HDC Cardiac Hospital

The project consists of the design, construction and operation of a cardiac surgery hospital in Slatina, Municipality of Laktaši, Republika Srpska, Bosnia and Herzegovina, approx. 15 km northeast of Banja Luka. The hospital will provide diagnostic, cardiology and cardiovascular surgery services to adults and children under a 15 year public-private partnership (""PPP"") agreement between the government of Republika Srpska (""GoRS"") and CEE Hospital Development Company GmbH, a joint venture between Gesellschaft für Sicherheit in der Medizin GmbH (""GSM""), Odelga Handelsgesellschaft m.b.H. (""Odelga"") and Aragosta Invest d.o.o. (""Aragosta""). GSM is responsible for building planning, Argosta for construction and Odelga for provision of medical equipment.

The hospital will be built on a vacant plot adjacent to a GoRS developed medical and health center comprising a cardiac rehabilitation centre, orthopedic clinic, retirement home and hotel. The first stage is scheduled to begin operation with an annual capacity of approx. 650 patients after a 14 month planning, permitting, construction, installation and commissioning period. The hospital will achieve its approx. 1300 patient total annual capacity 12 months later, after some complementary works are done. The approx. 5200 m² hospital is expected to include an inpatient ward, intensive care ward, recovery area, operating rooms, central sterilization, cardiac catheterization room, examination rooms, laboratory, ambulance bay and kitchen/cafeteria. Building services, including an emergency generator, medical gas and electrical transformer will be located on the building exterior.

This project is categorized B under MIGA’s Policy on Social and Environmental Sustainability because the potential risks and impacts are limited, few in number, site specific, largely reversible and readily addressed through mitigation measures. Key expected social and environmental risks and impacts include: planning and permitting, erosion, runoff, hydrocarbon spills, dust noise and vibration, traffic and worker health and safety during construction, life and fire safety, hazardous materials, solid waste, medical and bio-hazardous waste, wastewater, and worker and community health and safety during operation. These risks and impacts are expected to be mitigated through interventions outlined in the environmental management plan to limit negative impacts of the project to the environment and communities.

Environmental and Social Categorization

This project is categorized B under MIGA’s Policy on Social and Environmental Sustainability because the potential risks and impacts are limited, few in number, site specific, largely reversible and readily addressed through mitigation measures. Key expected social and environmental risks and impacts include: planning and permitting, erosion, runoff, hydrocarbon spills, dust noise and vibration, traffic and worker health and safety during construction, life and fire safety, hazardous materials, solid waste, medical and bio-hazardous waste, wastewater, and worker and community health and safety during operation. These risks and impacts are expected to be mitigated through interventions outlined in the environmental management plan to limit negative impacts of the project to the environment and communities.

While all Performance Standards are applicable to this investment, MIGA’s due diligence indicates that the investment will have impacts which must be managed in a manner consistent with the following Performance Standards:

• PS1:  Social and Environmental Assessment and Management Systems
• PS2:  Labor and Working Conditions
• PS3:  Pollution Prevention and Abatement
• PS4:  Community Health, Safety & Security

Performance Standards 5, 6, 7, and 8 do not apply to this project as biodiversity, natural resources, indigenous peoples and cultural heritage will not be directly impacted and no involuntary resettlement or livelihood impacts were identified as a result of land acquisition. The land was provided at no cost by GoRS, with development rights transferred to the project for the 15 year duration of the PPP agreement.

The following documents were reviewed by MIGA:

Technical Description: HVAC, Medical Gas, Equipment and Electrical Installations, CEE Hospital Development Company GmbH, June 2010

Business Plan: PPP Project Finance, Cardiac Surgery Hospital, Republika Srpska, CEE Hospital Development Company GmbH, June 2011

Overview of Proposed ISO 9001:2008 Quality Management System for Cardiac Surgery Hospital in Slatina, CEE Hospital Development Company GmbH, August 2010

PS1:  Social and Environmental Assessment and Management Systems

The PPP agreement has not yet been signed, therefore the sponsor has not initiated drafting a final design, applying for the necessary permits, permissions and approvals or developing plans, policies and procedures specific to managing social and environmental risks and impacts. The hospital will be designed, constructed and operated in compliance with the laws of Republika Srpska (“RS”). The project sponsor is also committed to providing health services in compliance with relevant Republic of Austria and European Union health care standards and good practice. All necessary social and environmental management plans to comply with MIGA’s Performance Standards and the World Bank Group Environmental Health and Safety (“EHS”) Guidelines will be developed prior to commissioning, in particular management plans for life and fire safety, and hazardous materials and wastes.

