PROPOSED DESIGN OF A PRIMARY HEALTH CARE CENTER

OBOKUN, OSUN STATE

BY

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 CHAPTER ONE

INTRODUCTION

1.1 Brief Description of Primary Health Care Building Type

Primary Health Care (PHC) is driven by a political philosophy that emphasizes a radical change in

both the design and content of conventional health care services. It also advocates an approach to

health care principles that allow people to receive health care that enables them to lead socially and

economically productive lives (Dennil et al. 1999: 2). The Alma-Ata declaration of September 1978

defined the concept of PHC as essential care based on practical, scientifically sound and socially

acceptable health care methods and technology, made universally accessible to individuals and

families in the community through their full participation and at a cost that the community and

country can afford to maintain at every stage of their development in the spirit of self-reliance and

self-determination. It forms an integral part both of the country’s health system, of which it is the

central function and main focus, and of the overall social and economic development of the

community. It is the first level of contact for individuals, the family and the community within the

national health system, bringing health care as close as possible to where people live and work, and

constitutes health care services (WHO 1998: 15). In addition, Alma-Ata declaration states that any

Primary Health Care program should include at least the following components, namely, education

about prevailing health problems and methods of preventing and controlling them; the promotion of

food supply and proper nutrition; an adequate supply of safe water and basic sanitation; maternal and

child health care, including family planning and care of high risk groups; immunization against the

major infectious diseases; prevention and control of locally endemic diseases; appropriate treatment

of common diseases and injuries and the provision of essential drugs, including vaccines.

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Primary Health Care Centre is the cornerstone of rural health services- a first port of call to a

qualified doctor of the public sector in rural areas for the sick and those who directly report or

referred from Sub-Centres for curative, preventive and promotive health care (India, 2002). Primary

Health Care Centre is a basic health unit to provide as close to the people as possible, an integrated

curative and preventive health care to the rural population with emphasis on preventive and

promotive aspects of health care. We are in a period of major change, with more being provided at

primary level rather than in hospitals.

1.2.0 Client Background History

The Client/User

As part of the “change” campaign of the current administration in the State of Osun, the Obokun

Local Government of the state under the leadership of the Local Government Chairman, has

proposed an efficient Primary Health Care Centre for the benefit of the people in Obokun Local

Government Area, as the current Centres in the area are inadequate in terms of quality of the services

they render/offer.

Brief History of Obokun Local Government Area

Obokun is a Local Government Area in Osun State, Nigeria. Its headquarters are in the town of

Ibokun at 7047’00”N 4043’00’E / 7.783330N 4.716670E. Other towns in Obokun Local Government

Area include Imesi-Ile, Otan-Ile, Esa-Oke, Ilase, Iponda, Ikinyinwa, Idominasi and Ora.

Project Location

The Primary Health Care Centre is being proposed to be located in Iponda town in Obokun local

government area, Osun state, Nigeria, Africa. Its geographical coordinates are 7 o 44’ 0” North, 4o 43’

0” East. Obokun local government covers a total land area of 527km 2 (203sq mi), and a total

population (according to 2006 census) of 116,511.

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 Fig: Map of the state of Osun, divided into thirty (30) local government areas, with

Obokun local government area arrowed.

1.3.0 Statement of Problem

Primary medical care is only an aspect of Primary Health Care. Primary care is “front line” or “first-

contact care”. It is person-centered (rather than being disease or organ system-centered) and

comprehensive in scope, rather than being limited to illness episodes or by the organ system or

disease process involved (Emeka & Masemote, 2011). Therefore, Primary Health Care Centre, being

a person-centred centre is expected to provide integrated and accessible health care services by

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having adequate building structure which is aesthetically pleasing and homey, together with a nice

and well landscaped environment.

Based on what is on ground presently, it is conclusive to admit that the Primary Health Care system

at Iponda, Obokun local government area is trying to be effective in addressing the health problems

in the community. But, the fact remains that the Primary Health Care Centre will only continue to

strive for effectiveness, and can never be effective with the facilities on ground. The facilities

presently are simply inadequate and cannot effectively address the health problems in the

community. the proposed building will be adequate enough to serve the neighbouring towns such as

Ilase and Ikinyinwa

1.4.0 Justification of the Study

Apart from the personal interest in Primary Health Care Centre design, it is observed that the people

of the Obokun Local Government Area are not satisfied with the existing Primary Health Care

Centres in the area. Also, the treatment departments and the support facilities in the existing

buildings are inadequate. That is why this project is coming up to provide solutions to the problem

and looking forward to bridging the gap of satisfaction.

