Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level

Hospital Health Establishment for the Department of La Paz

Product Consulting: Study of Expanded Prerequisites of the Construction Project

with its Equipment of one (1) Third Level Hospital Health Establishment for the
Department of La Paz
Code AISEM/LP/02/2018
8.3. Methodology
8.2.1 INTRODUCTION
This Section of the Technical Proposal presents the Approach with which the EDARMA
Accidental Association will develop the services of the Pre-investment Technical Design
Study for the Construction and Equipment of a Radio Therapy Unit in the Hospital de
Clínicas of the Department of La Paz.
The Present Approach to the Project has been developed based on the knowledge that
the technical team of the Accidental Association has, which gave rise to a specific work
structure for this project as well as the proposal of basic guidelines that will govern the
policy of the Accidental Association during the preparation of the studies.

8.2.2 APPROACH AND CONCEPTUALIZATION OF THE WAY OF CARRYING OUT

THE WORK

The consulting services intended for the Pre-investment Technical Design Study for the
Construction and Equipment of a Radio Therapy Unit in the Hospital de Clínicas of the
Department of La Paz to be carried out by the EDARMA Accidental Association, will be
carried out with a systemic integral, which combines four major components, which are
described below:
Quality and Excellence Approach
The Consultant will maximize its resources to carry out the services of the Pre-investment
Technical Design for the Construction and Equipment of a Radio Therapy Unit in the
Hospital de Clínicas of the Department of La Paz with the objective of having a quality
project that will later be tendered for construction.
During the service execution stage, the EDARMA Accidental Association team will provide
its greatest capacity and effort so that the Study is subsequently translated into the
physical construction and equipment of the project according to the parameters
established in the technical specifications of the work and good quality. engineering
practice in order to achieve a Radiotherapy Unit that satisfies the expectations of the Client
and finally of the beneficiaries for whom the project is intended.
To achieve the goals set, the Association is proposing to assign a team with high technical
capacity that will have the adequate and necessary resources to carry out its work with the
expected quality.

TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

The quality system that the companies that make up the Accidental Association have
contribute to this concept, which will be oriented to the project through the development of
the specific Quality Plan for this service.
Approach to Respect and Protection of the Environment
The services that will be provided by the EDARMA Accidental Association will be oriented
towards respect and protection of the environment in all activities carried out during the
provision of services.
The monitoring and control of this concept will be in charge of the environmental team that
is led by the Environmental Specialist who will have the support of the professionals who
will work on the preparation of the EEIA to obtain the Environmental License, as well as
the entire staff assigned to the environmental and social area.
The Environmental Specialist will promote the holding of internal seminars to disseminate
this basic concept that is common to the three companies that make up the EDARMA
Accidental Association.
Security Focus
Although it is a Consultancy aimed at a Pre-investment project, the EDARMA Accidental
Association will ensure that the services provided are developed under the framework of
priority attention to concepts of industrial safety and team personnel, foreseeing the
development of a Contingency Plan to address actions to be taken in the case of accidents
or unforeseen situations that require immediate intervention in the subsequent stage of
physical materialization of the project.
At the same time, the Environmental Specialist himself, or through a specialist in the
matter, will prepare a Safety Manual for personnel, which will also be disseminated
through specific seminars.
All of the Consultant's staff will have accident insurance, in addition to the mandatory
health insurance according to labor legislation for payroll staff.
Social Approach to Attention to Residents and People Affected by the Project
Due to the nature of the Consulting, the services to be provided by the EDARMA
Accidental Association will be developed considering a strong social focus that represents
the availability of having a permanent exchange of criteria with the Client and through this
with the target population that will benefit from the project. construction and equipment of
the Radiotherapy Unit.
This social work will begin with project socialization meetings coordinated with AISEM
officials and/or their representatives, and through them, address the concerns,
suggestions and recommendations of the Project beneficiaries.

TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

Phase 0 Coordination and Start of Activities

001 Study Coordination and Administration
This task includes the general monitoring activities of the project to guarantee that the
work is carried out with the necessary technical quality and within the planned deadlines.
The person responsible for its execution will be the Project Manager who will ensure
adequate coordination between complementary and/or parallel tasks and will establish the
role of the specialists offered by the Consultant.
Part of this task is the technical-environmental, administrative and economic control
activities of the study by the board of directors of the Accidental ARMACO Association,
which will be carried out using the management systems available therein, which allow for
a general overview of the projects in an updated manner and with the precision required
for their adequate monitoring. Likewise, the preparation of payment certificates for
consulting services is included among the activities to be developed as part of this task.
To contribute to the development of this activity, the Consultant has project control and
monitoring systems that allow obtaining a global and complete overview of the progress of
the work in a permanent and updated manner.
Finally, all the project coordination activities with the AISEM are constitutive aspects of this
task, who will be permanently informed about the evolution and development of the work,
for which they will have the support of professional personnel specifically assigned for this
purpose.
002 Preparation of reports
When any of the parties involved in the project require specific reports on particular topics,
the Consultant will prepare the corresponding report.
A similar procedure will be followed when situations arise that require special technical or
administrative criteria. As these are hypothetical situations, the content and scope of said
reports must be defined based on the problem analyzed. In principle, the following basic
aspects will be described:
• Reason for the report, indicating the entity that requested it, or if it was
carried out at the initiative of the Consultant
• Description of the problem treated.
• Criteria of the parties involved and analysis of the divergences, if they
exist.
• Consultant's opinion regarding the problem.
The specific reports will be delivered to AISEM in the shortest possible time from the
request or the determination of their preparation. The Client may request additional
information to this report, if deemed necessary. In this case, the Consultant will
complement the documentation according to the Client's requirements based on the time
necessary to carry out the requested work.
The special reports are applicable to both special reports of the technical and economic
areas as well as special reports of the environmental and social area.
TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

