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We are dealing with the problem of the village of GULUWI and know that you are a member of the community you can assist in any way, as a subsidy to help around. contact AFSC. Email. socialchangealliancefor@gmail.com.
PROJECT TITLE

IMPROVEMENT OF PRIMARY HEALTH CARE SERVICE: CONSTRUCTION OF IGULUWI DISPENSARY PROJECT

LOCATION

IGULUWI VILLAGE, MBUGA WARD
MPWAPWA DISTRICT


PROJECT PREPARED BY
MPWAPWA DISTRICT COUNCIL






August, 2018




1. BACKGROUND INFORMATION
1.1 Geographical area: Mpwapwa District Council has a total surface area of 7,379 Square Kilometres of which most of the area is predominantly with spontaneous mountain chains especially in the Southern and Western parts with steep hills, ridges, valleys and escarpments, and having a total population of 345,568 people (projection data - 2018) among them 176,240 (51%) females and 169,328 (49%) men. Mpwapwa district is one of seven districts in the Dodoma Region.


1.2 Social and economic status Main population of the village is very poor. They lack human basic needs of daily life. Most of the community members are involved in small-scale farming of their small landholdings. It is estimated that residents in Mpwapwa district especially women use about 80% of their time to get essential services such as health services and other services at a distance of 2 to 10 kilometres. Women do most of the works.


1.2 Proposed Project location

The proposed project will be implemented in Iguluwi village, Mbuga Ward in Mpwapwa District. It is located at a distance of about 135 Km away from Mpwapwa town. The village is one of the Mbuga Ward’s villages, which has a population of approximately 5,814 among them 2,965 females and 2,849 male, covering a fairly widespread area. The total number of 12,277 will benefit directly and indirectly from the proposed project. The total population is distributed as follows: Iguluwi (2,167), 1,344 Mbuga (3,316) and Kizi (1,154) are used to share common social services like water for domestic and animal purposes and secondary school. National Census, 2012.

Iguluwi dispensary is a community project aimed at helping all the community members in receiving proper and quality health services. The aim is to save the target population especially the most-at-risk populations (MARPs including pregnant women and lactating mothers from walking long distances (not less than 5 km) to access the nearest health facilities for reproductive and maternal child health services. Additionally, Iguluwi village and its vicinity have experienced an increase in population with high demand of primary health care services.

1.4 Available Public Services

Mpwapwa District: has a total number of 62 health facilities: 1 district hospital, 4 Rural Health Centres and 57 dispensaries (51 owned by the government; 3 FBOs; 2 Government institutions and 1 private). Approximately 64.4%% of the inhabitants of rural areas have access to health facilities to reasonably a distance of 5km and 65% to improved water schemes. The remaining 39.6 percent including Iguluwi village have no health facilities.

Iguluwi village: There is no any health facility in the village for health care delivery system. Available government institutions are Iguluwi primary school with a total number of 380 (186 girls and 194 boys) schoolchildren owned by the government. The village is served with electricity connected to the National Grid. There is a gravity water scheme connected with pipe networks but malfunctioning.

2 PROJECT STATEMENT

2.1 Health Facilities
Mpwapwa District Council, like many other District Councils in Tanzania Mainland, is faced with the challenge of providing adequate health services for better quality of life to the needy people. Despite substantial efforts of the local authority to provide adequate health services in terms of health facilities and human resources in the district, shortage of health facilities (dispensaries and rural health centres) still exist. Availability of national/district resources, especially finance, is insufficient to implement this massive task.

Consequently, under the Health Sector Reforms, the Government is working together with a number of partners to help the improvement of health care services to the people. Therefore, Mpwapwa district, is submitting this proposal seeks to strengthen efforts being made by the Government to contribute towards promotion of primary health care services in favour to reproductive health and MCH services.
This project is proposed for funding due to the major health problems facing the community members of Iguluwi village and their neighbourhood villages due to lack of health facilities. The community is benefiting from primary health care services in terms of dispensary and/or clinic to minimise incidence of child and maternal mortality and prominent communicable diseases (water borne and water related diseases) like Diarrhoeal diseases, Malaria, Acute Respiratory Infection (ARI), and Intestinal infestation and skin diseases.

