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Zarar Shaheed Trust Hospital
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Fri Apr 01, 2005 1:15 am    Post subject: Zarar Shaheed Trust Hospital Reply with quote

We have received a funding request from a new hospital being constructed in a rural area outside Lahore. This is an ambitious project requiring Rs. 50 million in total funding. The trust is currently fundraising but has already set up a dispensary where they've treated 6,000 patients to date (in 7 mths).

They are interested in ADP funding an expansion of the current dispensary by providing anything from equipment to medicines. You can get some background on the project at http://WWW.ZARARSHAHEEDTRUST.ORG.

I am reproducing the e-mail exchange with them below for reference. It took a fair bit of back and forth to help them understand the kinds of proposals we consider, since they are trying to raise a large amount. Read from the bottom.

Cheers,
Tarim

-----Original Message-----
From: Atif [mailto:atif@zararshaheedtrust.org]
Sent: Friday, April 01, 2005 2:04 PM
To: twasim@mba2005.hbs.edu
Subject: RE: ADP Funding request for Zarar Shaheed Trust.

Ok, I understand, and try to explain.

Zarar Shaheed Trust hospital is an ambitious project. The amount of funding required may have resulted in completion of the project in considerable time. Realizing this the trustees thought that they should construst a small basic health unit/dispensary adjacent to planned site for hospital. They thought they would be able to serve the community immediately instead of waiting for the time that hospital is completed.
So a small unit was constructed, which started functioning around seven months age. Two MBBS doctors were hired on permanent basis, along with one day in a week visit by eye specalist, dentist and gyanecologist.Additional staff like leady health visitor (LHV), dispenser, chokidar, aya etc are also hired.Along with medical advice/guidance, medicines are also provided. The initiative is proving its value and as per our records in last 5 months around 6 thousand patients have visited the health unit. Health unit, in turn is also acting as advertisement for the project, and also contributing in participation of the local community in the project. Hospital construction may take time,but this step has already started showing positive impacts.

Your contribution will result in adding facilities to this health unit,eg, you may help us buying an ultarsound machine, equipment required for a modest gyanae setup (commonly termed as labour room), medicines for six months etc etc. We will be able to give you concerete
suggestions, if so desired.

Hopefully I am able to clarify to some extent.If you have any question, please feel free to inquire.


Thank you and Best regards
Atif


-----Original Message-----
From: Tarim Wasim [mailto:twasim@mba2005.hbs.edu]
Sent: Thursday, March 31, 2005 9:36 PM
To: 'Atif '
Subject: RE: ADP Funding request for Zarar Shaheed Trust.

Atif,

Thanks for the reply. Relating to (1), we understand that we can receive metrics through patients treated. But you do need to request funding for a "specific" project that falls in the monetary range I have suggested (Rs. 50-200k), within the broader hospital. I have not received sufficient information from you to identify such a project within the broader hospital.


Best,
Tarim

-----Original Message-----
From: Atif [mailto:atif@zararshaheedtrust.org]
Sent: Friday, April 01, 2005 1:09 PM
To: twasim@mba2005.hbs.edu
Subject: RE: ADP Funding request for Zarar Shaheed Trust.


KINDLY VIEW THE REPLY AT RESPECTIVE POSITION DOWN BELOW.

-----Original Message-----
From: Tarim Wasim [mailto:twasim@mba2005.hbs.edu]
Sent: Wednesday, March 30, 2005 5:35 AM
To: 'Atif '
Subject: RE: ADP Funding request for Zarar Shaheed Trust.


Thanks Atif. I just went back and found the original proposal. The main issue we have with it is that you are looking to raise Pak Rs. 50 million in funds. We are a very small donor, and as I pointed out, like to be the sole funder of very small projects in the Rs. 50k-200k range. For example, we've funded tube wells in prisons, a computer lab at a school, cataract eye surgeries at a hospital, a teacher training program etc.. So, two requests:

1. What complete pieces of the hospital project may fall in the ADP funding range that we could look at? As I pointed out, we will most likely not be able to provide funding into a general pool for the hospital because we rigorously track the direct impact generated by our funding.

