Hospital for gastroenterology in Afghanistan Afghanistan has a National Health Service (NHS), providing free treatment and medicines. The total NHS budget for Afghanistan is half the budget of, for instance, the Maastricht University hospital. As a result patients have to bribe their way into the health chain, from guard to surgeon, to receive medical treatment. Private practices are available, often run by the same doctors who work in the NHS hospitals. Patients who can afford it fly to India and Pakistan for treatment.The local partner is a medical doctor who established a small diagnostic clinic specialised in endoscopic diagnostics. Forty patients are treated daily for gastroenterological problems like ulcers etc.In 2006, he and the Dutch applicant planned to set up a small private hospital for digestive diseases (gastroenterology), providing diagnostics and treatment including operations. For the last six years, the partners carefully prepared for the establishment of the hospital. To provide for the management skills required, the local partner sent a family member to get a MBA in health care administration in India, and he himself worked for one year in Iran as head of a laboratory of a major hospital. Other family members were sent to different relevant courses. Gradually, he extended his network to other hospitals, mostly in India, to ensure possibilities for training and second opinion. In 2011, he acquired a plot to build the hospital. The core business is to be gastroenterology, but as these diseases are often related with other diseases, other medical specialists are required as well. As they are not available in nearby hospitals, these specialists will have to be recruited for this hospital on a freelance basis. Telemedicine facilities reduce the need for patients to go abroad for a second opinion. Average treatment costs an estimated 60 euro. The capacity of the hospital at the end of the pilot face is to be 2,000 patients per month.The applicant is by origin an Afghan medical doctor who is licensed in the Netherlands as a district nurse. He runs a health care company and concerns himself mostly with setting up the management of the hospital, training programmes for medical personnel and telemedicine facilities. The major part of training and telemedicine will be done by the Narayana Health Centre in Bangalore and specialists in Maastricht and Amsterdam pledged their support to contribute to this end as well.Corporate Social Responsibility (CSR)The joint venture has ample reason to treat their personnel well. Basic-level workers should not be tempted to steal, highly trained medical personnel has sufficient employment opportunity to negotiate a good contract. The partners intend the hospital to become a training hospital for medical students in the future.Impact•	Employment and working conditionsBasic-level workers will be paid above living wages, other personnel will be trained extensively and paid competitive wages. There will be fringe benefits like free medical treatment, meals, paid leave, etc.•	Innovation / Transfer of knowledgeAccording to other doctors running private clinics in Afghanistan there is not a single facility that can provide for this type of medical care. Most doctors prefer to run an extended General Practice clinic with beds (“cottage hospital”) because of the investments in equipment and training involved in a specialised hospital.•	Chain effectsThere is some positive impact on local suppliers, mostly with regard to maintenance. The major impact is the supply of imported medicines.Impact on local customers is very high. Cost of medical treatment will be significantly lower as they do not have to travel to India or Pakistan. It also means that far more people will receive medical treatment than before.•	EnvironmentMost waste will be incinerated and what is left will be dumped in a gated dump site in the nearby dessert.•	Position of womenNearly half the high skilled staff will be female to mirror the patients. To treat 24,000 patients annually for digestive diseases and sell medicines.