Chapter 1

THE PROBLEM AND REVIEW OF RELATED LITERATURE AND

STUDIES

1.1 Introduction

Health is significant to every people in community. It keeps an individual away

from possible diseases, viruses, infections, etc. Nowadays, being healthy is one of the

strategies to survive in this world. But, due to continuous aging of the population, there

are still many people committing diseases due to: a) lack of food causing malnutrition;

b) lack of shelter causing an individual being prone to diseases and accidents; c) lack of

health facilities.

Therefore, our government provided us a several number of hospitals in every

community. So, that is why hospital is one of the important facilities in our community.

It provides wide range of services, such as medical, surgical, outpatient consultations,

dental, therapy, child health, pregnancy and etc.

For some instances and purposes, there are two main types of hospitals: public

hospitals and private hospitals. Public hospitals are funded by local funds. However, in

comparison, private hospitals have better technical facilities than public hospitals

which assure patients of higher quality service than public hospitals can provide. In the

other hand, public hospitals are more affordable.

As a result, public hospitals cannot turn anyone away especially someone who

is entirely poor comes in; the hospital must treat him or her. This became one of the

reasons of hospital congestion to assure the treatment of all patients.

 Arch. Viola (2018), architect of Regulation Licensing and Enforcement

Division, stated that the congestion in public hospitals is very common phenomenon,

such as: a) massive patients in ER; b) mothers sharing beds in Obstetrics ward; c)

patients in corridor are all common in public hospitals. In addition, this problem

worsens in times of disaster and calamities.

According to Department of Health statistics (2017), Philippines have 476

government hospitals and 960 private hospitals. For rural health units and barangay

health stations, there are 2,598 health units and 20,241 barangay health stations

nationwide. (Source: Marielle Medina 2017)

Moreover, Pampanga, the 9th populated province in the Philippines, covered 58

hospitals in total. Pampanga has a total population of 2,198,110 and it compromises 19

municipalities and 3 cities. (Source: PSA 2015)

One of the hospitals which has congestion problem is the Arayat District

Hospital or it is known now as Dr. Emigdio Cruz, Sr. Memorial Hospital located at San

Agustin Norte, Arayat, Pampanga. Arayat have a total of 8 hospitals, 7 are private

hospitals and only 1 public hospital which is the Dr. Emigdio Cruz, Sr. Memorial

Hospital. (Source: Google Maps)

Arayat is the 6th most populated municipality in Pampanga which has 133,492

residences with 30 barangays, and having a total land area of 134.48km2. (Source: PSA

2015)
 SAN AGUSTIN
YEAR ARAYAT
NORTE
2000 3,099 101,792
2007 3,220 118,312
2010 3,495 121,348
2015 3593 133,492

Table 1.1 Population of San Agustin Norte, Arayat and Arayat, Pampanga

Table 1.1 shows that the congestion in Arayat District Hospital is no wonder

due to increase of population based on Philippine Statistics Authority.

Arayat District Hospital was previously located at Barangay San Roque, Bitas,

about 8 km from the town proper. The roads going to the hospital were impassable; the

only transport system was tricycle or none at all specially during the night and rainy

season. The clientele would rather go to private clinics or travel to San Fernando for

their medical needs. On May 18, 1989, the hospital was transferred to its new site at

San Agustin Norte, Arayat, Pampanga. (Source: Hospital Management)

This Memorial Hospital is now serving not only the Arayat, but also the people

of Sta. Ana, Candaba, & Cabiao, Nueva Ecija. This is the only public hospital in Arayat

where people choose to go because it is publicly funded.

Prior to the congestion, the hospital management provided annual statistic report

for the researchers. It is stated that the hospital is currently having 25 authorized bed

for the average of 70 patients in each day.

 BED OCCUPANCY
YEAR TOTAL INPATIENTS
RATE (%)
2013 17,961 196%
2014 18,385 201%
2015 20,416 223%
2016 23,971 261.98%
2017 23,088 253.02%
Table 1.2 Annual Statistics of the Memorial Hospital

Table 1.2 shows the continuous increase of incoming patients in the hospital

which leads the hospital to congestion.

Arch. Viola (2018), architect of Regulation Licensing and Enforcement

Division, stated that if the current hospital has a BOR of greater than 75%, the hospital

needs expansion. Therefore, Dr. Emigdio C. Cruz, Sr. Memorial Hospital having an

average of 227% BOR should be expanded.

In addition, the hospital has 11 medical, 53 allied medical, and 64 non-medical

personnel.

Hospital management tried to solve the problem by admitting patients more than

the expected capacity of each ward room, and some of the patients occupied the

hallways. According to the management, they already know that it is not good for the

patients because it is too crowded, but they cannot decline them because they need help

and needed some medication.

 With interest and understanding the needs of the current hospital, this research

aims to create a design for an additional one-storey for the existing hospital without

demolition of the structure and by means of retrofitting the ground floor.

Fortunately, there is a similar study conducted by Maglambayan, Williamson, L.

et al. (2018) entitled “Design of Additional Two Floors of Existing One Storey

Classroom Building”—they designed an additional two storey to the existing building

using Ultimate Strength Design (USD) by means of retrofitting the ground floor.

Therefore, the researchers found out that their study is feasible, and by this time the

researchers used steel for the proposed structure.

Using steel for structure has made a name in the field of modern construction.

Many civil engineers were deciding to use steel as a primary framing materials

because: a) steel saves money; b) lessen construction time; c) minimize the needs in

labour; d) gives a lighter weight without sacrificing the strength of the structure.