2.2 Scarcity of Adequate Water Supply:

Health problems and scarcity of water supply are closely link. At the community level, an inadequate water supply is one of the contributing factors to various communicable diseases. Lack of health facilities in this village is contributing to the increment of prevalence rate of waterborne and water related diseases. When the patients have these kinds of infections they tend to apply self-medication, in some circumstances the situation creates major health problems. The population of Iguluwi village is getting water for drinking purposes from the traditional water sources (traditional shallow wells), which are not safe for human consumption. The available water sources are unreliable and inadequate. Women and girls have the burden of fetching water from those unreliable water sources in distant areas with buckets on top of their heads throughout the dry season. The above situation has negative impact towards to a better quality of life. Availability of health facility offering curative and preventive services will play a big role in the reduction of prevalence rate caused by communicable diseases and other health related problems.


2.3 Health Problems

Major health problems in the district especially in the rural areas have their route-cause associated with inadequate social services like health facilities for offering primary, water and sanitation services and poverty.
Due to lack of the above essential social services (health facilities, clean and safe water and poor sanitation) the village members remain prone to a wide spread occurrence of communicable diseases which is a significant cause in morbidity and mortality rates.
Lack of constant water supply in the village also intercepts the good practice of sanitation/personal hygiene services, increases the incidence of various waterborne and water related diseases. Limitations of public services like health facility and reliable water supplies and poverty have the direct negative impact towards community development in terms of socio-economic and welfare of the residents. In line with treatment of out-patient cases, through employed qualified health staff the community will be sensitised on the promotion of better sanitation and personal hygiene practices for reduction of morbidity rate associated with water-sanitation related diseases, which have been underestimated in some part of the rural communities in Mpwapwa district.

2.4 Poverty
Poverty burden has continued to weigh heavily among the local people in the rural areas especially to the most-at-risk populations (women and young girls). This is one of the crucial issues among beneficiaries and it reaffirms the rationale to focus on the provision of primary health care services in line with poverty reduction in any kind through integrated health and water services and calls for increased efforts to ensure that the burden of morbidity and constant poverty to the community is reduced.

2.5 Needs Assessment:

The needs of this project were primarily identified and requested by the village government through Mbuga ward. The needs were approved in the full village meeting and presented to Full District Council meeting, which usually involves representative of the community known as Ward Councilors. Therefore, the initiator of the proposed construction of new health facility is the community members themselves.

3. RATIONALE OF THE PROJECT

The construction of a new dispensary at Iguluwi village is aiming at strengthening Primary Health Care Services (PHC) by advising more rational use of resources and encouraging community participation in the utilization of health services.
The availability of community health facility will improve the health and development of women and children with favoring pregnant women and underfive children. Through qualified health providers the facility will play a big role to improve also the issue of personal hygiene to intercept the route of waterborne and water related diseases through community health education about health and good practice especially for children.
Establishment of Iguluwi dispensary for offering primary health care services would play a big role in the reduction of morbidity and mortality rates tremendously to a minimum negligible figure except for cases beyond human control.
Certainly, the beneficiaries with better health and good quality of life have the opportunity to participate effectively in the day to day income generating activities e.g. farming. This also will enable them to minimize the problem of poverty at the household level.
Therefore, the impact of the project will base on the reduction of the spread of communicable diseases in terms of curative and preventive measures delivered by qualified health providers employed by Mpwapwa District Council. That’s why we are focusing to implement the proposed construction of health facility in Iguluwi village in order to provide equity of services like other villages with health facilities.
In addition, Iguluwi dispensary will provide an additional infrastructure for the three locations and its neighboring villages / wards.

4. BENEFICIARIES (DIRECT/INDIRECT)

4.1 Direct Beneficiaries
The target group as direct beneficiaries of in the established health facility is composed by all the entire population including out-patient, pregnant women and under five children. A total number of 1,154 people will benefit directly from this project.

