DENVER, Colorado – In sessions filled with clinicians, health educators, program implementers, and policy makers, the last person I expected to meet at the 138th Annual Meeting of the American Public Health Association was an architect. Yet, Christine Kiefer is just that – an architect from the University of Washington who is building a new US$5 million, 3-story, 52,500 foot health facility in the Amhara region of Ethiopia.
The new Comprehensive Outpatient Center in Gondar is the result of a partnership between the Gondar College of Medicine and I-TECH Ethiopia and the University of Washington. The project, funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), aims to increase health care worker training in the Amhara region, an area where there are 50 percent fewer health care workers than recommended by the World Health Organization’s standard of 2.3 health workers per 1,000 people. The new Center will train nearly 300 health care students per year, in addition to offering nearly 370,000 health care visits per year.
We often talk about the “building blocks” of a health system, referring to the health workforce or service delivery. However, as Kiefer reminded the audience, in order to train health care students and provide quality services, careful planning and consideration must be given to very real “building blocks” – the bricks and mortar that make up hospitals and clinics. I-TECH provided technical assistance to Gondar College of Medicine in the form of institutional planning, architectural drawing, and construction design to ensure that the new facility could train medical students and provide health care services in the most effective manner possible.
While designing the building, architects had to consider a number of factors, ranging from infection control to the disposal of biohazards to the limits of electrical and plumbing infrastructure available in the area. Even the most basic project activities, such as constructing a map of the construction area, proved challenging as aerial photos and local maps did not match up, and certain streets were unmarked or did not have names. Sustainability was another major concern of the architects. For example, although the building is several stories high, architects ensured that each level could be accessed without the assistance of an elevator, as elevators require special maintenance and parts not readily found in-country.
Kiefer’s presentation reminded me that improving global health is truly an interdisciplinary endeavor. Without thoughtful, sustainable architecture, such as that of I-TECH architects in Gondar, medical facilities may not be able to carry out their appropriate functions in an effective manner. Furthermore, it is necessary for people from different disciplines to work together on such activities – architects must speak with microbiologists, clinicians, and water and sanitation experts to understand all of the factors that are important in the design of hospitals and clinics. Kiefer’s presentation also underscored the importance of careful planning – to build a successful building, you need a good blueprint and sound foundation. These lessons from architecture also apply to building health care systems – careful planning and firm foundations are needed at all levels in order to improve global health outcomes.