1.5.0 Aim and Objectives

The aim of this research is to prepare a program for the design of an effective Primary Health Care

Centre dedicated to improving the health status of the people in Obokun local government area of

Osun state. To achieve this aim, specific objectives put forward to be pursued are, to:

1. Carry out case studies on primary health care centre.

2. Assess the brief and requirements of the client

3. Assess the reaction of users (the patients and the health workers) to the existing facilities.

4. Assess/analyze the site and the environmental factors.

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 5. Propose a scheme that enunciate and encompass the client’s and users’ requirements.

1.6.0 Purpose of Preparing the Program

The purpose of this study is however, is to prepare a program for the design of a Primary Health

Care Centre for Obokun Local Government Area, to be located in Iponda, Osun state. The purpose

of the program is to gather information that is related to the project’s aim and objectives. How

people would use the building, the space requirements for specific areas, relationships and

adjacencies, and the desired level of quality. The purpose of the program is also to compile

information that will be used to translate the findings on how the building will function into design

criteria.

1.7.0 The Organization of the Program Report

The program will be organized into a conceptual framework which is as a follows;

Chapter one:- Introduction – this will include a brief description of the building type, the client, the

history of the client, demographic characteristics of the location, philosophy of the client, aims and

objective of the program.

Chapter two:- The state-of-the-art – this will include a historic review of the building type, category

of the building type, functions, spaces and relationships between spaces common in the building

type, technological and environmental solutions commonly used for this building type. Conceptual

approaches to this building type, summary.

Chapter three: - Case studies

Design criteria: project goals and objectives, functional/spatial criteria, technological and
environmental criteria, legal and planning regulations, behavioural criteria.
Chapter four: - Site and Environmental Analysis

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Site and Environmental Analysis: analysis of the topographical and the environmental conditions of
the site, analysis of the immediate environment or the area of the city in which the site is located (in
terms of activities and other relevant issue).
Chapter five: - Approach to the design – the designer’s idea/concepts (at different levels of the

facility) illustrated with the sketch designs.

CHAPTER TWO

2.0.0 STATE-OF-THE-ART

2.1.0 HISTORICAL REVIEW OF PRIMARY HEALTH CARE CENTRE

The term ‘Primary Health Care’ was used to mean the care given to the patient by the health worker

who saw him/her first. It was also called ‘first contact care’; but if the patient was referred to the

hospital it was called ‘secondary care’. Following this in May 1978, an international conference was

headed by World Health Organization (WHO) member states in town in former USSR (now Russia)

called Alma-Ata, where 134 nations including Nigeria declared that Primary Health Care (PHC) is

the key to attaining health for all. At the conference, it was agreed and concluded that Primary

Health Care (PHC) is essential health care made universally accessible to individuals and acceptable

to them, through their full participation and at a cost the community can afford (WHO/UNICEF

1978). In the global context, governments are searching for methods to improve the outcomes of

their health care systems. Since the Declaration of Alma-Ata in 1978, there has been a greater

acceptance of the fact that a strong primary care system is the foundation of an integrated health care

system since it is the first level of contact for patients with the health care system. Primary care has

been called the linchpin of effective health care delivery and can assist in greater continuity and

responsiveness of health care (Saltman, R.B. and Figueras, J., 1997; World Health Organization,

2002, as cited in Boerma, 2006). According to Rifkin (as cited in Barnes et al., 2005), there are three

approaches to community participation in health care. The first is the ‘medical approach’, in which
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the goal is to cure disease, and control lies with the medical professional. The second is the ‘health

services approach’, in which individuals are mobilized to take a more active part in the delivery of

services. The third is a ‘community development approach’, in which the community is actively

involved as a partner in making decisions to improve health.

Primary care encompasses the first two – “top-down” approaches. Primary health care embraces the

third approach, which is “bottom-up.” Primary care focuses on intra-sectoral collaboration

(collaboration within the health care sector and between health care providers). In Primary care,

individuals are empowered to make decisions about their health with the assistance of the provider.