4.2 Indirect beneficiaries:

The indirect beneficiaries are constituted by different categories including entire community, Individuals, and employed personnel. About 4,660 people will benefit from the project indirectly through community sensitization, health education delivery. Another group includes employed staff, village and Ward committees who will play an important role in supporting project activities and facilitating implementation process.

5. OVERALL GOAL OF THE PROJECT

The goal of the project is to make access to health care in the Iguluwi village and neighborhood villages which will lead to improvement of health state and reduction of morbidity and mortality rates among target population. Health education campaign through awareness creation will certainly help this goal. This campaign will be focused on early diagnosis of most frequent illnesses, and consequently also easier treatment and better outcome.

5.1 Objectives

• To improve primary health care services in Iguluwi village hence reduction of morbidity and mortality, malnutrition, antenatal care and post-natal care in the respective villages
• To sensitize the community about HIV infection and AIDS and other sexually transmitted infections



5.2. Outcomes - immediate and mid-term effects

• Access to primary health care (reduced distance, morbidity and mortality, quality care)
• Health awareness campaign for the population to fight against diseases

5.3. Outputs (results) - products of the project

• Completed new dispensary with curative and preventive services– indicators – the building and the equipment available in the premises.
• Qualified health providers staff – Clinical Officers, Nurses and Health Officers
• Long-term health care conception in the village and their vicinity
• Operation of the completed dispensary – records from the dispensary
• Health awareness campaign – capacity building for the community and school population

6.0 BILL OF QUANTITIES
We request a total of Tshs. 134,998,097.00 being estimated costs for Completion of the dispensary project as summarized below;

SHEDULE OF MATERIALS - MATERIALS REQUIREMENT AND THE ESTIMATED COSTSC
No Budget Item UNIT QNT UNIT COST TZS TOTAL AMOUNT

MATERIALS
A SUB- STRUCTURE-PROVISIONAL
1 Strip foundation -grade 15 plain
Trench excavation m3 75 3,500.00 262,500.00
Aggregate (3/4") trip 4 150,000.00 600,000.00
Sand trip 6 50,000.00 300,000.00
Cement -50kgs bag 45 14,500.00 652,500.00
SUB-TOTAL SUPER STRUCTURE 1,815,000.00
2 Foundation walls
6"cement & sand block (burnt bricks) no 4956 1,500.00 7,434,000.00
Cement -50kgs bag 125 14,500.00 1,812,500.00
SUB-TOTAL FOUNDION 9,246,500.00
3 Moran/aggregate, hardcore &site sterilization
Moram (lorry 4.5m3) trip 45 60,000.00 2,700,000.00
hardcore (lorry 4.5m3) trip 21 65,000.00 1,365,000.00
sand m3 5 50,000.00 250,000.00
Aldine solution or equal and other approved Lt 20 55,000.00 1,100,000.00
SUB-TOTAL MORAM/AGGRAGADE 5,415,000.00
4 Oversite concrete (100mm thick - 15grade) & Ground beam - 20 grade
DPM m2 25 5,000.00 125,000.00
Cement - 50kgs bag 125 14,500.00 1,812,500.00
Aggregate (1/2') trip 10 150,000.00 1,500,000.00
sand trip 15 60,000.00 900,000.00
Reinforcement - 12mmdiameter roll 68 21,000.00 1,428,000.00
Reinforcement - 8mmdiameter roll 32 10,000.00 320,000.00
Timber 1"x8"x12' Pc 36 14,000.00 504,000.00
Timber 2"x2"x12' Pc 22 2,500.00 55,000.00
Nails - 4" Kg 8 3,500.00 28,000.00
Nails - 3" Kg 4 3,500.00 14,000.00
SUB-TOTAL OVERSITE CONREATE 6,686,500.00
SUB-TOTAL SUB STRUCTURE 23,163,000.00