Additional social and environmental risks and impacts are expected to be managed through the development and implementation of a quality management system in accordance with the ISO 9001:2008 standard. The sponsor has preliminarily identified waste management, food supply and human resources as areas where policies and procedures are expected to be developed within the framework of the quality management system. A staff training and education program will also be developed.

PS2:  Labor and Working Conditions

The project is expected to create 140 permanent job positions. The selected chief executive is a foreign national, however the project expects to recruit and train local workers for the remaining positions. In addition to the chief executive, the management team will consist of a medical director, nursing director and director of administration. The medical director, a local national, has already been appointed and is engaged in the recruitment and training of physicians and nursing personnel prior to opening the clinic.

The hospital will develop a HR policy, procedures and manual within the framework of the quality management system, based on RS Labor Law. The HR policy, procedures and manual are expected to include provisions explaining employees their rights under national labor and employment law (including their rights to wages and benefits), collective bargaining, non-discrimination, retrenchment and a grievance mechanism in compliance with Performance Standard 2.

Occupational health and safety hazards for the health care providers, cleaning and maintenance personnel, and personnel involved in handling, treatment and disposal of health care waste are associated with exposure to infections and diseases, hazardous material and fire. These hazards will be mitigated through the framework of the quality management system through development of a risk management system. Additionally, management plans will be developed for fire and life safety, as well as hazardous material and waste that identify responsible individuals and define processes and procedures.

PS3:  Pollution Prevention and Abatement

Key expected social and environmental risks and impacts are related to hazardous materials, solid, medical and bio-hazardous waste, and wastewater during operation. These impacts will be avoided, reduced or mitigation through compliance with RS laws, implementation of the quality management system and compliance with MIGA’s Performance Standard 3 and World Bank Group EHS Guidelines.

Hazardous material and wastes: Biological, chemical, explosive and fire risks are associated with hazardous materials including medical gases, laboratory chemicals, sharps, pharmaceuticals, cleaners and other materials that are expected to be managed on-site. Hazardous, medical and bio-hazardous waste streams are expected resulting from laboratory and medical procedures. These waste streams potentially include chemical wastes and biologically contaminated medical waste, including syringes, needles, tubes, catheters and bandages. A management plan for hazardous material and waste will be developed that identifies processes and procedures for the safe handling, storage, sorting and disposal of each class of chemically and biologically hazardous material and waste. The project currently has a verbal commitment from General Hospital ‘Sveti Apostol Luka’, Doboj (“Doboj General Hospital”) to receive all hazardous, medical and bio-hazardous waste streams for disposal in their incineration plant. Doboj General Hospital is tertiary level health care facility located approx. 70 km due east and 125 km by road from Banja Luka.

Waste water: Sanitary waste water will be connected to the municipal wastewater treatment system. Process waste water will be collected from laboratory rooms. Laboratory and chemical waste are collected in chemical-resistant containers in the hospital and transferred either back to the supplier for disposal, or disposed of together with medical waste in the Doboj General Hospital incinerator. No liquids requiring waste disposal will incur in operating rooms.

PS4:  Community Health, Safety & Security

The hospital will evaluate community health and safety risks and impacts that could affect the local community during the design, construction and operation of the project. These impacts will be avoided, reduced or mitigated through compliance with RS laws, implementation of the quality management system and compliance with MIGA’s Performance Standard 4 and World Bank Group EHS Guidelines.

Fire and life safety: The new hospital building will be designed, constructed and operated in full compliance with all local building codes, local fire department regulations, and local legal/insurance requirements and in accordance with an internationally acceptable life and fire safety standard. The hospital will develop a life and fire safety plan that will identify responsible individuals, applicable codes, standards and regulations, and define policies and procedures for risk reduction, mitigation and emergencies. Elements of the plan should incorporate design features of the building, including sprinkler and alarm systems, as well as a schedule for maintenance and testing of these systems, and periodic review and updating of the plan.

Outstanding permits, permissions and approvals include final design approval, planning permission, construction permit, operating permit and certification as a health care institution. The final design would include architecture, construction, mechanics, electronics, water supply and sewer system as well as administration and organization. Requirements for obtaining a construction permit include providing information regarding urbanistic compliance, design planning and statutory requirements, occupational safety, fire protection and environment protection. 

Compulsory certification of health care institutions was mandated by the 2009 RS Law on Health Care. Certification is a procedure to evaluate and confirm that a health care institution meets predefined and published standards in the process of providing health care. The certification process is based on a formal audit conducted by the Agency for Certification, Accreditation and Health Care Improvement (ASKVA), with the resulting report submitted to the Minister of Health and Social Welfare for rendering a decision, and renewal of the certification status required every four years.

Project documentation is available for viewing at the following location:
Ulica Jevrejska broj 79
Banja Luka
Republika Srpska
Bosnia and Herzegovina