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1.9 PLANNING AND PROGRAMMING CONSTRUCTION

Once the basic planning and preparation of the master plan are finished, a plan should be made for the construction of the hospital. It should proceed as follows: 1.9.1 plans, specifications and cost estimates; ~ tender documents; selection of contractor and award of work; construction activities; project management and control; and handing over for commissioning. Appropriate construction technology

The choice of building materials affects the cost and length of construction and also the long-range operation and maintenance costs. Locally available materials and traditional building techniques should be given priority, as they are usually cheaper and better adapted to local conditions. Although walls can be made of local materials, roofing sometimes poses a problem. In many countries of the Western Pacific Region, reinforced concrete, hollow concrete tiles and precast concrete elements are not available locally and must be brought in. In general, building materials should be economical, durable, easy to clean and to maintain, sanitary and attractive. They should also be easy to handle on the site and to replace in case of breakage or damage. At the inception of the project, the designer must choose: (1) the type of construction of the project: (2) indigenous technology on-site methods, prefabricated modules and components assembled on site, or a combination of prefabricated components and on-site construction.

the level of technology: low, medium or high.

Types and levels of construction technology should suit the conditions of site, geography, slope, time constraints, availability of labour and raw materials, construction equipment and other related factors. Whenever possible, the methods adopted should be within the capability of local manpower and resources. Sometimes, it may be necessary and practicable to introduce new

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methods. Whenever imported techniques are used, the necessary skills should be taught so that the facility can be constructed and maintained using a high percentage of local skilled and unskilled manpower. Similarly, when outside design professionals are hired, they should work in association with local architects and engineers so that there is a transfer of knowledge and enhancement of local ability to design hospitals. This is essential for proper maintenance of the hospital and its expansion when the need arises. 1.9.2 Tendering

Documents for the preparation of bids by contractors for the civil, structural, architectural, electrical and other work for the hospital buildings and services should be drawn up. These documents must contain the following information: (1) general conditions of contract; technical specifications tender drawings; and bill of quantities.

General conditions of contract This should consist of: cover or title sheet index instructions to bidders bidding form form of agreement performance bond and bidding bond forms description of the site standard labour regulations and other statutory provisions applicable in the country right of access to the work by the owner details of liability insurance for bodily injury and property damage special conditions of contract, if any other relevant details, including taxes and duty

(2)

Technical specifications

These should supplement the drawings to describe fully the types, sizes, capacities, workmanship, finishes and other characteristics of all materials and equipment, including the

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codes of practices and standards, both national and international, to be followed with regard to materials, workmanship and tolerance. (3) Tender drawings

These should include (i) a survey drawing and the soil investigation report; and (ii) preliminary sketches of plans, as follows: (a) Architectural and structural plans of foundations and basement, floors and roof, showing assignment, sizes and outlines of major fixed and movable equipment; all elevations and typical sections showing various finished floor levels; -plot plan, showing roads, paving and sidewalks; and indicative details of reinforcement of foundations, beams and columns, floor slabs and special structures, if any.

(b)

Mechanical and sanitary single-line diagram of all external and internal sewer lines and water lines, indicating the diameter of pipes and location and invert levels of manholes, etc. location and size of all soil, waste and vent stacks with connections to house drains and equipment; single-line layout of all ducts and piping systems, including fixture connections; diagram of riser and wet drains in the case of multi-storey constructions; layout of boilers and major associated equipment, including central heating, cooling and the air-conditioning and ventilation system; air-conditioning and ventilation system, with equipment, water and refrigerant piping, ducts and exhaust ventilating duct openings; details of pumps and layout of lifts, including other handling systems; location and layout of various services in the laboratories and elsewhere, including gas tanks

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(c)

Electrical and associated services plans showing space assignments, sizes and outline of fixed equipment, like transformers, main switch and switchboards; electricity entry, with switches and feeders to the public service feeders; -emergency electrical system, with details of supply, feeders and circuits; fire alarm system, telephone layout and all other electrically operated systems and equipment, showing service entry, switchboards, annunciators and wiring diagrams.

(4)

Bill of quantities

The reliability of the cost estimate of any building depends upon the accuracy of the information available at the time the estimate is made. "Preliminary" and "approximate" cost estimates are prepared at the briefing and planning stages, on the basis of approximate floor areas, the cost indices of previous projects and the prevailing market rates for similar projects. When bidding for a multidisciplinary project like a hospital, contractors should know not only the technical specifications but also the approximate quantities of each item of work (such as excavation, blockwork and shuttering), so that they can price them by considering the labour, raw materials, equipment, taxes and their margin for overhead expenses and profit. Quantity surveyors estimate the quantity of each type of work, with a variation of about + 10%, in the form of bills of quantities. If this document is prepared carefully, both the client and the bidder obtain a reasonably accurate idea of the cost of construction. 1.9.3 Project management

Like any other complex process, the planning and construction of a district hospital must be coordinated and monitored if they are to be carried out. effectively and delays are to be avoided. A high level of discipline and good record-keeping are essential, because of the numbers of people involved at various stages, the lengthy duration and their intermittent involvement. It is therefore desirable that someone-preferably .a member of the planning team with previous experience in managing planning and construction-act as a project manager. The project manager is responsible for coordinating and expediting the whole process, organizing and motivating all groups, forecasting and programming their activities and monitoring and controlling their performance. The project manager is involved continuously in the project and is committed to its successful completion. It is the job of the project manager to ensure that all team members perform their tasks both on time and within the budget. He or she must obtain from them regularly updated information on all activities, both at the site and on the shop floor, so that corrective action can be taken, either to the budget and financial approvals or to the project. Above all, the project manager must see that everything is properly recorded and must keep everyone informed of all major decisions that are important to them in order to attain completion on schedule.