The special reports will be presented in three (3) copies in Spanish. In the event that any
documentation to be delivered is in another language, it must be translated by certified
personnel and, where appropriate, corrected at the expense of the Consultant, until the
final approval of the Audit. The same documentation must be delivered on magnetic or
digital media in three (3) flash memories and six (6) DVDs. Likewise, it must provide all
documentation and information regarding the associated systems that are installed and
are part of the Project, containing information and recommendations on aspects requested
by the Health Infrastructure and Medical Equipment Agency in order to make the most
appropriate decisions. In special cases related to Environmental Issues, the reports may
be presented in a greater number of copies.
003 Deliverable Reports

According to the Tender Documents, the Sub Products that will be presented by the
Consultant will be the following:

 Sub Product 1 – Initial Report – 15 calendar days after receiving the order
to proceed, which includes:
 Updated Activity Plan
 Programming of Activities according to the CPM method.
 Human Resources Allocation by Activities
 Gantt chart
 Confirmation of the participation of the proposed specialists
 Justification of the Project initiative
 Other important information

 Sub Product 2 – 120 days after receiving the Order to Proceed, which
includes:
 Idea, concept, project scope
 Epidemiological profile study
 Study of supply and demand
 Study of soils and geotechnics of materials
 Project size and location
 Health services portfolio
 Architectural medical program

 Sub Product 3 – 130 days after receiving the Order to Proceed, which
includes:
 Volumetric zoning
 Document social commitment or indicate courses of action to follow.
 Status of impacts and management of agreements
 Hydraulic hydrological study
 Identification of sources of environmental impact and mitigation
measures.
 Other aspects that the Consultant considers necessary

TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

 Study of Preliminary Conditions, Terms of Reference and Reference Price

150 days after receiving the Order to Proceed, which constitutes the Final
Report in Draft of the Study.

 With the previous delivery, the delivery of the Final Product in Draft would
have been completed - scheduled 150 days after receiving the order to
proceed. The clean report, in the number of copies established in the Terms
of Reference, will be presented, once the Nuclear Elements Handling
License has been obtained and the Client's observations have been
corrected and clarified.

The deadline indicated for the different reports initially corresponds to the delivery
of the Draft Reports which, in each case, will be subject to the review and
observations to be formulated by AISEM so that the Consultant can make the
pertinent clarifications and/or complementations.

 Clean Final Product Report that, according to what is stated in the Terms of
Reference, will be delivered once the contractual period has concluded,
given the conformity and acceptance of the reports of the main objectives
and the license to handle nuclear elements has been obtained.

The Consultant considers that it will be very difficult to obtain the license to handle
the nuclear elements of the project up to 150 days, because this process involves
the IBTEN, which has procedures and deadlines to grant said licenses. In any
case, the EDARMA Accidental Association reiterates its commitment to attend to
the project until the final delivery of the documentation generated therein, including
the process of obtaining the Nuclear Element Handling License, although this
process takes longer than the time provided for in the Bidding Documents.

TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

PHASE 1 - START AND DETAILED PLANNING OF THE STUDY

101 Compilation of Available Information

The Consultant will initially proceed to compile and analyze all existing
documentation related to previous studies in the places subject to this call.
Initially, the identification and compilation of all basic and engineering information
from previous studies will be carried out, for which, immediately upon receipt of the
Order to Proceed, all documentation will be requested from the Health
Infrastructure and Medical Equipment Agency, to begin. the analysis and review of
said documentation.
Permanent coordination will be maintained throughout the duration of the activities
with the Health Infrastructure and Medical Equipment Agency, which is the
institution in charge of project administration.

102 Identification of Actors and Entities Involved

The current government policy aims to ensure that the Bolivian population has
timely access to effective, safe and quality medicines at affordable costs, through
the regulatory action of the State. With the participation of the sectors involved, the
community organized, recognizing traditional therapies used by the population.
Technically regulate the logistics of supplies of medicines, medical supplies and
reagents under a single system, promoting their rational use.

For this reason, the consultant will document the social commitment that enables
the execution of the Project prepared by the communities and/or actors involved. If
the commitment does not exist, the courses of action to be followed will be
precisely indicated.

103 Contacts with Involved Entities – Obtaining Necessary Permits

The consultant will make all contacts with the entities involved in the project in
addition to managing all the corresponding permits for the proper development of
the project.

104 Sub Product 1 - Initial Report

Thirty (15) calendar days after receipt of the Order to Proceed, the Consultant will
deliver an Initial Report in 7 printed copies, 2 originals and 5 digital copies. It will
contain the updated Activity Plan (work), Scheduling of activities according to the
method (CPM), Allocation of human resources by activities, Gantt Chart in
Microsoft Project or similar, Written confirmation of participation of the proposed
specialists, other information that the Consultant considers important, Justification
of the Project initiative
TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

Said report will be prepared by the Project Manager, with the collaboration of the
different specialists, who will collaborate in the execution of the work schedule, in
order to identify the critical tasks in each of the specialties.