AS SAID EARLIER, YOU CAN VIEW THE IMPACT BY OBERVING THE NUMBER OF PATIENTS TREATED IN THAT PARTICULAR AREA WHEREH YOU DONATE.

2. For background, could you give me some high level breakdown of where the Rs. 50 million is planned to be spent (how much for buildings, equipment, operating costs etc)? What units are envisioned in the entire hospital? And how much progress has already been made on fundraising?


YES, SURELY. ZARAR SHAHEEDTRUST IS PRESENTLY AFFILIATED WITH LUMS, THEY ARE MAKING THE FEASIBILITY STUDY AND CONSOLIDATED COST ANALYSIS (SPENDING, BUILDING COST, EQP, OPERATION COST ETC). WE HOPE TO RECEIVE IT BY TWO-THREE WEEKS, AND THEN WOULD BE IN POSITION TO INFORM YOU ACCORDINGLY.

BEST REGARDS
ATIF
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Fri Apr 01, 2005 9:24 am    Post subject: Previous contact with Zarar Shaheed Reply with quote

Tarim,

How did you first make contact with them? We first received a proposal from them in late September. Amberin exchanged one round of questions and answers with Atif Mansoor (your contact as well I think). She then requested a more concrete plan from them providing details on how they planned to use the money and they had not responded as of December. Given the budget and non-responsiveness, we were inclined to let it sit, unless they followed up.

I'll check in with Amberin now to make sure there was no further interaction... We may want to contact Mr. Ghaznavi, as the Trust had indicated there was an existing relationship with LUMS.

~Justin
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Fri Apr 01, 2005 10:00 am    Post subject: Reply with quote

Justin,

Amberin is the one who asked him to get in touch with me. Atif e-mailed me last week. We may have to work with them to get a well-formulated plan. There are going to be plenty of good uses as he mentions from medicines to equipment. The question is: is this something we are even interested in exploring?

-Tarim
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Fri Apr 01, 2005 10:14 am    Post subject: Reply with quote

Okay great. It sounded like a new project, so wanted to make sure you had the history...

I'm hesitant about the project, mostly because it's a small drop in the pond and I expect they will get funding elsewhere (and in greater volume). But, I'm open...

~Justin
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Adnan Khalid



Joined: 25 Jan 2005
Last Visit: 14 May 2009
Posts: 67
Location: Boston, MA
PostPosted: Fri Apr 01, 2005 11:43 am    Post subject: Reply with quote

Sounds to me like it worth exploring as long we dont get turned off by their apparent non-responsiveness. As long as we can quantify our contribution (for instance, in terms of some medical equipment that would be used ot serve x number of patients per month) I would not be worried about this being a drop in the bucket. After all, by that logic, isnt anything we do simply a drop in the bucket in the bigger scheme of things and in terms of our bigger goals? I think this lead has potential of producing a project that fulfills impact, sustainability and measurability criteria.
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Thu Apr 07, 2005 10:46 pm    Post subject: Reply with quote

So here's some more correspondence with ZST. It appears that buying an ultrasound machine for their OBGYN lab for ~$4k could be a potential project for us. We may not decide to fund, but I think it's worth exploring and discussing. I'll bring it up in the Sunday meeting (if we get through the other gazillion things on the agenda!).

-----Original Message-----
From: Atif [mailto:atif@zararshaheedtrust.org]
Sent: Friday, April 08, 2005 12:48 AM
To: twasim@mba2005.hbs.edu
Subject: RE: ADP Funding request for Zarar Shaheed Trust.
Importance: High


Tarim,

Thanks. The reply to your queries are:

1.Is there already an OBGYN section with staff, equipment etc?

YES, ZST have Obstetrics and Gynecology doctor to staff this room. For ultra sound requirement, trust hires the equipment for two days in week presently. Getting the ultrasound machine will not only save that amount, rather help in full time availability of this vital service.

2. Cost?
They are the two options.

SSC-210 is designed for China market by Aloka CO. LTD(japan)and is assembled in China. Therefore it is cost effective.

While Aloka SSD-500 is the most versatile unit in its class, offering superb image quality in a compact design, made possible by the extensive use of new technology.It is light weight, just 10 Kgs.

