the rising costs of the house rent,
the rising living costs of life making it difficult to recruit personnel who
accept low wages and
the rising costs of providing good quality health services to the community which can not afford.
Such challenges have stimulated him to seek for external support so as to fulfill his devotion to save humankind.

To achieve this goal a rather larger project which will save majority is under consideration. In order to set affordable rates the project shall be the property of an NGO mentioned above which is a tax exempted organisation. Various health insurance companies have been consulted and are willing to utilize the services of the hospital once it takes off.

DEMAND FOR HEALTH SERVICES

According to the planning commission, the current population of Tanzania is estimatedto be 40 million people. About 49% are male and 51% are female. Consequently,the demand for health services in the country is very high.
Table 1.0 shows utilization of health services in the country by type of facility.

Table 1.0 Utilization of health services

The table shows that the utilization of health facilities has increased from a total number of 136,868 in 1989 to 205,742 patients in 1994 an increas by 50.3 %. This can be attributed to, inter-alia, increase in the distribution of health facilities after partial privatization of the sector and improvement of economic conditions in the country. For the past ten years the private health sector has expanded significantly, the actual data were unavailable during this write up.

The epidemiology of diseases in the country show that malaria, URTI and diarhoea diseases are the main threats to the life of most Tanzanians followed by AIDS.According to the ministry oof health reports more than 50% oof patients reported at health facilties in the country during the past three years suffered from these diseases. However malaria and AIDS related diseases are the most cause of mortality. In the urban areas road traffic accidents requires special attention.

AS REGARDS THE SURGICAL PRACTICE IN The city of Dar es salaam personal observation in private sectors shows that the surgical inpatients beds are occupied by less than 15 % while the government sector they are always 100% occupied and theatre days for elective surgery booked for more than a year ahead. This desrepancy is attributed by the cost involved. A new institution which will fill the gap between must therefore adopt charity service as well be self sustainable.

Supply of health services in Dar es salaam
As regards to medical services, there are both public and private health facilities.The patient pays fully for the private service but partially for the government services. The health insurance companies are still few and does not cover more than 10% of the population. The list of major hospitals in Dares salaam is shown in table 2.0 below.

Table 2.0 Major hospitals in Dar es salaam

Table 3.0 Availability of health facilities in the Country

Source: Ministry of health, Health statistics Abstract

It is evident from the above information that unlike the period before liberalization of health sector, the role of private sector in the delivery of health services isa very significant to-date. Private sector own about 54% of the health facilities in the country. However they are not fully utilized.

The government sector on the other hand is over utilized and face shortage of essential drugs and medical equipment mainly due to financial constraints.
The shortage of health services in the country is also manifested through the fact that the current ratio of doctors to patients is 1: 23,000. Explanation to this is not related to the factor of less numbers of doctors graduating per year as currently the country has five medical schools but also due to the fact related to ideal working conditions which lead to many Tanzania doctors opting to work outside Tanzania. This ne project under consideration is a result of ideas of committed Tanzanian doctors seeking to solve the health problems of Tanzania rather than escaping for greener pastures. It will also provide ideal environment for practical studies of medical students and nurses as well as providing employment.

PROJECT OBJECTIVES:

Broad objectives
1) To provide affordable general outpatient and inpatient medical and surgical care to the people of Dar es salaam and neighboring regions
2) To be fully involved in formal and continuous education of medical and paramedical personel.
3) To carry out a program of sensitization and health education on prevention of diseases to the community
4) To be involved in providing health insurance or social security support for health care for the majority of the people who can not afford. At this stage the centre is expected to offer all services of a modern quality oriented hospital.
5) To be a centre for medical research and advancement of appropriate medical technology

Specific objectives
1) to set up an out patient department with: consultation rooms for general practitioners and specialists, modern general laboratory, emergency room, female and male observation room, antenatal and postnatal clinics,x-ray and ultrasound department
2) to set inpatient departments for: general surgery, obstetric and gynecology, internal medicine and pediatrics
3) to open two major operating rooms for General surgery and obstetrics and one operating room for minor surgeries
4) To establish a college of nursing with intention to produce and or upgrading to highly qualified nurses who will meet the increasing demand in high quality care.
5) To conduct seminars/workshops for continuous education for nurses, doctors laboratory and other paramedical personnel in order to increase their skills in service provision
6) To open a department of public health promotion which will deal with health education to the community vis a vis preventable communicable and non communicable disease e. g malaria, HIV/AIDS, obesity and related disease
7) To open a unit for physical therapy, stress management and counseling
8) To be one of the centre for practical experience of the medical as well as nursing students and exchange of knowledge and shariring of culture and values between Tanzanian students and Germany students

METHODOLOGY

The Board of directors is constituted of doctors who are working on fulltime or part time for JPM dispensary and the key reliable members approved by Dr. Mkiramweni who are committed to upgrade the JPM Dispensary to a health centre (See Appendix 1). The board will be responsible for day to day management of the centre including recruiting personnel, finance control and project expansion. The project will be divided in five phases according to the five broad objectives above and they will be implemented in that order. Where funds allows more than one objective can be implemented simultaneously The centre intends to create a balance between business success of competitive standards and affordability. The last fourth objective is expected to finalize this intended balance. When the whole project is over all services will be available in one 5story building(Architectural plan to follow).

PROJECT SUSTAINABILITY
The major problems facing the developing countries is capital input.We kindly request our friends in the first world to support us with the initial capital input required for construction purpose and purchaaseof the equipment together with initial one year salary.
To make sure that the project will be self sustainable the following shall be abided:
1) Good leadership which is governed by the board
2) Marketing strategies including contracts with the insurance companies, education campaigns for the society as regards to subscription to the insurance companies,awareness of their health needs
3) Transparency of the activities and financial reports at any given time to all members which must appear in the website http://www.charitable-hospital.org
4) legal procedures, rules and regulations and project objectives
5) Receiving technical support and advices of the academicians, consultants and economical and financial experts

PROJECT IMPLEMENTATION: Phase one

The first task is to solve the problem of the building by purchasing a house and a plot which has a room for expansion. Such a venue has been identified in Kijitonyama, Dar es salaam (Block B plot no. 196) a neighboring location to the existing JPM dispensary. It has a house originally constructed and used as a dispensary but large enough to start a health centre. It originally belonged to my patient Hellen-Eichers Mbagala a Belgian widow who passed away last month and had handled the power of sale to THE SOUTH LAW CHAMBERS,P.O BOX 11727, TEL +255 22 2184660 and mobile Tel +255 713 333 390.
The next step will be to renovate the building and to shift the current venue of the JPM Dispensary to this new location. This will be followed by purchase of the equipment and registration of JPM SURGICAL HEALTH CENTRE. The summary of implementation schedule is given in Appendix 2.

Alternatively the same total amount of money requested can be used to purchase a plot and construct a five story building for the purpose. Second phase of which will mean to do the internal finishing and to install the required equipment. Architectural drawings are included. This alternative solution is equally important because the date of securing funds is not known such that by the time the funds are available may be the above plot initially described is already sold.

MANPOWER AND ORGANISATION STRUCTURE