they prefer to use
Japanese equipment probably because of reliable after-sales services and convenience in repair services and spare
parts replacement etc.
In the global market, on the other hand, production facilities and equipment of foreign manufacturers occupy a
high share and the presence of Japanese manufacturers is limited. Japanese products are generally regarded as
excellent in quality but expensive, and these views of Japanese products makes Japan prone to be excluded from
cost-conscious procurement projects.
Thus, the products of Japanese manufacturers have a competitive advantage in the domestic market in terms of
maintainability, but they are not particularly competitive in pricing for Uzbekistan. For Japanese equipment to
achieve a competitive advantage in this project, measures to add more values, such as the establishment of a
maintenance scheme (e.g., after-sales services) are required.
3) Expectations of the Host Country Government
As mentioned in an early part of Chapter 3, this project originates in the presidential order of the ex-President
Karimov (No. 4639, issued on April 19, 2016), in which a Japan-Uzbekistan project was envisioned as part of the
economic cooperation between the countries. Uzbek deep trust in Japanese products and technical competencies
built through past economic activities between Japan and Uzbekistan must be the primary reason of designating
Japan in the order statement. Taking into account the background of project formation, Uzbekistan primarily seeks
Japan’s participation in the project and it is likely that Japan can take the initiative in this project when other
conditions are met.
(2) Japanese Materials and Equipment, and their Prices
1) New Plasma Product Factory
Equipment items of Japanese manufacturers are not particularly competitive in the global market. However,
Uzbek government has shown deep trust in Japanese products and an arrangement to promote the adoption of as
8-2
many Japanese products as possible in the project needs to be considered.
The following table lists equipment items of Japanese candidates for equipment proposed for introduction to the
new plasma product factory. As Japanese manufactures can supply most of the items to be procured, there would
certainly be a chance for Japanese manufacturers to win contracts if they can show competitive advantages in
price and quality over foreign products.
8-3
Table 8-1 Main Equipment Items for Plasma Product Factory
Equipment Room Maker
Unit price
(in million
JPY)
Remark (specs, etc.,)
CIP room
Boiler room,
cleaning room,
bottle-washing
room, etc.
Reagent
preparation
rooms,
fractionation
room,
inactivation
treatment room,
final preparation
room,
purification
room, etc.
Brine room
Reagent water
room
Freeze-dry room
Pre-freeze-dry
room
Plasma
dissolution room
Filtration room
Final albumin
preparation room
Bulk
pasteurization
room
(provisional)
8-4
Centrifugal
separator room
Fractionation
room
Alcohol storage
Autoclave
(secondary zone)
Final filtration
room
Purification room
Autoclave
(tertiary zone)
Bottle-washing
room, dispensing
room
<Control
system>
Factory
equipment
Instrumentation
Source: Study team
2) Blood Centers
NAT equipment used in Japan are foreign products. However, there is a chance that Japan’s bloodmobiles and
other equipment for testing, analysis and blood collection will be introduced to the blood centers if competitive
pricing, quality and maintainability are established.
(3) Measures Required to Help Japanese Companies Win Contracts
1) Provision of Maintenance and Technological Support in Yen-Loan Package
As mentioned above, while Japanese companies are capable of supplying the proposed facilities and equipment
for this project, they do not have a particular competitive advantage and various side conditions should be
satisfied as a prerequisite for them to win contracts.
The scope of the proposed project package is planned to include facility development, post-procurement
equipment maintenance, reagent/consumable supplies, guidance on maintenance and management, and
technology transfer etc., which are not common among yen-loan projects. The period was set to 4 years, during
which Uzbek stakeholders are expected to become capable of operating the blood services independently toward
their goals. This package configuration would create a cost benefit in relatively expensive Japanese equipment in
terms of total costs including running expenses. Because of its longstanding history of blood services, Japan has a
number of experienced experts, and technological guidance provided by such experts would add substantial value
to the proposed project.
It is important to continue consultation and evaluation on both the Uzbekistan and Japan sides in order to establish
a package containing a software support plan.
8-5
2) Evaluation of STEP Conditions
The project proposal has been developed with a view to use the STEP yen loan. Despite lack of a particular
competitive advantage of Japanese equipment, Japan can source most of the items required for the project and,
thus, there is a possibility that STEP conditions can be satisfied. This is particularly that case since the quality
control and safety measures to be implemented for the entire blood services are the fields where the excellent
technology of Japan can be applied. If these items can become part of the yen-loan project scope, they can be a
basis for STEP application.
While further consultation and adjustment with stakeholders including JICA are necessary, Uzbekistan has
expressed high expectations toward implementing a Japan-tied project, and evaluation of the potential of this
project should be continued further.
