1. Courtyards between the inpatient bed units allow for light and ventilation and add a social and religious component to the plan. The
geometry of each courtyard is oriented towards Mecca. Courtyards between the inpatient units provide views of nature from the beds. Gender
segregated circulation pathways flow around the perimeter of the courtyard, offering patients dignity and privacy in accessing their care.
Images © Cannon Design (unless where noted)
A PROTOTYPE IN AFGHANISTAN
THE STORY OF THE DEVELOPMENT AND CONSTRUCTION OF A
PROTOTYPE HEALTHCARE FACILITY TO HELP TRANSFORM CULTURE
By: Deborah A. Sheehan, Principal and Health Market Leader, Cannon Design, Chicago, USA
W
omen and children in many parts of the world are only to Sierra Leone as a result of measles, malaria, malnutrition and
thwarted from leading productive lives due, not only, more. Access to quality healthcare for pregnant women and their
to lack of education but also basic healthcare. The children before, during and after childbirth would eliminate most of
design of a new prototype healthcare facility to serve these deaths and immensely improve the education and productivity
as a template for the delivery of medical services in Afghanistan would picture for the Afghan society overall. Based on World Health data,
meet that country’s dire need and help improve its social progress. Afghanistan was selected as one of four sites to be part of a project
With a per capita income amongst the lowest of all developing by the International Organization for Migration and USAID (U.S.
countries, Afghanistan is second to last on the United Nation’s human Agency for International Development) to create a template for
development index, with a life expectancy of 43 years for women, and delivery of basic medical services. Public health services would provide
one of the highest maternal mortality rates in the world, according to disconnected rural communities with a way to bridge the gap to move
UNICEF. The long war-torn country’s child mortality rate is second upward in cultural development.
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2. FEATURE PLANNING
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SIMPLE, FLEXIBLE DESIGN health and education, with enough space to house a couple of
What would be the ideal building block to make this progress key specialities. In Afghanistan, the need for training midwives and
possible? Architects answered with plans for a simple, flexible, female caregivers is essential to lowering infant mortality rates.
transferable community hospital that could demonstrate a Orthopaedic services are also in high demand due to land mine
permanent commitment, yet be small enough to be placed in rural injuries. The 100-bed module provides enough space for basic
villages. The basic 100-bed model requires a minimal investment, medical-surgical services, as well as an emphasis on obstetrics and
yet is capable of bringing a leap in the quality-of-life to thousands. orthopaedics. One of the flexible planning innovations proposed
The solution distinguishes itself in that it invites participation and is a six-bed unit that can be operated as a three-bed unit when
investment of the local people. The plan uses universal techniques staff levels permit. By dividing the units into gender specific wards
to adapt to the cultural and medical needs of the visitors. of 24, then into rooms of six, then into groups of three, there is
The size for the hospital prototype is especially supportive tremendous adaptability of use over time of day, shift, or season.
of sustainability. Because water, power and waste removal are Depending on evolving care delivery model, clinical service line, 
assumed unavailable, the hospital must be small enough to operate
off the grid, yet large enough to achieve an economy of scale
in water and power production. Depending on the size, power Bed configurations can adapt to future change in patient acuity to
generation and sterile processing are either in the building or support elevated care at bedside
supported by mobile resources. Several architectural features
support low energy consumption. Roof overhangs, for example,
protect the south façade from direct sunlight during the hottest
part of the day. Air is brought in through low windows while
operable clerestory and openings in the ceiling allow warm air to
escape. Basic fans facilitate air movement. In the winter, a lower sun
angle allows direct sunlight and heat gain deep into patient rooms.
Baseboard units provide radiant heat, while fans bring in tempered
fresh air and circulate it throughout the building.
The plan’s flexibility emphasises changes in size, according
to a community’s needs. Three smaller modules can be created
based on the 100-bed prototype: a 50-bed women’s hospital,
a 20-bed day hospital and a clinic. Because the modules are
flexible and expandable, a hospital can be reconfigured as needs Flexible Nursing Models flex staff to patient census over time of day
change. By selecting the necessary module for a particular location,
construction and operational costs are kept low. Modules can be
built with any common material, including walls of brick, adobe,
concrete or sandbags. Construction of the modules requires that
utilities be secured and protected on the site. Water is extracted
from a well by deep boreholes and pumped through a treatment
facility. A water tower provides a two-day reserve in case of power
failure. Fuel tanks for the generator are sized for a three-month
reserve. Wastewater generated from food production is collected
and treated in separate tanks, as required by Islamic law. The tanks
then discharge into a sand filter bed.
ADAPTED TO SPECIALITIES
A key difference between this and other solutions typically
implemented on a semi permanent basis is the clinical model. This
prototype can provide all the basic services needed for community Illustration shows financial investment in ratio comparison to healthcare
efficacy measured by mortality rate.
