Basrah Childrens Hospital

Team 7
Rohan Deota
Razan Fashho
Casey Franz
Ju Lee Hyung
Uzair Mansuri

Overview

Background
Risks
Problems

Timelines and Costs

Prevention
Recovery
Lessons Learned

Background

Basrah Location

15% Children die before 5years of age

Children suffering from preventable diseases
Childhood Leukemia >8% prior to 2000
Children accounted for 56% of reported Leukemia
cases.

Background
As part of the Iraq Relief and Reconstruction Program, the United
States Agency for International Development (USAID) was tasked
with constructing a State of the Art 50-bed pediatric hospital in
Basrah, Iraq.

Background

Congress authorized $50 million to be spent for project from Iraq

Relief and Reconstruction Fund by USAID. (November 2003)

USAID and Project HOPE had Memorandum of Understanding

(MOU) where Project HOPE would take lead in providing a
significant portion of the hospital equipment and have responsibility
for training medical and administrative staff. (January 2004)

USAID awards Bechtel National Incorporated with a design-build

contract that required the hospital to be completed by December 31,
2005 (October 2004)

July 2005, the design changed to a 94-bed facility including an

oncology center at request of Iraqi Ministry of Health

Risks

Natural: Earthquakes, Termites

Location: Insufficient Water, Sewage Systems

Mitigation Structural Design

Mitigation Additional water system inlets, new gravity

conveyance sewage system

People: Hostility, Rebels

Mitigation Security Personnel

Timeline Problem Signs

April

2005

USAID reports completion date to be May 31, 2006 (originally

December 31, 2005)

October

USAID reports completion date to be October 31, 2006

March

2006

Bechtel reports completion date to be July 31, 2007 with an

estimated cost of $98 million (originally $50 million)

July

2005

2006

Special Inspector General for the Iraq Reconstruction (SIGIR)

audited the project and found that USAID had insufficient
oversight, inadequate accounting systems, and that they failed to
report the increasing budget to congress.
SIGIR estimated cost of project to be at least $149.5 million

Problem Signs

Bechtels in depth analysis submitted in 2005,

though BCH consideration was in 2004.

Thorough technical feasibility analysis was not done

Error in basic engineering design. (water availability, seismic

design, pumping stations in parallel)

Unrealistic timeframe for design and construction

Term-Contract or fee contract

Kadhim Hassan little to no work had been done

for months. James Glanz

Basrah Childrens Hospital

Project Changes
June

2006

USAID issues a Stop-Work notice to Bechtel

Program oversight transferred from USAID to the US Army

Corps of Engineers Gulf Region Division (USACE)

Project was approximately 30% complete at time of transfer

September

2006

New contract awarded to MID Contracting with a new

completion date of July 21, 2008

Structural Timeline
Vendor Evaluation & Finalization Jul-04 to Oct-04
Detail design started Oct-04
Actual Construction started 14-Apr-05 (9 Months later than JO date)

Problems
Seismic

Soil

design did not meet standards

Bechtel had to resubmit design for approval

at sight could not support building

Bechtel added to foundation, adding 90 days to the schedule and $2.5
million to budget

Security

By 2005, local militia and gangs had killed 24 on-site workers

Changing

Scope

50-bed pediatric hospital 100-bed facility based on oncology 94-bed

facility supporting oncology and pediatrics

Communication

Multiple partners involved, funding sources

Problems

Lack of effective oversight

No on-site project management by USAID

Nationwide construction cost escalation

30-40% per year

Complex chain of subcontractors used by Bechtel

Quality Issues

Civil work was not ready for installation

Contract work was poor (cracks in walls and floors)

Since project was so far delayed, medical equipment provided

in 2005 was not longer State of the Art

In 2009, the hospital had to change slogan to Modern

Stakeholders/Agencies Involved
Government of
Iraq(GOI)

Project HOPE
(US based
Health
Opportunities
People
Everywhere)

US
Government
US Commanders
Emergency Relief
Program (USCERP)
USACE (GRD)

