Dr. Michael Bennish discusses challenges in designing health facilities in South Africa. He notes the country faces difficulties balancing an urban model based on expensive high-tech hospitals and providing rural care. More attention needs to be given to low-cost, sustainable rural facilities and innovative mobile units. At his organization Mpilonhle, they are refining their mobile unit design and examining components. International influence can provide model programs, but local knowledge is crucial for effective partnerships in design for the poor.

1. Health Facilities Design and Development
South Africa Summit
08‐11 November 2010
Radisson Blu Gautrain Hotel, Sandton,
Johannesburg, South Africa
Speaker Q & A with
Dr. Michael Bennish
Managing Director
Mpilonhle
Conducted by
All opinions and statements in this interview are of the interviewee themselves and do not reflect the opinion(s) of
IQPC and/ or its personnel.

2. Q. What changes do you foresee with design and development of health facilities?
A. Countries like South Africa, because of economic and social disparities, have two
often contradictory health models that make for difficult challenges when
designing health facilities.
One health model, largely based upon industrialized countries, is based upon
very high tech and expensive to build and sustain fixed facilities in urban
areas. The other is providing services to the poor, especially the rural poor –
which in South Africa still constitute nearly 50% of the population, and live in
widely scattered homesteads in rural areas that have poor transportation.
The former takes up a disproportionate share of the health budget – a problem
that has persisted for many decades despite sustained critiques. There are a
number of reasons for this – including the graft that is inherent in large building
projects in developing countries (or any country for the matter), the political
attractiveness of this sort of large scale project, and the sense that high‐tech
facilities and service are a symbol and measure of equality for impoverished
persons who have long suffered from exploitation.
The latter – rural facilities – receive far less attention, and far less funding in
proportion to the population that they serve. There is clearly a need to design
facilities for rural areas that are robust, energy efficient and low
maintenance. There is an even greater need for attention to the role and design
of mobile units, where innovation has been lacking.
A more balanced strategy in terms of the utility and value of health facilities is
clearly needed. Whether it will occur, given the economic, political, and social
forces at work, is uncertain.
Q. What are some of the upcoming projects relating to health facility
development?
A. At Mpilonhle we are trying to perfect our model of an integrated mobile unit
what provides a variety of services. This involves tweaks more than a
fundamental redesign – as we currently do not have funding for building
additional mobile units.
Should such funding become available, we would start over again – critically
examining the functioning of all of the design components of the mobile unit.
All opinions and statements in this interview are of the interviewee themselves and do not reflect the opinion(s) of
IQPC and/ or its personnel.

3. It may be that we end up with virtually the same design – or something radically
different. But we would critically look at how we have used the facility, and well
the current design has functioned – improving things that need improvement,
and keeping those that have worked well.
Q. Please explain what your current challenges are when designing and
developing health facilities?
A. Imagination, imagination, imagination – or lack thereof.
As an NGO we have had a relatively free hand in what we were able to develop
in collaboration with schools. Developing facilities for the government (or the
private health industry) comes with a set of constraints, in that design is often
handled by persons with little inherent interest in design. They are often more
amenable to the lowest risk solution, the lowest cost (in the short‐term) solution,
or the least radical solution.
Q. What international influence can we expect in this arena?
A. For services to the poor the primary contribution and influence can be in design
and developing model programs. International designers and supporters,
however, have to be aware of their usually modest knowledge of local conditions,
and develop effective partnerships that bring the best in design to those who
know local conditions.
The Health Facility Design and Development South Africa Summit takes place from 08-11 November 2010
atthe Radisson Blu Gautrain Hotel, Sandton, Johannesburg, South Africa. For more information and to confirm
your participation, call on +971 4 364 2975, email enquiry@iqpc.ae or visit www.healthfacilityafrica.co.za
All opinions and statements in this interview are of the interviewee themselves and do not reflect the opinion(s) of
IQPC and/ or its personnel.