TECHNICAL PROPOSAL
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

PHASE 2 – BASIC MEDICAL STUDIES

201 Epidemiological Profile Study

The offer of services is based on the epidemiological profile of the insured

population at the national and regional level, according to their life cycle, gender
and interculturality.
The actions of health professionals are fundamental in identifying the
characteristics of the sociocultural context in which the patient develops,
understanding and understanding the social, economic and cultural processes
underlying the life of the population.

202 Study of Demand for Services

The analysis of supply and demand must be based on chronological series of care,
coverage, growth rate and other parameters that allow establishing the future
behavior of the requirements of the hospital care service. The demand projection
must be stratified according to the different Medical Specialties, taking into account
the existing Epidemiological Profile in the intervention area and its medium and
long-term projection.
The future behavior of the offer must be determined through the analysis of the
implementation of similar projects and the analysis of the existing offer. In this
sense, additional plans and programs must be foreseen in the project evaluation
horizon.

203 Study of the Service Offer

a) Supply study - Supply of existing Health Hospital infrastructure and services,

according to characteristics of the service: physical infrastructure, installed
capacity, available medical equipment, human resources, materials and supplies,
others.
b) Projection of supply and demand.

The demand analysis must be based on chronological series of care, coverage,

growth rate and other parameters that allow establishing the future behavior of the
requirements of the hospital care service. The demand projection must be stratified
according to the different Medical Specialties, taking into account the existing
Epidemiological Profile in the intervention area and its medium and long-term
projection.
The future behavior of the offer must be determined through the analysis of the
implementation of similar projects and the analysis of the existing offer. In this
sense, additional plans and programs must be foreseen in the project evaluation
horizon.
204 Preparation of Service Folders
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

205 Sizing of Hospital Units

206 Architectural Medical Program

The consolidation of the Medical Architectural Program of the new radiotherapy unit
must be carried out, which was structured based on the analysis of the current
situation of the demand for services provided in the current unit, in addition to the
demand at the National level, considering the current requirements. of the insured
population throughout the country and its projection in the medium and long term.
For this reason, the location, the formulation of the definitive Medical Architectural
Program and the sizing of the Project are part of the tasks that the Consulting
Company must develop.

207 Presentation of three Zoning and Building Implementation Alternatives

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

PHASE 3 – BASIC ENGINEERING STUDIES

301 Situational Report

The property planned for the preparation of the Design for the project of the
“Third Level Hospital Health Establishment” for the Department of La Paz is
located on the property of COTA COTA, Calacoto Alto Sector Hilusaya area,
identified as the Cota Cota University Campus of the UMSA – La Paz.

Its accesses are paved and it has all the services related to drinking water,
sanitation, electricity and fluid communication.

There are some sports facilities and some housing intended for security.

302 Topographic Studies

The topographic survey must reflect the accidents and characteristics of the
terrain, as well as the elements or constructions that are located in the sector,
also indicating the unevenness. Likewise, indicate whether the characteristics of
the basic services will be able to supply the future project.

The topographic survey must include the location and characteristics of the
service connections, substations, water boxes (water meters), drainage register
boxes, in addition to the inspection chambers, sanitary and storm sewer
chambers, the elevations cover and bottom, networks outside the terrain, and
must indicate any existing interference that does not allow the sanitary, electrical
and communications networks to be properly installed.

303 Climatic Condition Studies

In the corresponding Meteorology entities, current and historical data from the
Cota Cota area will be searched with statistical data to determine the central
values, particularly the Mean or Average of the different meteorological
variables.

In this sense we will determine the hottest or coldest months, rain regime of the
sector.

The stations that have records of observations of temperatures, precipitation,

atmospheric pressure, wind, humidity, evaporation and others will be identified.

Likewise, information will be collected that served as a basis for climatological

research in the past and that at present can be very useful to study possible
changes in our Climate.

304 Studies of Basic Services

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

To prepare the Basic Services studies, the technical department of the Mayor's
Office of the Southern zone will be visited initially, and the corresponding
EPSAS, to obtain data from the public network, likewise, the entity in charge of
providing electrical energy to area.

In summary, data will be sought regarding: The drinking water supply system,
the wastewater sewage system, the stormwater drainage system, the road
system, the public lighting system, the energy distribution network. electricity,
solid waste collection service, Gas service and other necessary
305 Geological Studies

The geological study will start from obtaining geological maps of the area,
prepared in studies previously carried out for the Municipal Government of La
Paz, on several occasions. It should be noted that one of the geologists who will
work on this project, on behalf of EDARMA, was linked to the preparation of the
Urban Development Study of the City of La Paz, by the companies BCEOM
(France) – BRGM (France) and PCA Consulting Engineers SA (Bolivia)

Based on the analysis of this information, field geological mapping will be carried
out that will cover the Hospital location (in detail) and the upper area of the basin
to identify its effects on the site.

Then the office work will be carried out to prepare the corresponding geological
maps and reports. It should be noted that this activity extends to the preparation
of draft maps and reports. The final documents correspond to the specific tasks
of preparing reports, maps, etc.

306 Deep Probes

In accordance with the requirements of the Amendments to the Base

Contracting Document, the Consultant will carry out deep drilling using rotary
diamond equipment with an adequate diameter to carry out dynamic penetration
tests – SPT at every 1.5 meters of depth, until reaching a total depth of 100
meters.

The location and depth of each survey will be defined by the geology and
geotechnics specialists of the EDARMA Accidental Association and coordinated
with the Study Prosecutor.