MOU

USAID (US
Agency
International
Development)

Ministry of
Health (MOH)
Iraq
Department
of State
(DoS)
Government of
Spain (GOS)

Bechtel
(original
contractor)

MIDCON, UHS &

Hospital Design and
Planning(HDP)

Sub-contractors

( US Army
corps of
Engineers Gulf
region
division)

UNDP (United
Nation
Development
Program)

Project Cost
180

165.7

160

Total Project Cost ($ Millions)

140

117.4

120
100
80
60

50

40
20
0
2004-Jun

2006-Jun
Duration

Original Total Project Cost: $50 million

2009-May

Project Timeline
USAID awarded
contract to
JO amendment Initial Project
Bechtel
with official Completion date
scope defined

2003

2004

2006

2005
6/7/04

1 year

11/30/09

2007

2008

2009

2010

6/1/06

JO released
on Bechtel

Conceptualization

Phase opening of
BCH started

12/31/05 6/27/06

1/5/04 7/7/04

2003

USAID issued
"Stop Work"

2010
10/21/10

USACE
taking
over
project
from
USAID

BCH completely
inaugurated

2003 - 2004

Fundamental Scope Change

Bechtel Work: (30% Project
Completed, 9 Months Delay with
cost overrun)

1 year

2004 - 2005

2 year

2004 - 2006

8 subsequent modifications in scope 1 year 2006 - 2007

United Nations ordering of 18 contracts in process

2 year

2007 - 2009

Phase Opening of BCH

started

1 yr

2009 - 2010

PMI Areas Matrices

Project Scope
Management
Level:

Requirements Statement of
Definition
purpose

Process to
identify
requirements

Deliverable
Identification

Names of
deliverables

Scope
Definition

WBS

3
Stakeholders
involved in
requirements

Project Time
Management
5

Functions fully Incorporates

documented quality
improvement

Level:

Activity
Definition

Few or no
activities or
milestones

Scope
statement,
milestones

Process,
Activities
assumptions, regularly
constraints
monitored

Customer &
Detailed
Consistent
Improvement
management description of template for all in process
identify deliv. deliverable
projects

Activity
Sequencing

Ad hoc
sequencing

Process for
precedence
analysis

External
dependencies Improve
dependencies regularly
dependency
monitored
analysis

Ad hoc, no
standards

Defined scope Assumptions

statement
& constraints
clear

Schedule
No process for Process for
Development scheduling
scheduling
time & costs

Historical data Resource

base for
utilization
scheduling
maximized

Basic work
components

Third level
template

Jointly identify Inter-project

Regularly
all tasks
dependencies monitored
documented

Schedule
Control

No baseline
control or
reporting

Schedule
status, chg.
control

Change
control,
earned value

Documented
change
process

Baselines
Integrated with Lessons
established & organ.s
learned
managed
systems

Schedule
Integration

Ad hoc
grouping of
schedules

Manual
grouping of
schedules

Organization- Decisions
wide
across
schedules
programs

Scope Change Ad hoc

Control
communication

Documented & Project

monitored
experience
data used

Continuously
improve
activity defin.

Improve
networks,
resource alloc

Assess project Schedule

efficiency
performance
analysis

Lessons
learned for
integration

PMI Areas Matrices

Project Cost
Management
Level:

Resource
Project office
listing defined resource
repository

Project Risk
Management
5

Level:

Integrated w/ Improve
project office & resource
HR
priorities

Risk
Identification

Resource
Planning

Individuals
identify
resource req.