Cost of machine in Pak Rupees is as follows:

(a)Aloka portable liner, Rs one lakh seventy thousand only
Ultrasound scanner Model SSC--210 Nr 500

plus Ulrtasound Printer, Rs. Fortyeight thousand only

(b)Aloka SSD-500
Rs Three lakh seventy five thousand only


3. How many patients will be served by the ultrasound machine every month?

Presently there are around twenty five patients per months. With full time availability, it's assumed that it will increase to around seventy to hundered.

4. How much will patients be charged for the ultrasound?

Presently they are charged Rs, one hundered only.

5. What is the expected life (years) of an ultrasound machine?

It'a approx ten years.

6. How much is the operating cost on an annual basis beyond the initial equipment purchase for ultrasounds?

Thirty thousand only per year

Regards
Atif
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Sat Apr 23, 2005 11:56 am    Post subject: Reply with quote

I'm copying a reply from a doctor in my class regarding some questions I asked about the importance of ultrasound machines and how we'd measure impact. Thought folks might find it helpful...

-----Original Message-----
From: Claudia Wyss
Sent: Saturday, April 23, 2005 11:37 AM

Hey Tarim,

To answer your question from my perspective:

1) I would consider ultrasounds critical: they are used to identify pre-natal problems that can be life-threatening to the mother or baby (e.g. bad positioning of the placenta that can lead to life-threatening hemorrhage during labor, but that can be managed if found early on ultrasound). I would actually say that other than simple listening tools, ultrasounds are probably one of the most essential tools in OBGYN.

They are also used to diagnose ‘non-maternal’ illnesses: e.g. cancers, cysts, ectopic pregnancies (life threatening). They are fairly simple to use and value for money tends to be very high (esp relative to other tools such as CT/MRI).

The good thing is that you can also use the US for other non OBGYN purposes: General surgery (to diagnose e.g. abnormal abdominal lesions).

2) A word of warning: The metrics you ask for will determine the output you ultimately receive. In saying that, you can certainly look at utilization and pre-exam indication. I would be cautious about the ‘how many times was useful measure’ – it is considered a basic OBGYN tool that should probably be used on all pregnant women, and a definition of ‘useful’ is likely to be misleading.

You may also want to consider if the unit can be used within other departments (I don’t know how large this clinic is). It may be helpful to ensure that the OBGYN dept doesn’t consider it solely theirs, so that other depts get to use it. You could then measure the capacity utilization and indication per department. They should probably also outline how they would split the time and what they would do with OBGYN has US downtime.

You may want to consider getting them to put a business case together for why they need an ultrasound. I’m sure they understand what would be most important to them and generally it seems that departments become much better at identifying their true need and managing their funds better if they put it down on paper in terms of a mini-business plan.

It may pay for you and I to actually talk in person. That way I can get a better understanding of what services the clinic actually provides and what equipment they currently have. Once I better understand your needs, I could try to put you in touch with an ‘appropriate’ colleague in NZ (e.g. someone who was in charge of the radiology dept or a radiographer). Also, you may want to search MedLine (access may be available at Baker Library, although unfortunately I don’t think it’s on the HBS site).

Hope this helps. Have a great weekend and good luck!

Claudia
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Wed May 11, 2005 1:23 am    Post subject: Reply with quote

We're received responses to the questions from the last meeting. They are keen to work with us, but we need to somehow get comfortable that it will happen. Please let me know if you have thoughts or further questions.

I will in the meanwhile try to get our hands on any official study/feasibility that has been completed by LUMS. I do feel that we should try to do a site visit before deciding on this. Sajjad/Sundas, any chance one of you will be able to go out there? It's in the outskirts of Lahore.

-Tarim


Questions for ZST
- What healthcare alternatives are available to the target communities? How far is the closest hospital/clinics? Where do patients go for radiology services right now?

-Alternatives available to target communities are presently some part time private practicing GP, quacks, hakims etc. GP (General
practictioners) don't have adequate infra structure/facilities etc.

The closet state hospital is around 25 Kms. Patients have to go to Mayo (around 35 km ), Lahore General around 25 km or Ghurki hospita around 30km. They can refer to private practioners for basic type of radiology services.