During the execution of the surveys, samples will be obtained for laboratory
tests, which will allow the materials crossed to be characterized.

Lithological description sheets will be prepared for each drilling carried out.

307 Geotechnical Studies

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

The geotechnical studies of the Third Level Hospital location site will be carried
out in accordance with the requirements indicated in Amendment No. 5 that
considers the following objectives:
 Geophysical Studies
 Open Pit or Austrian Type Wells
 Construction Materials Research
 Laboratory tests
 Test Interpretation

a) Geophysical investigations will be carried out to support deep drilling, based

on recommendations from EDARMA geology and geotechnics specialists,
with a research depth of 50 meters.
b) In accordance with or required in Amendment 5, open pit wells or using the
Austrian-type technique will be drilled, up to a total of 50 meters deep. The
location of the wells will be defined based on field work, by the Consultant's
geology and geotechnics specialists.
c) Investigations will be carried out on possible sources of materials for the
manufacture of the concrete that will be used in the project. In the case of
having a concrete sales service manufactured by specialized companies, the
tests of the materials with which these companies work will be presented,
which would be the ones that would be used for the construction of the
Hospital.
d) The samples obtained in the field will be transferred to the EDARMA
Association laboratory to carry out the most common tests, according to
what is indicated in the DBC and the real needs of the project. EDARMA
specialists will monitor the completion of these trials. Specialized
laboratories will be used to carry out more sophisticated or special tests.
e) The results of the tests will be interpreted appropriately to have parameters
that can be used in the task410 referring to the design of the project
foundations and other geotechnical analyzes and designs, if applicable.

308 Hydrological and Hydraulic Studies

The situation of the natural drainage of the area that affects the location of the
hospital to be predesigned will be evaluated, by identifying the existing water
courses and their morphological situation (old and current location, sediments,
type of bed, etc. ), taking into account the anthropic works carried out and
anticipating possible modifications to the channel. .

The hydrological study of the basin will be carried out to estimate the flows for
different return periods.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

Based on the results of the hydrological study, protection measures for the
hospital land will be recommended and the effect of water flow in existing works
will be analyzed, especially in the bridge located at the exit of the UMSA land.

This study will be carried out in compliance with the DBC requirements and
using specialized computer programs (software) for this component of the study.

309 Basic Studies for Risk Management

Field work will be carried out to obtain information regarding possible natural
risks that may affect the location of the tertiary hospital. This information will be
obtained in coordination with specialists from different work areas, especially
with the geologist specialist, geotechnics specialist, hydrology and hydraulics
specialist, social specialist, architect to identify anthropogenic interventions that
may represent risk to the health establishment and economist or doctor
specialized in public health.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

PHASE 4 – PRELIMINARY DESIGN STUDIES

401 Pre architectural design

For this stage of the alternative architecture, it must be developed as a pre-design

containing all the necessary details and specifications necessary for a perfect
interpretation of all the elements.

The architectural program, specified in the architectural design, is the result of

complementing the program required by the radiotherapy unit through the DBC,
with international and national standards, inclusion of additional environments and
units based on own experience and mainly as a result of the Research of the
Health Diagnosis, carried out by the consulting firm's health specialist.

The main objective of the design of the third level hospital must be under strict
regulations of functionalism, the Final Design of the Hospital will be carried out with
characteristics of modern architecture and minimalist criteria, expressing a
morphology of acceptability for tranquility and safety mainly, complemented by
green areas and of landscaping.
They are the abstract concepts that must be covered by the architectural object
and formulated as a proposal by the team of architects. For example: functionality,
security, monumentality. Comfort, etc.

402 Pre design structures

The main objective is to propose a structural system so that it fulfills a specific

function with a reasonable degree of safety and that under normal service
conditions it has adequate behavior. It is important to consider certain constraints
that arise from the interaction with other aspects of the overall project; the global
limitations in terms of cost and execution time as well as satisfying certain aesthetic
requirements.

Then, the solution to the pre-design problem can be obtained through a rigid
mathematical process, where a certain set of rules and formulas are routinely
applied.

The structural pre-design methodology will mainly be the optimization of the final
result of the design, which depends largely on the success that has been obtained
in adopting the most appropriate structure for a specific building of the structure for
a public place such as a 3rd Level hospital.

In many situations, the loads and other actions that introduce stress into the
structure are defined by construction regulations and it is the designer's obligation
to adhere to them to achieve an optimal result.

In this structuring stage, the materials that will constitute the structure are selected,
the main structural system and the arrangement and preliminary dimensions of the

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

most common structural elements are defined. The objective should be to adopt
the optimal solution within a set of possible structuring options.

403 Predesign of electrical installations

Carry out the pre-design of the Electrical Installations and Communication System
project of the 3rd level hospital; guaranteeing the electricity supply at all times due
to the characteristics required by the equipment, based on the respective Bolivian
Standards. Determine the power needed for the equipment. Provide and guarantee
the constant electrical supply service to the equipment according to standards.

Calculation of the different electrical and communication systems. Various methods

will be used for electrical and communications design. Initially, the basic collection
of information and investigation of the construction standards and municipal
ordinances related to the project will be carried out. Basic data of the architectural
project, availability of networks in the area, dimensions, etc. will be obtained.

An analysis will be carried out between the theoretical part and the technical part in
order to provide an alternative electrical and communications design, following the
corresponding Bolivian regulations for the pre-design of the 3rd level hospital.