Cost
Estimating

Scope
Top WBS,
Cost analysis Integrated w/
statement; ad cost-estimate of alternatives finance, acct,
hoc estimates template
risk mgt

Improve
forecasting vs.
estimates

Cost
Budgeting

No established Baselining
practice
process not
org standard

Baseline
lessons
learned

Performance
Management

Informal, ad
hoc

Cost Control

Non-standard Periodic cost

tracking
reports

Time phased
estimates,
baselines

Integrated w/
finance, acct,
risk mgt

Summary level Earned value, Performance

tracking
corporate
indices
financials

Variance
Cost reports
analysis, est to integrated w/
complete
tech reports

Measure
efficiency &
effectiveness

Cost
assessments,
lessons learn

Risks not
identified

Risk
identification
process

Standards for Integrated w/

risk/symptom cost & time
identification mgt, PMO

Identify org.
priority,
lessons learn

Multiple
criteria
prioritization

Integrated w/
cost & time
mgt, finance

Improve
quantification

Risk
Risks
Informal
Contingency
Response
considered as strategy for
plans
Development they arise
handling risks

Integrated w/
cost & time
mgt, PMO

Tracking
project
reserves

Risk
Speculate on Structured
Quantification impact if risks approach to
occur
rating risks

Risk Control

Day-to-day
problem
solving

Individualized Risks routinely Integrated with Risk assess

approach to
tracked
control
included in
managing risk
systems
proj execution

Risk Documentation

No historical
database

Some
Historical data InterdepenImprove
historical data on common
dent risks
collection
risks
betw projects activity

Prevention

Identification

Prior to Design

Risks
Location
Engineering
Financial

Contingent Contract
Realistic Timeframe
Cost
Contract Details
Management

Analysis

Scope

Funding Allocation

Location
Design
Technical and Financial
Feasibility

Monitoring and Reporting

Identify warning signs for

potential problems
Communication between
stakeholders

Recovery

Evaluate/Audit Project

Determine Tradeoffs

Problem areas and flaws

Review objectives and assumptions
Feasibility
Must have versus would like to have

Urgent changes
Cost Effective changes
Feasible changes

Revise Goals

Change deliverables
Update WBS
Incorporate customers/stakeholders

Lessons Learned

Technical feasibility of basic design and approval of those prior to start

of work

Project timeframe should be evaluated and should be realistic

Evaluate risks and their impact on scheduling and cost

Ensure availability of resources required for the project and site survey
for understanding the suitability of surrounding.

Baseline scheduling, monitoring and reporting for warning signs in

project

Designated project team with project manager coordinating between

different agencies and taking the accountability of the project progress

Lessons Learned

Have personnel for on-site management and project oversight

Identification and implementation of control process.

Define a specific communication protocol for stakeholders with

the project management team

Cost estimation and cash flow to be organized and distributed

over the project life cycle

Understand different local governments budgeting process

Progress status reporting at regular intervals of time

Works Cited
"Al Basra Children Hospital Historical Records" Enr. Construction.com. N.p., n.d. Web. 10 Apr. 2013.
<http://enr.construction.com/news/intl/archives/docs/060728-AlBasraChildren.pdf>
Basrah Childrens Hospital Basrah, Iraq. Special Inspector General for Iraq Reconstruction (SIGIR) Report. PA-08160. 28 July 2009.
Glanz, James. "SERIES OF WOES MAR IRAQ PROJECT HAILED AS MODEL." The New York Times. The New York
Times, 28 July 2006. Web. 10 Apr. 2013. <http://www.nytimes.com/2006/07/28/world/middleeast/28basra.
html?pagewanted=all&_r=0>
Kerzner, Harold. Recovery Project Management: Techniques and Tactics for Reversing Failing Projects. International
Institute for Leaning, Inc. www.iil.com. Web. 10 April 2013.
<http://www.iil.com/freeresources/downloads/white_papers/recovery_pm_technique_HK_0310.pdf>
Rageh, Rawya. "Iraq Hospital Touted by Laura Bush Delayed." The Washington Post. N.p., 28 July 2006. Web. 10 Apr.
2013. <http://www.washingtonpost.com/wp-dyn/content/article/2006/07/28/AR2006072801276_pf.html>
Review of the US Agency for International Developments Management of the Basrah Childrens Hospital Project.
Special Inspector General for Iraq Reconstruction (SIGIR) Report. SGIR-06-026. 31 July 2006.
Photos: http://www.fayeandsteve.com/Basrah%20Children's%20Hospital.htm , http://www.army.mil/article/47156

Questions