Date of Award

8-2012

Document Type

Thesis

Degree Name

Master of Science (MS)

Legacy Department

Architecture

Advisor

Allison, David J.

Committee Member

Jacques , Annemarie

Committee Member

Bruhns , Robert

Committee Member

Troung , Khoa

Abstract

The network of healthcare facilities in Mozambique is made up of facilities that are old and do not meet the current healthcare needs of the country. Many facilities have already existed well beyond their useful life of, with approximately 50 to 75 years, and continue to operate without considerable maintenance. The access to care is very low. According to the Ministry of Health, the ratio of population at the primary level of care delivery (health centers) is an average of 17,000 people per each healthcare unit and for the secondary level (district and rural hospitals) is 501,000 people per each healthcare unit. World Health Organization recommends a ratio of 10,000 inhabitants per primary health (first referral hospital and health centers).
The population is growing very fast, with projections pointing to 23,700,715 inhabitants in the year of 2012, and 29,310,474 inhabitants by the year of 2020. Basically, the population will increase 23.7 percent in less than 10 years. The population is extensively immigrating from rural to urban areas, settling in peripheral unplanned ex-urban areas which are currently unserved in terms of access to healthcare. Because most existing healthcare facilities are old, in a state of disrepair, and do not support state of art practices in healthcare, it is evident that future interventions in will require the use of new planning and design tools. The tools proposed in this thesis, 'Guidelines for Healthcare Design in Mozambique' should meet the new healthcare design challenges considering the principal country's characteristics, limitations and its stage of growth.
Currently, urban areas (urban and peripheral areas) are experiencing an exponential population growth derived from migratory factors and high birth rates. These populations are settling in fringe areas around cities without any previous urban settlement or planning. These crowded and unserved settlements require new and improved healthcare facilities to ensure equity and quality of healthcare service delivery for the entire population. Additionally, there are higher expectations for improved health care from middle class population with better income which is also permanently increasing.
The secondary and tertiary levels of healthcare service delivery, including general and provincial hospitals, both referred for urban areas, is the only way of addressing the current and future needs of the population of these urban settings.
Thus, this study aimed to compose a set of design guidelines based on universal standards and best practices in healthcare design that can be applicable and sustainable in the current Mozambican reality, with major focus in urban settings, while improving the level of healthcare services delivered to meet (i) patients, staff and family needs; (ii) to ensure health and improve safety; (iii) to improve efficiency and effectiveness; and (iv) to provide building fabric design that positively responds to the diversity of environmental and social conditions of the country.
As result, the set of proposed guidelines bring the awareness and underlines two main topics. (1) A focus on how the overall site, surrounding context and infrastructures should correlate in order to build a healthcare facility that is integrated in the natural environment. A friendly instead of harming facility; and (2) how to plan, organize and design a building fabric to ensure the current state of art in healthcare delivery while responding the overall healthcare needs of the population underlined on the main goals of this study.
The set of guidelines includes (a) site selection criterion, (b) security, (c) outdoor space use, (d) facility growth and adjacencies, (e) wayfinding - circulation hierarchy and signage, and (f) building form and scale. The expected outcomes of the implementation of these guidelines includes but are not limited to (i) reduction of hospital-acquired infections, medical errors and other adverse events; (ii) reducing patient stress and pain; (iii) providing settings that enable social support; (iv) provide settings that enable privacy and confidentiality; (v) providing settings that improve communication; (vi) optimizing care delivery to address staff shortage; (vii) maximizing the use of natural resources; and (viii) and building facilities that allow flexibility, adaptability and expandability for accommodating change over the time.
Future studies will be needed to address and carefully adjust the physical features of overall facility spaces including patient room, patient ward, exam and treatment room, intensive care rooms, nurses' stations and core services spaces, family accommodation spaces and public realm spaces, in order to make these spaces friendly and comfortable, which role will be to reduce anxiety, frustration, fear, angry, stress and dissatisfaction of patients, staff and family while in a healthcare setting

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