B. SUPER STRUCTURE
1 Walls, columns and Ring beam (burnt bricks)
6"Cement & Sand Block No 3400 1,500.00 5,100,000.00
DPC Roll 7 90,000.00 630,000.00
Sand Trip 8 60,000.00 480,000.00
Cement-50kgs bag 90 14,500.00 1,305,000.00
Aggregates(1/2") Trip 6 150,000.00 900,000.00
Reinforcement-12mm diameter high tensile roll 78 21,000.00 1,638,000.00
Reinforcement-8mm diameter roll 50 10,000.00 500,000.00
Binding Wire-1kg Bundle 40 3,000.00 120,000.00
Timber 1" X 10"x 12' Pc 60 19,000.00 1,140,000.00
Timber 1" X 6" x12'(Plates) Pc 30 6,500.00 195,000.00
Timber 2"X 2"x12' Pc 28 7,000.00 196,000.00
Supporting Props Pc 40 2,000.00 80,000.00
SUB-TOTAL SUPER STRUCTURE 12,284,000.00
C. ROOF STRUCTURE & COVERING
1 Roof Structure
Timber 2" X 3" purlins Pc 300 7,000.00 2,100,000.00
Timber 2" X 4" kingpost Pc 120 9,500.00 1,140,000.00
Timber 2" X 6" rafters and tie beam Pc 280 12,000.00 3,360,000.00
Hard wood Timber 1"X 10" Pc 38 14,000.00 532,000.00
Nails -5" Kg 35 3,500.00 122,500.00
Nails -4" Kg 160 3,500.00 560,000.00
Nails -3" Kg 50 3,500.00 175,000.00
SUB-TOTAL ROOF STRUCTURE 7,989,500.00
2 Roof Covering
28G Iron sheet (3m) Pc 194 28,000.00 5,432,000.00
HIPS -28 G Pc 46 16,000.00 736,000.00
Roofing Nails Kg 80 5,500.00 440,000.00
SUB-TOTAL ROOF STRUCTURE 6,608,000.00
3 Gutters
Upvc 150mm half round (6m long )- 5" Pc 8 35,000.00 280,000.00
Upvc 100mm dia. down pipe; class B. Pc 6 33,000.00 198,000.00
Clamp Pc 24 8,000.00 192,000.00
Upvc bend Pc 12 10,000.00 120,000.00
Upvc Elbow Pc 5 10,000.00 50,000.00
Screw and fisher box 3 7,000.00 21,000.00
SUB-TOTAL 30,056,000.00
D. CEILING
1 Gypsum board -12mm thick Pc 86 20,000.00 1,720,000.00
Plain Cornice Pc 56 1,200.00 67,200.00
Gypsum Screw 1" Box 6 7,000.00 42,000.00
Screw 1.25" Box 3 8,000.00 24,000.00
Gypsum powder bag 15 20,000.00 300,000.00
Fibre tape Pc 4 6,000.00 24,000.00
Softwood timber 2" X 3"X12' pc 90 7,000.00 630,000.00
Softwood timber 2" X 2"X12' pc 55 3,000.00 165,000.00
Nails 4" Kg 35 3,500.00 122,500.00
Nails 3" Kg 25 3,500.00 87,500.00
SUB-TOTAL FOR CEILING 3,182,200.00