In contrast, Primary health care involves integration and collaboration within community sectors to

address social and economic development. By this process, communities become more involved in

health issues. Primary health care also addresses matters related to the determinants of health,

emphasizes collective decision making and collective action and results in a redistribution of power.

Muldoon, Hogg and Levitt (2006) compared definitions of primary care and primary health care and

found that features common to both definitions included first-contact care, accessibility,

comprehensiveness and coordination of care. The elements they found in definitions of primary care

included person-focused care (not disease-oriented), care over time and sustained relationships with

patients. These elements also define primary health care. Primary health care is delivered in the

community at the first contact point between members of the public and health workers. In the past,

people would see their general practitioners either at their homes or in the doctor’s surgery. If

necessary, they would be referred to specialists to receive care. However, the sustained trend

towards specialization amongst doctors starting out on their careers has produced a shift towards

medical and diagnostic centres offering extensive medical services. The advantages for the patient

are shorter waiting times and a greater possibility of being able to receive a diagnosis and treatment

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 without having to be referred to another doctor. For the doctor, the advantages are the introduction of

more regulated working hours and ability to exchange and learn from the experiences of other

doctors in the practice. This is a combination of two or more practising doctors with shared staff and

premises.

2.2.0 The Three Levels of Care and Hierarchy of Health Care Delivery Units

Whatever their administrative organisation and in whatever way they are financed, all the systems of

health care delivery comprise a range of institutions which are graded according to their degree of

sophistication and specialization, and the level of care they can provide.

The health care system in Nigeria is built on the three-tier responsibility of the Federal, the State and

the Local governments. These three levels of government correspond to the three levels of care viz;

the primary level, the secondary level and the tertiary level.

LEVELS OF HEALTH CARE

PRIMARY CARE SECONDARY CARE TERTIARY CARE

COMPREHENSIVE PRIMARY HEALTH HEALTH POST/ SPECIALIST HOSPITAL TEACHING HOSPITAL

HEALTH CENTRE HEALTH CLINIC MOBILE CLINIC

CENTRE

GENERAL HOSPITAL

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(A) The Primary Care Level

This includes all the general health care practice and services based in the community and relatively

accessible to patients and their family. These services are: preventive, curative, promotive and

rehabilitative health measures to the people at the entry point of the health care system.

To a very large extent, the provision of this level of care is the responsibility of the local

governments, often assisted by the state(s) ministries of health and often by UNICEF.

On the whole, there are about four distinct classes of health institutions established to fulfil the

primary health care delivery system while the others are to fulfil either the secondary or the tertiary.

Those for the primary care level are as follows:

i. Mobile Health Centre/Health Post

This is a primary level health care delivery unit. It is concerned with rendering minimum health care

services to the community with the participation of the community leaders and health auxiliaries. It

is involved in giving health education to the people; it is involved in immunizations e.g. Expanded

Programme on Immunization (EPI), simple preventive and curative activities and also the referral of

patients to more specialized levels.

ii. The Basic Health Centre/Health Clinic

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This form of centre also renders primary health care services, though, this form is more defined by

the provision of a building located in the community. It is usually made up of a five bed ward with

treatment room.

iii. Rural Health Centre/Primary Health Centre

This form of centre renders basic health services including simple preventive, curative and

supervision of pregnant women and short time hospitalization of post-natal mother and patient

pending transfer to other levels of care. This category is usually organised for communities between

10,000 – 30,000 people.

iv. Comprehensive Health Centre

This is a form of centre with comprehensive structures and equipment. It can be established either in

an urban or in a rural settlement. It carries out the health functions of the primary health centres and

not very complicated cases referred to it from other primary health centres. This category is usually

made up of thirty to forty (30-40) beds ward mainly for child delivery and/or short time

hospitalization pending transfer of patients with complicated cases to another centre (higher level).

This type serves a community of between 20,000 and 50,000 people.

(B) The Secondary Level

This level of care provides a more sophisticated diagnosis or treatment for patients referred to it from

the primary level for general, medical, surgical, paediatric and community health services. Adequate

supportive services like: diagnosis, rehabilitation and physiotherapy are provided. The general

hospital belongs to this secondary level of health care.

i. General Hospital

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 This in addition to general health care services handles cases referred to it from the lower level

health institutions as long as specialization is not required. It is equipped to cater for all common

medical and surgical specialities and sometimes attached to medical school.