In addition to establishing the technical conditions that must be taken into account
to design all the necessary systems, with the aforementioned standards.

404 Pre-design of sanitary facilities

Carry out the pre-design of the hydrosanitary installations project for the 3rd level
hospital health establishment, complying with the efficiency of the drinking water,
storm sewage, sanitary and wastewater treatment systems, in addition to the fire
fighting system.

Determination of flow rates and pressures and consequently the calculation of the
diameter of the pipe.

Provide and guarantee constant water supply service in all sanitary devices and
comply with the minimum pressures in them according to regulations.

Protect the water supply so that the water is not contaminated by sewage.
Calculation of the building's sanitary drains and eliminating these towards public
networks or treatment systems. Provide security to the occupants of the equipment
by calculating a prevention system in the event of fires.

Choosing the most optimal water distribution and wastewater evacuation system
for the equipment according to its characteristics.
Various methods will be used for hydrosanitary design. Initially, the basic collection
of information and investigation of the construction standards and municipal
ordinances related to the project will be carried out. In addition, they will be
supported by topographic and geotechnical studies that help understand both the
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

topography of the place, the type of soil, and the terrain factors that would affect
the development of the project. An analysis will be carried out between the
theoretical part and the technical part in order to provide an alternative
hydrosanitary design, following the regulations established in the Bolivian Standard
NB 688: sanitary installations and other references.

One of the most important aspects is the design of the network of drinking water
and sanitary facilities, because the basic needs of human beings must be satisfied,
such as drinking water for food preparation, personal hygiene and cleaning. of the
equipment, eliminating organic waste through sanitary drains, through treatment.

405 Pre-design of air conditioning installations

The air conditioning system of hospitals must be zoned according to the activity or
department, therefore this specialty must be closely related to that of architecture.
A study of appropriate architectural morphology will be carried out, complying with
current regulations and the use of spaces, based on which the necessary designs
will be made.

406 Pre design mechanical ventilation system

The design will be prepared in detail according to the distribution of all the
environments required for mechanical ventilation.

Design of a central heating system, that is, there will be a Hot Water boiler, this
boiler will operate based on Natural Gas, all of this as a pre-design which could be
modified in the study. The boiler will distribute hot water to the different rooms of
the project through a system of special pipes for this type of heating method.

407 Pre-design of medical gas installations

The medical gas system (MSG) of a hospital is conceptualized as a vital

installation, since it turns out to be an extremely important installation and its
presence in areas where critically ill patients are cared for is fundamental,
necessary and priority. Due to the importance of medical gas systems in the
process of providing life support to people, it is essential that all system
components be designed in accordance with design criteria, standards and norms,
in order to have the certainty that the facilities that supply medical gases are
efficient, safe and protect people's lives.

408 Predesign of communication and signaling facilities

Establish safety signage criteria and standards through graphics.

Pictograms that facilitate orientation and information for personal, patient and
visitor users of health establishments and medical support services, based on the
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

national technical standards of the competent authority.

The tertiary hospital must have safety signage, in its different classes, each of
which has a specific purpose.

Traffic routes and crossings must be marked to avoid obstructions and

interference. The different services or areas of the establishment and the medical
support service must have graphics that indicate the evacuation routes to the
meeting area or external security zone.

Pipelines through which hazardous fluids circulate, as well as environments with

specific hazards, must be clearly identified. Signs must be easily identifiable and
visible. The size of the signs must be in accordance with the distance at which
they must be perceived.

409 Redesign of gas installations

To prepare this pre-design we base ourselves on all the Regulations for the Design,
Construction, and Operation of Natural Gas Networks and Internal Installations,
which are framed in the regulations.

Minimum Provisions and Standards for the Execution of Natural Gas Installations.
Standards and Recommendations for the use of Natural Gas in Industrial Facilities
due to the capacity that the 3rd level hospital will require.

Taking into account that the supply will be through the primary line, for the supply it
is necessary to build diversion chambers, where a blocking valve and other systems
required for the pre-design will be installed, and then continue to the project site. of
the 3rd level hospital.

410 Pre-design of foundations

For the pre-design of the foundations, the following studies will be carried out:
geological pre-study, topographic survey, geophysical evaluation and soil study.
The results of the studies must indicate:

Parameters and conditions for structural design.

Determination and selection of the type of structure and foundation.
Determination of the structural system.
Comprehensive coordination for the execution of the architecture and engineering
study that go together in the design of the structure.
Carry out the structural calculation with all the regulations for this purpose

411 Pre design vertical transport

Based on the number of levels determined in the architectural solution, the location,
traffic study for vertical transportation, as well as stairs, layouts, dimensions,
slopes, materials and finishes of the ramps and determination of location and

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

capacity for the project must be calculated. 3rd level hospital. At all times they must
be governed according to the parameters established in the rules that regulate
facilities for people with different abilities in accordance with Law No. 223, General
Law for People with Disabilities.