E. DOORS
1 Hardwood door shutter flash/buttoned 1200X2500mm high. Pc 17 360,000.00 6,120,000.00
2 Hardwood shutter flash /buttoned 1800 X 2500 mm high Pc 2 450,000.00 900,000.00
3 Frames (hardwood),Varnish, Glass & Burglar bar 1200 x 2500mm high Pc 17 180,000.00 3,060,000.00
4 Frames (hardwood),Varnish, Glass & Burglar bar 1800 x 2500mm high Pc 2 220,000.00 440,000.00
5 4mm thick clear glass to Vents Pc 21 12,000.00 252,000.00
6 16 mm burglar bars rol 2 24,000.00 48,000.00
7 Brush 3" Pc 2 4,500.00 9,000.00
8 Clear Varnish - 4Litres Tin 3 8,500.00 25,500.00
9 TINA for Varnish - 4Litres Lt 2 7,500.00 15,000.00
10 Iron Mongeries -
11 Mortice lock Three lever - ref: union No 17 55,000.00 935,000.00
12 Brass hinges - 100mm Pc 42 4,000.00 168,000.00
13 Barrel bolt - 200mm No 19 5,000.00 95,000.00
14 Wood screw box 4 7,500.00 30,000.00
SUB - TOTAL FOR DOORS 12,097,500.00
F. WINDOWS
1 Supply and fix Aluminium Windows 2mm thick frem with fibre glass, mosquito gauze and its iron mongeries 1500x 1500mmhigh. pc 20 250,000.00 5,000,000.00
2 Supply and fix Aluminium Windows 2mm thick frem with fibre glass, mosquito gauze and its iron mongeries 9000x 1500mmhigh. pc 8 150,000.00 1,200,000.00
3 Supply and fix 4mm thick flat bar & square pipe3/4" grill painted red - oxide 1500 x1500mm high. pc 20 170,000.00 3,400,000.00
4 Supply and fix 4mm thick flat bar & square pipe3/4" grill painted red - oxide 900 x1500mm high. pc 8 120,000.00 960,000.00
SUB TOTAL WINDOWS 10,560,000.00

G. FINISHING
1 Floor finishing
Sand Trip 6 60,000.00 360,000.00
Cement- 50kg bag 55 14,500.00 797,500.00
600 X 600 -Non slippery porcelain floor tiles Box 46 40,000.00 1,840,000.00
Epoxy - Grout ( 1kg /packet) Packet 15 3,000.00 45,000.00
Spacer Packet 6 3,000.00 18,000.00
Skirting (600mm long ; 25No /Box) box 7 30,000.00 210,000.00
2 Wall Finishing -
Sand Trip 14 60,000.00 840,000.00
Cement-50kgs bag 45 14,500.00 652,500.00
White cement -50kg bag 15 40,000.00 600,000.00
Gypsum powder bag 28 20,000.00 560,000.00
SUB-TOTAL FOR FINISHING 5,923,000.00

H. PAINTING & DECORATION
Emulsion Paint - 20 LTRS Bucket 22 35,000.00 770,000.00
Weather guard Paint - 20 LTRS Bucket 4 150,000.00 600,000.00
Silk paint -20 LTRS Bucket 6 150,000.00 900,000.00
Primer paint -20 LTRS Bucket 5 80,000.00 400,000.00
Solvent 5ltrs tin 4 32,000.00 128,000.00
Brush 3" Pc 5 4,500.00 22,500.00
Roller Pc 4 5,000.00 20,000.00
Gloss paint-4LTR TIN 12 26,000.00 312,000.00
Bitumen paint - 4 Litres TIN 6 32,000.00 192,000.00
SUB-TOTAL FOR PAINTING & DECORATION 3,344,500.00

I. ELECTRICAL INSTALLATION
1 Electrical service in the building (including service line) Item 1 3,500,000.00 3,500,000.00
SUB -TOTAL FOR ELECTRIFICATION 3,500,000.00
J. PLUMBING &SANITARY INSTALLATION PROVISIONAL
1 Symtanks (5000lt.) No 2 1,200,000.00 2,400,000.00
2 Water network system Item 1 2,800,000.00 2,800,000.00
SUB - TOTAL FOR PLUMBING & SANITARY INSTALLATION 5,200,000.00
TOTAL MEASURED WORKS 109,310,200.00