(C) Tertiary Care Level

This level of care consists of highly specialized services provided by teaching hospitals and

specialists hospitals which provide care for specific diseases. These specific requirements include:

orthopaedic, psychiatry, ophthalmology, maternity and paediatric hospitals.

i. Teaching Hospital

This is a form of medical centre attached to university for academic and research purposes. It also

renders health care services to the public and it is involved in the training of medical doctors and

paramedical personnel’s in the various branches of preventive, curative and rehabilitative services.

ii. Specialist Hospital

This is a hospital with specialization in every unit of all medical fields. Each unit is headed by

specialist medical personnel. All equipment’s in each unit are specification required by it. This

category of hospital handles any medical case however complicated. It is also involved in the training

of medical personnel’s and research programmes. The national health policy emphasizes that selected

centres should be encouraged to develop special expertise in advanced modern technology thereby

serving as a resource for evaluating and adapting these new developments in the content of local

needs and opportunities.

2.3.0 Space Types

The activities generated by the range of services listed above do not all need different types of

spaces. Their activities will require one or more of the following types of space:

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 Entrance/waiting/reception/patient amenity

 Record storage/administration

 Consulting/examination rooms/interview rooms/counselling rooms

 Treatment rooms (general and specialised)

 Diagnostic rooms (general and specialised)

 Large spaces with associated storage for group activities (baby clinics, health education,

relaxation classes)

 Staff office bases

 Seminar rooms/meeting rooms/library

 Staff facilities

 Support facilities (clean and dirty utility rooms, storage, disposal, cleaners’ rooms)

 Non-acute in-patient wards with support

 Plant rooms

 Car-parking/drop off points

To facilitate the multi-use of spaces, provide adequate and secure equipment storage; size rooms so

that their function can be flexible. Where rooms are tailored too tightly to a specific function, it

limits their flexibility.

1. Car parking

Car parking needs to be provided for staff and patients. The number of places required will depend

upon the functional content of the building and on local circumstances. For traditional primary

health care buildings, an approximate guide would be four parking spaces per consulting room (1.5

for staff, 2.5 for patients). Provision for disabled parking must be made adjacent to all buildings and

for patient transport by ambulance for some buildings.

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 2. Main entrance

The main entrance should be clearly visible, identifiable and easily accessible, preferably with a

covered setting-down point from cars. Ideally, only one public entrance to the building should be

provided, as this avoids confusion and aids security. A draught lobby is usually required. Secondary

public entrances may be required, however, where standalone specialist clinical units are included

within the development.

3. Reception

The reception area should be visible from the main entrance. Receptionists need to oversee the

waiting area and the main circulation routes. Allow 1.5 m counter length for each receptionist, and

space in front of the counter for patients to stand without encroaching on circulation routes or

waiting space.

Counter design should be open but providing some protection for staff. Provision for people with

disabilities should be incorporated, e.g. with a lower section for wheelchair users and incorporating

aids to hearing. The main entrance point should be overseen by a desk, which is staffed whenever

the building is open. In larger buildings this first desk may simply provide information and greeting

point, and is often staffed by volunteers and/or non-clinical staff.

4. Record storage

Record storage needs to be close to the reception area, but ideally not part of it. Records should be

out of sight of patients and secure. GP records will be kept centrally near reception. Other records

may be held at reception or in staff offices. The space required can be extensive and needs to be

calculated for the selected storage system (lateral shelving, filing cabinets, and carousels).

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 5. Administration and office bases

Some clerical/administration is usually associated with the record storage. Offices are required for

other administrative functions.

Some medical staff require offices for full-time use. Others, such as health visitors, district nurses

and midwives, need to return to an office base once or twice a day. Consideration should be given to

flexible arrangements which meet this requirement, e.g. sometimes this is done by providing a run of

work stations for use by anyone, with mobile personal storage units, rather than personal desks.

6. Waiting areas

Waiting areas should be visible from reception but sufficiently separated to provide some privacy for

patients at the reception desk. Pram storage and WCs need to be near the reception and waiting area.

