DESIGN FOR MEDICAL BUILDINGS : A Manual for the Planning and Building of Health Care Facilities under Conditions of Limited Resources

Abstract

This manual contains design, construction and cost guidelines for the building and extension or improvement of medical facilities. It has been prepared primarily for the doctor and his staff who, in rural Africa, must often be their own architects. It may also be of value to the architect who, perhaps for the first time in his career, is confronted wi th the special problems associated with the provision of medical buildings in rural areas. Furthermore, it provides information which could be useful to people who are engaged in raising funds and allocating money for medical purposes in developing countries. The manual concentrates on the rural hospital which is a reasonably well defined and familiar element in most health systems and which exemplifies many of the functions found in medical buildings both higher and lower in the health care chain. The principles and guidel ines herein are considered equally relevant to the design of health centres and dispensaries or to smaller district hospitals. Hospital buildings at present tend to be excessively expensive, consuming funds which are sorely needed in other areas such as the primary health sector. The guiding principle in this manual is that, for medical buildings, the expenditure of material, monetary and manpower resources should be reduced to the lowest level consistent with adequate and acceptable medical care. The full range of architectural activity, from initial feasibility study to supervision of the work on site, is covered, the emphasis being that each building problem requires its own solution according to local needs and ~enefitting from the use of local materials and skills. To this end a considerable amount of space has been devoted to explaining how buildings can be designed from scratch. Where plans are shown they are intended only to illustrate the design principles involved and not as prototype solutions to be applied indiscriminately. The material in this manual is based primarily upon a study made over a 12-month period by the authors, of some 15 hospitals and hearth centres in different regions of Kenya and Tanzania. At each place a detailed physical and functional survey was made and discussions with staff recorded. Existing documentation on the subject has been drawn upon as well as the collective experience of the Housing Research and Development Unit in architectural matters and the African Medical and Research Foundation in medical matters. The recommendations and guidelines contained in this manual do not necessarily reflect either medical or building regulations in force at a particular time. In live situations these regulations may have considerable effect on such items as accommodation requirements and space and construction standards. One of the consequences of this is that, in actual building projects, costs will tend to rise above the levels indicated