412 Risk Management Analysis

In accordance with the provisions of the DBC, the analysis of risk management
will be carried out based on Framework Law 602 “Risk Management” to include
risk management in this study through prevention, mitigation and recovery and
attention of disasters caused by natural, socio-natural, technological, and
anthropogenic threats, as well as social, economic, physical, and environmental
vulnerabilities.
The risks will be evaluated and analyzed in order to verify the need to implement
specific protection plans to minimize the consequences of their eventual
occurrence.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
Hospital Health Establishment for the Department of La Paz

PHASE 5 ENVIRONMENTAL IMPACT ASSESSMENT STUDY

501 Environmental Categorization Level
In compliance with Supreme Decree No. 3549 dated May 2, 2018, the level of
environmental categorization will be determined by applying the procedure
established in said Decree, based on the categorization lists of the sectors of the
multisector area, which is found in the Annex A, where Category 3 is established
for the Public Health and Social Security Sector and within this sector, the
construction and equipment of second and third level health centers.
To make the categorization official before the Competent Environmental Authority,
the environmental categorization level form will be filled out, and with the
signatures of the Legal Representative and the Technical Responsible, it will be
presented to the Authority.
502 Analysis of the Project from an Environmental Point of View
As part of this task, the Consultant will compile the existing specific information,
referring to the different environmental and socioeconomic factors that must be
involved in the evaluation of environmental impacts. At the same time, the available
bibliography on studies carried out in the area will be investigated and reviewed.
The analysis of the project from an environmental point of view will allow during the
study to verify which environmental factors will be most affected and based on this
knowledge, to formulate mitigation, prevention and compensation plans for impacts
during the implementation stage. of the project.
503 Identification and Evaluation of Environmental Impacts
This task begins the stage of identification and evaluation of the impacts on the
ecosystem divided into abiotic physical, biotic physical, and socioeconomic and
cultural environments. In this sense, the environmental impacts on the different
attributes of the environment will be identified and evaluated: physical, biological
and socioeconomic-cultural.
To identify environmental impacts, the use of different methodologies is required,
which must be adapted in each case, depending on the environment, legislation
and conditions found in the place. The different impact identification methodologies
are structured mechanisms for determining the environmental impacts caused by
different activities of each project.
The format indicated in Annex C-1 of the DS will be applied 3549, recording in a
structured manner each stage of the project, the activity that causes the impact, the
environmental impact of each environmental factor and attribute and its effect, as
well as the permissible standards and pertinent observations.

As it concerns hospital infrastructure and equipment in an urban area, emphasis

will be placed on the generation of hazardous solid waste (bio-infectious and toxic),

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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common and special wastewater, gas emissions and radioactive sources, in

addition to safety and security measures. hygiene for this type of establishments.
Regarding environmental factors, the emphasis, without neglecting other
environmental factors, will be placed on socioeconomic and cultural attributes.
504 Prevention and Mitigation Program
In this activity, the alternatives that minimize or eliminate the identified
environmental impacts will be analyzed, based on which the Prevention and
Mitigation Program (PPM) will be structured, according to the format indicated in
Annex C-1 of the DS. 3549, which systematizes the measures proposed to mitigate
the previously evaluated impacts.
For each impact, a code will be recorded, the environmental factor and attribute
that suffers environmental impact, the prevention and mitigation measures, the
priority in their application, the implementation period indicating the start and
conclusion dates and the review or inspection date.

505 Environmental Application and Monitoring Plan

The Environmental Application and Monitoring Plan (PASA) will aim to control and
guarantee compliance with the protection and mitigation measures.
In accordance with the provisions of Annex C-1 of the DS 3549, the PASA will
record for each environmental impact on environmental factors and attributes; The
determined mitigation measure, the location of the sampling point, the verification
parameters, the permissible limits, the sampling frequency, the required material,
the cost of monitoring, the person responsible for monitoring and the observations
that are relevant.
506 PPM Plans – PASA
The PPM – PASA will include a Solid and Liquid Waste Management Plan that will
be generated in the hospital operation stage, in which emphasis will be placed on
the separation of waste at source, collection, temporary storage, transportation and
disposal. end of the different types of solid waste that will be generated. Without
neglecting the complete cycle of waste generation, emphasis will be placed on the
management of bio-infectious, toxic and special waste, typical of hospital
establishments. Regarding liquid waste, emphasis will also be placed on separation
at source and the corresponding treatment based on its characteristics, prior to
discharge into the sanitary sewer of the public network or into a watercourse.

The risk analysis and contingency plan will also be included, which will be
specifically structured to prevent the risks that arise in hospital establishments and
define the contingency measures that may be necessary to apply if necessary.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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A closure and abandonment plan will also be included in which the dismantling and
disposal of all structural elements and disused equipment will be considered.
507 Documentation of Social Commitment or Actions to Follow
As part of the Study, a social commitment will be documented that makes the
execution of the project viable, prepared by the neighbors and other actors
involved. If the commitment is not achieved, the courses of action to be followed
will be precisely indicated in order to achieve social acceptance of the project.
Social management will focus on promoting the need to have a tertiary public
hospital in the South Zone of the city of La Paz, the benefits for the health of the
population and the economic revitalization that the facility generates in the area. of
an establishment with the characteristics of the hospital. The prevention and
mitigation measures that will be applied to prevent and mitigate environmental
impacts will also be explained, as well as the contingency plan that will be applied if
necessary.

508 Presentation of the PPM-PASA

The PPM – PASA prepared with the methodology indicated in the previous
activities, will be structured with the format established for the project, and will be
presented to the client as part of Subproduct 3. If necessary, the corrections and/or
additions requested by the client will be made, so that they can later be delivered to
the Competent Environmental Authority.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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PHASE 6 – MEMORIES, SPECIFICATIONS, COMPUTATIONS AND BUDGET

601 Memories of calculation

The “calculation reports” will describe how the calculations involved in the
development of the construction project were carried out, they will describe the
procedures that were carried out to determine the sections of the elements, and
they will also indicate what were the criteria with which which each and every one
of the elements and parts of the project were calculated

A calculation report will be presented for each of the disciplines involved in the
project, among which the following can be found:

o Hydraulic calculation memory.

o Electrical installation calculation report.
o Healthcare installation calculation report.
o Air conditioning system calculation memory.
o Fire protection system calculation memory.
o Calculation memory of special facilities

602 Metric calculations

The metric calculations will be carried out in all areas and specialties separately to
then evaluate the budget for the execution of the project and its total cost, and a
detail of the calculations will be prepared.