- ZST says they currently rent the machine. How much does the rental cost? As per the existing criteria, Rental cost is made related to patients reviewed. 70 % of the fee is given as rental cost.

- Can the machine be used for more than OBGYN to increase its utilization and benefit? Yes, the machine can be used along with OBGYN for abdomenal Gastic diseases, liver, gall bladder, urology/urinary bladder, large/small intestine views and other organs etc purposes.

- What will we be able to learn from this funding? Learning is one of our core goals, and we'd like to get some feedback about the problems of these communities and how ZST is going to address them?

You will be able to get the related data (area health statistics), health standard parameters, poverty statistics, etc according to your active participation in the project.


- How much funding for the hospital has ZST already raised. What are the sources? What is the expected timing of completion?

ZST is already running the basic health unit. The primary sources of funding are donations. ZST recently arranged two functions with the active collaboration of the local community. Assets/financial feasibility study of the project has been conducted by professionals of LUMS. Your represenative can contact us in this regard. Project is divided in three phases. Final phase is expected to be completed by year 2008.
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Adnan Khalid



Joined: 25 Jan 2005
Last Visit: 14 May 2009
Posts: 67
Location: Boston, MA
PostPosted: Wed May 11, 2005 2:28 pm    Post subject: Reply with quote

Quote:
What healthcare alternatives are available to the target communities? How far is the closest hospital/clinics? Where do patients go for radiology services right now?

-Alternatives available to target communities are presently some part time private practicing GP, quacks, hakims etc. GP (General
practictioners) don't have adequate infra structure/facilities etc.

The closet state hospital is around 25 Kms. Patients have to go to Mayo (around 35 km ), Lahore General around 25 km or Ghurki hospita around 30km. They can refer to private practioners for basic type of radiology services.


If my assumption is correct then the Lahore General referred to in the response must be in Lahore, which means that Lahore city itself is not too far from this place. Given that we should definately have a site visit conducted to this place before putting this project up for vote.

Quote:
ZST says they currently rent the machine. How much does the rental cost? As per the existing criteria, Rental cost is made related to patients reviewed. 70 % of the fee is given as rental cost.

This still does not answer our orignal question about the cost of renting the equipment (not the source of funds to pay for these costs, though that is also a useful piece of information).

Quote:
What will we be able to learn from this funding? Learning is one of our core goals, and we'd like to get some feedback about the problems of these communities and how ZST is going to address them?

You will be able to get the related data (area health statistics), health standard parameters, poverty statistics, etc according to your active participation in the project.

What does "according to your active participation" mean in this context. Are they saying they will provide information poportional to how much we contribute to their cause?

Quote:
How much funding for the hospital has ZST already raised. What are the sources? What is the expected timing of completion?

ZST is already running the basic health unit. The primary sources of funding are donations. ZST recently arranged two functions with the active collaboration of the local community. Assets/financial feasibility study of the project has been conducted by professionals of LUMS. Your represenative can contact us in this regard. Project is divided in three phases. Final phase is expected to be completed by year 2008.

This hardly answers our question. Can we get a at least a few numbers for broad categories such as annual cost of operation, revenue from donations, revenue from events, cost of expansion, etc?
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Wed May 11, 2005 5:29 pm    Post subject: Reply with quote

Adnan has asked all the right questions. I would add to this that I think you will really need to make the case for this project if you want to present it for a vote.

I am by no means opposed to it, but I am having a hard time seeing how it fits with ADP's broader goals of affecting institutional change or fascilitating 'hollistic' development. Right now, I am worried it is one of those very compelling one-offs we want to move away from.

Good work trying to get detail from them!

~Justin
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Fri May 13, 2005 1:03 am    Post subject: Reply with quote

Adnan, good questions. I will follow up. I think the need for a site visit is quite evident in the end.

Justin, could you please elaborate on why this doesn't fit our broader goals while the other funded projects do?
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Justin Stone



Joined: 08 Feb 2005
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PostPosted: Fri May 13, 2005 9:27 am    Post subject: Reply with quote

Sure Tarim. I'm not sure that it does differ from the other funded projects. I'm also not sure any of our funded projects should be the yardstick for funding criteria.