Many civil engineers, particularly the structural designers are still searching for

the new principles in structural design. One of the fastest growing importances in the

design of structural members for steel structures is the use of limit state design or Load

and Resistance Factor Design (LRFD) method.

LRFD is a scheme of designing steel structures and structural components

which may result a safer structure because of considering behaviour at collapse. A

structure under this design could sustain any activity that would test its limit in any

circumstances and remain fit for its use.

LRFD gives assistance to design structures based on both safety and

serviceability, unlike Allowable Stress Design service loads were only considered. In

this method, factored loads are applied to a steel component to determine the required

absolute strength, and this is evaluated with the component's assumed strength and a

suitable reduction factor.

Historically, the Allowable Stress Method (ASD) has delivered safe and reliable

steel and composite structures. However, method does not comprehend inconsistency

of various load effects (live load, dead load) and resistances (i.e shear capacity,

bending, cracks, etc.). For this reason, Load and Resistance Factor Design (LRFD) is

the preferred method of structural steel design.

Therefore, the researchers would like to create a design of an additional floor for

the current hospital to improve its serviceability and to be more sufficient in admitting

the patients, with the use of steel and LRFD as materials and design method

respectively.

1.2 Statement of the Problem

General Statement of the Problem

Dr. Emigdio C. Cruz Sr. Memorial Hospital is located at San Agustin Norte,

Arayat, Pampanga which suffers to congestion problem. This hospital is being funded
by the government which leads the people to choose this hospital. The hospital

management tried to solve this problem by admitting patients more than the capacity of

each ward room, and other patients occupied even the hallways. The researchers

decided to design another storey for the existing one storey hospital using the Load and

Resistance Factor Design (LRFD) and Ultimate Strength Design (USD) for the

retrofitting of the ground floor thus, it can sustain a two storey. This will also give

benefits to the community around San Agustin Norte if the project will be studied and

improved more. Moreover, the hospital will be more sufficient in admitting the

patients.

1.3 Research Objectives

1.3.1 General Objectives

The general objective of this study is to analyze the structure of the existing

hospital, and to design an additional one-storey using the LRFD method by means of

retrofitting the ground floor.

1.3.2 Specific Objectives

This study aims to:

 conduct a structural analysis of the structure.

 determine the appropriate retrofitting measures used in the design.

 provide structural design computations for both steel and retrofitted members

of the structure.
  identify which is more economical between retrofitting of the existing

structure to carry the additional floor or demolition of the existing structure to

construct a new two-storey hospital.

1.4 Significance of the Study

This study will be significant to the residents of San Agustin Norte, Arayat,

Pampanga. Through the help of this study, the hospital can serve more patients due to

the increased of facilities. Also, the hospital’s services will be more accessible and

comfortable for the patients. Hence, there will be an additional employment

opportunities to those who took medical degrees.

Furthermore, this proposed study can be used by the Provincial Engineering

Office for the other district hospitals that are suffering in congestion. It will also a big

help to those who seek solutions for congestion problems.

1.4 Scope and Delimitations

This study will focus on the structural design of the existing building, and the

additional one-storey using the Ultimate Stress Design (USD) of the ground floor

Also, a Load and Resistance Factor Design (LRFD) will be used for the additional

floor by means of retrofitting the ground floor. The other studies such as sanitary,

architectural, mechanical, marketing, plumbing will be delimited.

In structural analysis, the researchers used the STAAD.Pro software. Through

the use of this software, the researchers could construct a model of proposed building,

and could input all the forces (including wind load and earthquake load) acting in the
structure to clearly identify the critical points of the structure. Also, the dead loads and

live loads will be specified from NSCP 2015 (National Structural Code of the

Philippines). In the structural design, ASEP Steel Handbook 2004 was served as a

reference to identify the best sections to be used.

The feasibility studies about the construction of the proposed plan without

stopping the operations of the hospital will be excluded from this study. This study

will not determine the actual effectiveness of the proposed plan due to the inability of

the researchers to identify the actual number of patients in the near future.

1.5 Definition of Terms

Allowable Stress Design (ASD) – It refers to the traditional method of designing

steel structures. The objective of this method is to make sure that the actual stress

provided by the loadings is less than the allowable stress of the structure.

American Iron and Steel Construction (AISC) – It refers to the American institute

and trade association for the use structural steel in construction industry.

Beams – It refers to the horizontal structure members that carry loads.

Bed Occupancy Rate – It refers to the measure of intensity of hospital resources

utilized by inpatient over a given period of time. (January 1 – December 31)

Column – It is a vertical structural member that carries loads.

Dead Load – It refers to the load that is permanently fitted in the structure.

Earthquake Load – It is a lateral load acting on the structure during an earthquake.

Also, it is commonly considered when designing a structure.

Footings – It is usually embedded structural members that carry the whole structure.

Jacketing – It is a common type of technique in retrofitting which is the existing

member of the structure is chiseled, reinforced, and covered by reinforced concrete to

increase its strength capacity.

Live Load – It refers to the moving load.

Load and Resistance Factor Design (LRFD) – It is a steel method design that can

determine the required absolute strength, and it is evaluated using the components of

the assumed strength, and suitable reduction factor.

National Structural Code of the Philippines (NSCP) – It is a reliable reference of

specifications and procedures in designing safe structure.

Reinforced Concrete – It is a strengthened concrete by reinforcing a steel bar inside

the concrete.

Retrofitting – It is a way of restoring, adapting, furnishing, and installing new parts

in the existing structure.

 1.6 Conceptual Framework

Collection of Data

Structural Analysis

DESIGN RETROFITTING

STRUCTURAL
RESULTS