603 Analysis of unitary prices

These must include indications and costs of materials, hospital and non-hospital
medical equipment, transportation, waste, yields, labor costs and all kinds of
incidents that affect the analyzed unit price.

Basic price list: The budget must include the basic price list of materials, medical
equipment (hospital and non-hospital) and salaries used. Basic prices must be
included within the unit analyzes and presented as an annex.

List of reference costs of medical equipment (hospital and non-hospital): In one

section, the cost of hospital equipment, considered in the design, must be
included; Likewise, the medical, administrative and general furniture that served
as an ergonomic basis for the sizing of the spaces.

List of reference costs for the training of medical personnel (white coat): In one
section, the cost that the training of medical professionals in the identified
specialties and subspecialties will require must be included.

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Technical analysis of the Architecture and Engineering of the project that allows
determining the investment costs and operation costs of the project. It will include:
Detailed study of the selected alternative (Basic Architecture and Engineering and
Structure Design). Design of auxiliary and complementary works. Metric
calculations. Unit prices. General Budget for Architectural and Engineering Works.
Maintenance costs. Execution program. Preparation of technical, administrative
and operational specifications for construction.

604 Construction Plans

The project will describe the process of execution of works, set deadlines for
completion and include:

Topographic plan of the land, its planimetric characteristics, dimensions and

dimensions, with specification of angles between sides, contour lines and location
of all existing elements on the lot, natural or built. Topographical notebooks.

Location plan of the building on the lot, cut and fill areas, wall slopes and other
planned areas.

Dimensional plan of the land, the buildings and the most significant points of the
exterior elements (accesses, steps, ramps, roads, sidewalks and others).
Layout plan of the buildings showing foundation axes (isolated and continuous),
bounded with reference to pre-established, identified and immovable elements,
topographic points.

Location plan of the exterior elements built such as parking lots, walls, auxiliary
buildings and others.

Plans of all floors with nomination of rooms and nomenclature in accordance with
the provisions of the National Guide for the Design and Construction of Health
Establishments, interior dimensions of rooms, thickness of walls, location of doors
and construction elements, material and types of finishes .

Sections, facades and roof plan similar to those of the preliminary project,
expanding details and indicating definitive specifications, dimensions and
dimensions of all the elements, openings and materials to be used.

Specifications for interior and exterior waterproofing of walls and other elements
of protection against humidity. Larger scale details of wet areas with location of
hydraulic-sanitary devices, type and specifications.

Detailed plans of all the construction elements that were necessary for a correct
interpretation of the works to be executed such as: doors, windows, floors, steps,
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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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ramps, railings, balconies, special construction elements in exposed material,

other construction plans. Cabinets, screens, divisions, safety equipment and other
fixed elements, materials and technical specifications.

605 Engineering Budget

A summary table will be prepared of the estimated quantities of work for the final
design, for the different construction items that will be used in the preparation of
the estimated project execution budget.

The budget for the execution of works will be prepared based on justified
estimates of work quantities and unit price analysis sheets, supported by quotes
for inputs and machinery - equipment previously made.

A breakdown of the budget will be made based on the origin of the inputs, to
establish financing needs, both national and foreign.

Finally, a breakdown of the budget will be carried out into its components of
materials, machinery and equipment, and labor, so that the owner has sufficient
data to allow him to adequately establish the project execution strategies.

This budget will include items related to civil construction work and medical
equipment.

606 Work Execution Schedule

Depending on the production of the project activities and the quantities of work,
the Consultant will develop the following tasks:

Estimation of a Works Execution Schedule based on the performance of each

activity and quantities of work, this must consider the periods from the order to
proceed, coinciding with the disbursement of the advance, execution of
construction itself, warranty period, until receipt definitive, with the most
appropriate construction time estimate.

Each activity will have an assigned code, which will allow its easy and simplified
use within the model to be used.

At this stage of the work, the precedence relationships with other activities that
must be executed sequentially or simultaneously will also be defined.

Preparation of a disbursement schedule during the construction of the works,

according to the schedule of activities and estimated progress of the work.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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Determination of the requirements regarding financial resources, personnel,

equipment and materials, based on the adopted execution time.

The scheduling of works will be prepared in the Microsoft Project software, which
corresponds to project scheduling according to the critical path method.

These concepts will be displayed graphically in plans in order to give a global

vision of the execution, and allow the works planner to determine the main
sequences of the execution of works.

Finally, the investment schedule will be determined, which will be based on the
previously prepared construction schedule. This disbursement schedule will allow
the preparation of the accumulated investment curve.

607 Technical specifications

Documents of General, Special and Environmental Technical Specifications will

be prepared for the project.

The first refer to general conditions found in projects based on current regulations
at both the national and municipal levels.

The Special Technical Specifications correspond to particular aspects of this

project, so their preparation must have the intense participation of the specialist
engineers who participated in the design,

The environmental specifications include the activities for the activities of the
replacement and compensation plans for affected populations, in addition to other
aspects related to the environmental part of the project.