GENERAL SUMMARY
A SUB - STRUCTURE - PROVISINAL 23,163,000.00
B SUPER STRUCTURE 12,284,000.00
C ROOF STRUCTURE & COVERRING 30,056,000.00
D CEILLING 3,182,200.00
E DOORS 12,097,500.00
F WINDOWS 10,560,000.00
G FINISHING 5,923,000.00
H PAINTING & DECORATION 3,344,500.00
I ELECTRICAL INSTALLATION 3,500,000.00
J. PLUMBING & SANITARY INSTALLATION -PROVISIONAL 5,200,000.00
TOTAL MATERIAL COST 109,310,200.00
GHARAMA ZA MAJI 0.5% 546,551.00
SUPERVISION 5%
LABOUR CHARGE COSTS 18% 19,675,836.00
SUPERVISION 5% 5,465,510.00
TOTAL MEASURED WORKS 134,998,097.00

PREPARED BY:
BERNARD P. LUBUVA - P.TECHNICIAN


7. PLANNED ACTIVITIES AND INPUTS

Among factors affecting the spread of communicable diseases include low education level on sanitation and personal hygiene, lack of appropriate information and effective communication among targeted population. Community sensitization and creation of awareness activities have demonstrated the effectiveness to support the community women and men in the health utilization and prevention of major health problems.
When the dispensary will be completed and equipped with qualified health providers, advocacy and sensitization through the component of information, education, communication/ behavior change communication (IEC/BCC) will be the key entry at all levels of health care delivery system.
As part of IEC/BCC, the project will put emphasis to the beneficiaries in order to understanding the nature of water borne and water related diseases and other health problems and to let them know what behaviour to avoid; understand how to reduce risk of new infection associated with poor sanitation. In order to achieve the desired goal the following activities will be implemented:

7.1 Outcome 1: Access to primary health care
• Project introduction to the district and full village meeting at Iguluwi village: Project will be introduced to the village members in order to create awareness for community participation.
• Preliminary arrangement in the construction sites: site preparation, clear site of bushes, shrubs and undergrowth, excavation of trenches to receive foundations.
• Mobilization of building materials in terms of local building materials (sand, burn bricks, and aggregates hardcore) will be provided by the community through participation.
• Purchases of industrial building materials (cement, corrugated iron sheets, iron bars, nails etc) and transported to the construction site.
• Technical personnel and labourers for construction of dispensary building
• Provide management services include transport and follow-up

7. LEVEL OF INVOLVEMENT

7.1 Community as direct beneficiaries

The target population has raised the request of health facilities (dispensary) in their village to justify the demand of primary health care services. The participants in the project implementation mainly will be the target population in terms of non-skilled labour. The attainment of community health interventions and consequently improved health status of the people depends on the response by the community themselves on health promotion. Instilling sense of ownership and ability to identify issues related to health problems in the individuals at community level is very important. Participatory approach in all stages of construction will be emphasised as a role of individuals, families and community at large. To achieve this, the existing channels of linkages such as village government will be utilised.

7.2 Mpwapwa District Council as indirect beneficiaries:

The District Councils through District Executive Directors and its technical departments (Health and Community Development) will be involved in the implementation of the planned activities. The Local Authority will be responsible to provide qualified health personnel e.g. Clinicians, Nurses, Public Health Officers and Social workers to be stationed at the completed new dispensary for health service delivery. The staff’s monthly salary will be paid by the District Executive Director (Employer).


8 MONITORING OF PROJECT IMPLEMENTATION

Monitoring will receive more orientation during the implementation of the construction activities. Two types of monitoring systems will be set up: a project internal monitoring and project external monitoring systems. It will start right from the beginning of project implementation in order to provide information by which management can identify and solve as early as possible management constraints, and assess progress in relation to what was originally planned. Monitoring in this action will be fulfilled through the following aspects: supportive site visits, project progress reports and progress review.

9. FACTORS ENSURING QUALITY AND SUSTAINABILITY

According to community need the conditions for implementation of the project are very good. The project is based on long-term co-operation and demands from the community themselves. This means that he element of ownership is feasible because the services is highly demanded the target population. Availability of permanent employed staff by District Authority justifies the long-term provision of health services. Community Health Fund (CHF) from the health users will guarantee the service in many years to come


10. CONCLUSION
The project will be implemented through self-help, tendering according to the procurement act, the District council will be the implementing agent with consultations from the regional commission office.


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