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The job of the project manager does not finish when the building is completed; he or she must ensure that all relevant information for operating and maintaining the facility is handed over to the client. Drawings of all structures and services as they have actually been constructed must be prepared and handed over to the client for future reference. As staff changes, the client who works in the building may not be the same person who assisted at the original briefing and planning of the hospital. Decisions that were made about the intended methods of operation and use at those stages may be questioned at a later stage. An understanding of those intentions and proper communication in recorded form are essential. The tasks of management and control of the complex, interdependent activities of a construction project become impossible without systematic planning and organization. The most important element in project management is a realistic time schedule. A basic schedule should be worked out at the early stages of the planning process, and this should serve as a framework for all activities. As the lapse of time between the decision to build and the actual taking over of a completed district hospital is very seldom less than 3-4 years, a time schedule should be prepared during the briefing stage, which should indicate the major stages and also provide for such activities as tendering, major construction activities, planning and procurement of medical equipment and furniture. Once the client has approved the start of the project, the project manager must prepare a time schedule for each of the major aspects of construction and must set a target date for completion of the project. This schedule should indicate how construction of different elements will proceed; at what stages the working drawings and detailed technical specifications will be made available to the contractor by the architects and engineering consultants; when materials will be procured; and when plant and medical equipment will be commissioned and installed. As the choice of construction method and building materials significantly affects the schedule, it should be considered in detail at this time. Figure 78a shows a typical time schedule for the major steps in setting up a district hospital, from the time the project is approved to its commissioning. This simple bar chart shows the start and finish of specific activities. It shows how they are linked, how long each will take, where they overlap, where they parallel one another, or whether there is a lag between them. It does not, however, show the interdependence of some activities, i.e. in some cases, unless one activity is complete within a predetermined time another cannot be begun, which will result in delay. Such delays are almost always followed by an increase in the cost of the project. This aspect can be monitored and controlled by critical path analysis or project evaluation and review. (1) Critical path analysis

The nature of a multidisciplinary project like the building of a hospital means that complex, time-consuming, interdependent sequences of events are encountered. These can be organized by critical path analysis, which involves a diagrammatic representation of the project as a network of activities. The major consecutive activities are defined as "the critical path". Any delay in one of the activities on the critical path will delay the overall schedule for completion of the project. Although there is usually only one critical path on a network, there may be more than one sub-critical path. Too much delay in any sub-critical path would turn it into a critical path, and this will require careful monitoring and control so that further delay is avoided. Figure 78b illustrates this approach.

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The process of network planning thus involves four steps: breakdown of project activities listing of activities constraints and sequential relationships of activities network diagramming

It is a logical representation of all the activities, with definite points of start and finish. Once the network diagram has been completed, the duration of each activity is determined on the basis of site location, climatic conditions, availability of raw materials, quality of available labour, method of construction, height of construction, safety regulation and all other relevant factors. Although the contractor has the prime responsibility for progress on site and for completing the project by the scheduled date, the project manager must monitor the contractor's progress in order to ensure compliance. The latest situation can be ascertained by regular comparisons of actual progress with the time schedule. If delays occur, corrective action must be taken immediately to catch up with the schedule. (2) Cost control

The project manager should also actively control the final cost and not merely passively register payments. The client's acceptance of the budget provides the basis for economic control over the final cost (cost control), payment of contracts and variation orders (payment control) and availability and use of funds (control of cash flow). Payments to the contractor for work done and services rendered are usually made on a fixed-price basis, either: as a schedule of prices, giving unit prices for the items listed in the bill of quantities (item rate contract), or as a lump sum for the complete work, as defined by the drawings and technical specifications (lump-sum contract). The first arrangement is the most common, in which the total price is determined by the actual quantities, measured on the site and multiplied by the unit price quoted in the contract. This is a reasonably fair and straightforward method, which works quite well for present-day construction systems. In times of high inflation, it is the usual practice in the case of projects with a construction time exceeding one year to pay the contractor some form of compensation for rising prices, if agreed in the contract. In current international practice, the construction agency usually gets 90% of the payment for work completed each month, and the client holds the remainder as "retention money" until the end of the "defects liability period", usually one year after handing over, during which time the contractor is responsible for remedying any defects in materials or workmanship in the buildings.

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Suitable variations to this procedure may be made, depending on practices prevalent in the country, as long as the quality of the work and the construction schedule are not compromised. The final payment to the contractor is based on the final certificates of the project manager, including a final account. This account should contain a summary of all variations, changes in quantities, price fluctuations and escalations, for which adjustments to the contract sum are to be stipulated.

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