I'll use Chakwal as an example. On it's own, it is a one-off - very similar to ZST. But, if we think of it as a piece in a larger puzzle, it makes more sense as an initiative. I am working with MMH to identify other complementary projects in the region which would help create opportunities for the beneficiaries of this program (and others). My hope is that part of the Chakwal region could become a model for comprehensve (aka 'hollistic' development), which we could then export to other communities. And, others might independently adopt the model based on its success.

Even so, at the present level of funding (approx 200 surgeries per year), the MMH project would barely qualify as an ongoing venture. If however, we were to fund 3,000 surgeries per year, the public health crisis would be eliminated in ten years time, as an equal number or people would be going blind due to cataracts and being treated per year.

I want us to be more mindful about putting each ADP project in context, and maximizing the potential value, not just to individuals, but to society at large.

~Justin
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Danish Saleem



Joined: 16 Feb 2005
Last Visit: 27 Apr 2007
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Location: San Jose
PostPosted: Fri May 13, 2005 9:59 am    Post subject: Reply with quote

I think we have all the information that we need. We have been discussing it for more than 1.5 months now, the questions that Adnan pointed are pretty clear, I dont know why they would not answer it to the point.

Personally, I dont think its a good project for ADP. If they can raise Rs 50 million they can raise another Rs100,000 or so. We all know what ADP is trying to achieve, small, direct, wholesome, impactful projects, I dont think this project hits comprehensive mission of ADP. Buying the same machine for a local small clinic would be much more impactful.
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Fri May 13, 2005 11:11 am    Post subject: Reply with quote

I am not sure which way I go on this project, but I want ADP to come out with some criteria from the ZST decision. Our project decisions should serve as a yardstick for future ones if we want some meaning to what we do.

So, here are a few thoughts I'd like to offer:

Size of ADP funding relative to total project size

There are three reasons why this may be relevant
- They'll find other donors to cover our small share
- Inability to measure impact of our funding
- Poor responsiveness, transparency or feedback from NGO
- Our funding is ineffective unless they raise the total amount

Let me address how I view each with respect to ZST, and more generally:

- I actually think we should avoid this logic for two reasons. First, it's hard to know when it's true: ZST may say they'll raise 50m but not have donors lined up at all. Second, it can lead to perverse logic on our part, by which we start avoiding promising efforts because the entrepreneur is so talented and hence is very likely to find other funding. We want to be associated with the best entrepreneurs/efforts, not the ones who don't get funding.

- Assessing impact: We should never fund if we can't assess the impact of our portion of the funding. Since the ultrasound machine is a somewhat discrete project, I am not too afraid that ZST will be able to give us utilization or other direct stats.

- ZST may not spend the time needed to educate us or provide feedback after funding. This is somewhat mitigated by the fact that they appear responsive right now. However, as I point out below, I am concerned about whether they're a good partner.

- This is a valid one since we want our funding to have impact. The solution in my mind is matching funding or conditional funding (eg, we may have gone this route with Alif Laila if we felt they needed the whole $6k to launch)


Poor Partnership: While ZST has been very responsive, we have struggled to get the information we need. This may be due to the ineffectiveness of e-mail correspondence, their inability to think in our terms, or a real issue with their project.
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Justin Stone



Joined: 08 Feb 2005
Last Visit: 12 Mar 2007
Posts: 145
Location: Cambridge, MA USA
PostPosted: Fri May 13, 2005 11:27 am    Post subject: Reply with quote

I agree with all of your thinking on ZST, but think you misunderstood my point about prior projects serving as a yardstick. I beleive every project we have funded is appropriate to ADPs model, if our follow-up is intentional and comprehensive. Otherwise, one can easily challenge whether any of them stand on their own in terms of broad and lasting impact.

I expect that few projects would independently meet all of our criteria. I think central to ADPs model is the idea of coordinating complimentary efforts. In addition to potentially extending/expanding funding for our past projects, I want to see us examine the context in which they operate and seek to support other complimentary development projects in their respective areas.

~Justin
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