Reprinted with permission © World Bank Group
IN SHORT
 he design of a new prototype healthcare facility to serve as
T
a template for the delivery of medical services in Afghanistan
would meet the country’s dire need and help improve its
social progress
 ortality, education and productivity could all be improved
M
in Afghanistan by providing a new system for the delivery of
basic medical services
 he size for the hospital prototype is especially supportive of
T
sustainability because water, power and waste removal are
assumed unavailable
www.lifesciencesmagazines.com

3. staff resources, and cultural preference, the units can be managed and women can reach inpatient services along separate routes.
in many configurations without renovation. Because of their A main courtyard creates a secure public space for visiting family
adaptability, these health centres also function as social centres members, between wings and oriented towards Mecca. 50-bed
for education, security and employment, positively impacting the women’s hospitals target prenatal care to blunt Afghanistan’s
community as a whole. momentum of high infant mortality. By designating the entire
facility for women, cultural boundaries in education and access are
THE PROTOTYPES removed. Education facilities in the hospital can be expanded to
The 100-bed hospital includes bedded care, outpatient clinic, train speciality caregivers, increasing the employment of women in
diagnostic and treatment, emergency department surgery, x-ray, the community.
dental, support space, education and administration, and an The 20-bed day hospital, also supported by mobile surgery, can
ambulance port. The 15-metre clear span, single story, single slope rotate as an outpatient day hospital or overnight inpatient care.
roof accommodates many types of space. The hospital can provide Inpatient exam rooms can receive day visitors, and then be quickly
all the basic services needed for community health and education, converted to overnight recovery as needed for the last surgery
as well as allow enough space to house key specialities. An cases of the day. Classroom space can double for public health
emphasis on obstetrics and orthopaedics can be accommodated, screenings and inoculations. This smaller hospital can grow to the
along with basic medical-surgical services. Flexible bed units allow 50-bed and 100-bed size by building shell treatment spaces and
that a six-bed unit can be operated as a three-bed unit when staff using the space for interim support, reserving places for expanded
levels permit. Gender-specific wards of 24 are possible and can be bedded care, reusing public health spaces for new healthcare
further divided into rooms of six or three, for many configurations worker programmes, and leveraging staff and resources across
without renovation. long distances with mobile modality trailers and trucks. As the
The 50-bed hospital, supported by mobile surgery, number of highly trained personnel increase for inpatient services,
accommodates the separation of the sexes, an important cultural so will the need to recruit and train staff from the immediate
consideration, and multi-patient wards. From the main entry, men community. On-site housing that was built to house construction 
A strong connection to place makes these permanent, scalable hospitals a part of the communities in which they are built. Universally understood building-organising principals
like courtyards are combined with local influences in colour and materials. Knowing that mechanical ventilation would not be maintained or was unavailable, the naturally
ventilated architecture responds to both summer and winter conditions
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4. workers can be converted to a dedicated dormitory. Combined their resources across much larger areas, and react to catastrophe.
with the 20-bed hospital’s education and administration spaces, a They also allow outside organisations an opportunity to contribute
complete school of nursing is possible for the community, further with a proprietary platform and controllable logistics. This means that
contributing to productivity. imaging equipment companies, for example, could access markets that
The no-bed clinic is the prototype’s most basic building block. This are not currently available. Services that are highly technical, such as
module is adaptable to support major care surges during catastrophic cardiac cath, can be brought to many new patients. Services that are
events. Primary and routine surgery care is conducted during normal too specialised for wide use, such as lithotripsy and cataract surgery,
periods, with a triage centre during mass casualty. Divided into high can be brought to rural areas. The hub clinic provides an interface for
and low acuity, the building is further divided into public and support the local and international community to interact, via technology and
functions. Every side of the building specialises in a group of functions, expertise. In Afghanistan, it is the beginning of new expectations for
based on access and privacy. The plan creates a hub for future both the patient and the care industry. Higher expectations are that
expansion or addition of mobile units. The ‘hub’ clinic serves as the suffering is no longer acceptable and that medicine is not just available
docking platform for mobile medical units, which can carry medical for those in urban centres or for only the wealthy who can travel to
resources throughout large remote areas, reaching people without access healthcare.
access to healthcare of any kind.
CONCLUSION
THE HUB CLINIC Mortality, education and productivity, all of these can improve in
As an outpost in a developing nation’s health network, the hub clinic Afghanistan by providing a new system for delivery of basic medical
is the ideal docking platform for mobile medical units. These units may services. A flexible, transferable hospital plan makes a commitment to
reside at other facilities, or in storage, but would be installed here to communities that urgently need not only healthcare, but also learning,
respond to a temporary or overwhelming need. The mobile units can jobs and a better way of living. Women and children will be the most
also serve as an interim step prior to a permanent addition. These dramatic winners, and will be far better able to contribute to the
mobile units provide developing governments the ability to leverage positive transformation of their ravaged nation.
The main courtyard is situated just east of the main public entrance and provides a central gathering space for communal events. This courtyard creates a secure, public space
for worship and education events. This central feature also orients visitors to the campus’ key services
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