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PHASE 7 - EQUIPMENT

701 Medical Equipment Program – identification

Biomedical equipment has a significant impact on determining the requirements of

the building, especially in electrical, sanitary and mechanical installations, as well
as structural elements.

It must consider all medical equipment (hospital and non-hospital), incorporated in

the Medical Equipment Program necessary for the good and optimal functioning of
a third level Hospital (correctly coded and with Technical Specifications for
subsequent identification), subject to the requirements implementation of the health
facility's service offering

702 Preventive, Corrective and Predictive Maintenance Plan

Likewise, the Medical Equipment Program must include a preventive, corrective

and predictive maintenance plan for all proposed assets.

The Consulting company must consider the list of medical equipment for the
Architectural design, in order to guarantee the correct functioning of the tertiary
Hospital.

703 Justification of Quantities

The Medical Equipment Program (hospital and non-hospital) will include the
quantities, origin and technical specifications of the proposed goods, considering
that these must meet high quality standards and must have national and/or
international certifications that support them.

704 Technical Specifications of the Equipment

The Consulting company must consider the specific technical specifications for all
medical equipment for architectural design and engineering, in order to guarantee
the correct functioning of the tertiary hospital.

705 Quotes and Budget

Present technical specifications of the materials, equipment and devices

supported by quotes with reference prices of the current market to the extent
possible with local suppliers or, failing that, consider transportation and shipping
costs.

706 Equipment Implementation Schedule

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The schedule will be developed in the implementation of the equipment that is

on the critical path of the project. It will also present a program for the use of
equipment and materials.

707 Technical Specifications Sheet

Preparation of Technical Specifications for each of the work and equipment

items, for subsequent bidding and commissioning of the equipment according to
its specifications.

708 Conclusions and recommendations

There is a political and social mandate of the Health Sector that guarantees the
full exercise of the right to health, inclusion and access to health for all people,
eradicating poverty and inequality to Live Well.
In La Paz, the incorporation of newly created hospital structures and the process
of reform and adaptation of existing ones, to achieve an adequate dimensioning
and offer of services for the region and reference regions defined in the National
Health Network established in the New Comprehensive Health System.
In Infrastructure and Equipment, because the project establishes a physical
work according to the available investment and the complexity of the service.
In Health Human Resources, because the project requires professionals suitable
for the position, who are in the labor market.
Technology, having technology that is useful for staff and beneficiaries, the cost
of this technology must be within the investment as well as at reasonable prices.
Drug companies, due to the project, must take into account the demand for
them, prices and donations.
Market Regulation are similar aspects but different in their execution. Market
Control regulates the prices of some services that the project will provide.
The Overdemand of the Population is a constantly growing actor, it saturates the
market, developing one of the main problems.
The Health Education factor is influenced by El Mercado because the more
people benefited by the project, the coverage, the better the care.

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Product Consulting: Study of Expanded Prerequisites of the Construction Project with its Equipment of one (1) Third Level
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PHASE 8 STUDY CLOSURE

801 Management for Obtaining a License for Nuclear Elements

As part of the Study, the Consultant will prepare the technical documentation
required by the IBTEN to obtain the corresponding authorization or license, for the
construction, operation and decommissioning for the installation of equipment for
nuclear medicine.
In addition to presenting the technical documentation, the client will be advised to
generate the required legal documentation. With all the documents, the folder will
be put together to request the corresponding license and it will be presented to the
corresponding entity, in order to continue the process.
Once the documentation is presented, the consultant will follow up on the process
until the License is obtained.

802 Project Conclusions and Recommendations

There is a political and social mandate of the Health Sector that guarantees the full
exercise of the right to health, inclusion and access to health for all people,
eradicating poverty and inequality to Live Well.

In La Paz, the incorporation of newly created hospital structures and the process of
reform and adaptation of existing ones, to achieve an adequate dimensioning and
offer of services for the region and reference regions defined in the National Health
Network established in the New Comprehensive Health System.

In Infrastructure and Equipment, because the project establishes a physical work

according to the available investment and the complexity of the service.

In Health Human Resources, because the project requires professionals suitable

for the position, who are in the labor market.

Technology, having technology that is useful for staff and beneficiaries, the cost of
this technology must be within the investment as well as at reasonable prices.

Drug companies, due to the project, must take into account the demand for them,
prices and donations.

Market Regulation are similar aspects but different in their execution. Market
Control regulates the prices of some services that the project will provide.

The Overdemand of the Population is a constantly growing actor, it saturates the

market, developing one of the main problems.

The Health Education factor is influenced by El Mercado because the more people
benefited from the project, the coverage, the better the care. .
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803 Preparation and Delivery of the Final Project Report

Once the contractual Term has concluded and given the conformity or acceptance
of the By-product Reports indicated in the Terms of Reference, the Consultant will
present the documentation and plans according to the quantity and form that is
contractually established.

804 Delivery of the last Payment Certificate

With the approval of AISEM, the Consultant will present the latest Payment
Certificate in the format and amount contractually established, through which the
absence of any technical, administrative and/or legal pending that prevents
continuity of the disbursement process will be verified. this last Payment Certificate
805 Final and Official Closing of the Project

Once all the requirements of the Contract have been concluded, the Consultant will
proceed to issue its Final Settlement Certificate, as well as the request for the
Contract Compliance Certificate, a document that establishes the satisfactory
conclusion of the contract.

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