Part of the waiting area can be designed and furnished for children. Some seating suitable for the

elderly should be provided. Six seats should be allowed for each consulting room and treatment

room, allowing 1.4m2 for each. This can be reduced for larger premises, particularly when

appointment systems are operated. Arrangements can be made to screen off part of large areas to

provide space for other activities at times when it is not all required for waiting. Patients should not

wait in corridors nor outside consulting or treatment room doors. Sub-waiting areas should usually

be avoided.

7. Consulting/examination rooms

Consulting rooms are usually provided for each practitioner on a personal basis. Where this results in

under-use, they can be scheduled for use by other staff or for other purposes. Combined

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consulting/examination rooms are more economical of space than having separate examination

rooms but patterns of practice vary and separate rooms may be required.

8. Treatment rooms

The increase in practice nurses, in addition to district and school nurses, has resulted in enhanced

requirements for treatment facilities. Some GPs also use treatment rooms for some clinical

procedures, e.g. fitting contraceptive coils. In addition, GPs now undertake minor surgery. As a

result, the conventional provision of a treatment room of 17 m 2 for use by one nurse is being

replaced by treatment suites comprising several treatment rooms, with separate clean and dirty utility

rooms, a specimen WC (sometimes with a hatch to the dirty utility room) and a nurse base. A mix of

treatment chairs and couches may be provided. Couches in treatment areas must be accessible from

both sides and one end.

9. Minor surgery

Treatment spaces used for surgical procedures need to be equipped and finished to standards

appropriate for the proposed procedures. There may be requirements for general anaesthetic (not for

GPs), additional ventilation and a recovery space. Minor surgery facilities can be provided as

separate suites with their own clean and dirty utility areas or as part of a larger treatment suite,

sharing support spaces.

10. Chiropody treatment rooms

Allow 11m2 for a one-chair room plus changing facilities. Many chiropody patients will be in

wheelchairs.

11. Speech therapy rooms

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Requirements can range from rooms where individuals can be assessed and treated to larger spaces

for groups of adults and children sometimes with viewing facilities. Noise levels need to be low, 40

dBA is recommended and must not exceed 45 dBA.

12. Dental suites

Allow 16.5m2 for each surgery, and 28m2 for a laboratory if required. If the throughput of patients

warrant it, separate waiting, reception and record storage may be required; but dental staff should not

be isolated from other staff.

13. Multi-purpose rooms

Large rooms will be required for health education, baby clinics, relaxation classes, physiotherapy

and other group activities. Associated storage is essential for chairs, relaxation mats, baby scales,

etc. Hand-washing facilities are needed for some of the activities. Tea-making facilities are

desirable. Ideally, this room should be accessible when the rest of the building is closed for evening

activities. Allow 40m2 for eight relaxation mats.

14. Interview rooms

These are small rooms for two to four people to speak privately in a relaxed atmosphere.

15. WCs for patients

These must include at least one WC for wheelchair users; and facilities for baby changing. Patients

may be required to produce urine specimens. A hatch can be provided between a WC and the dirty

utility room (or treatment room if there is no separate dirty utility room). Patients should not be

required to walk through public areas with specimens. The number and location of WCs required

will depend on the design. In small buildings it is often sensible to provide individual WC cubicles

containing a toilet and wash-hand basin. In larger buildings multi-cubicle public WCs will be

appropriate.

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 16. WCs for staff

These should be conveniently near working areas and common rooms.

17. Staff amenities

Kitchen and beverage facilities are usually provided. A shower is desirable. Lockers are needed for

staff with no secure office base.

18. Out-patient consulting and diagnostic facilities

These should be to the same standards as in hospital out-patient departments.

19. Beds

Ward provision should usually be to community hospital standards with appropriate support

facilities.

20. Educational facilities

Seminar and other teaching spaces should be to normal education standards. A student or students in

a clinical area requires the room to be enlarged so that the clinical activity is not compromised.

21. Storage

Requirements for storage must be established and quantified for each of the services.

22. Building service requirements

Space requirements for heating, ventilation, electricity, telephone, security, computer, intercom and

call systems will be determined by the operational policies.

2.4.0 Grouping of Spaces

In grouping rooms within the building, consider the activities that spread across several spaces, e.g. a

baby clinic may use the waiting/multi-purpose, consulting/examination and treatment rooms. Parts

of the building may be in use when the rest is closed; for example, GP Saturday and evening

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surgeries, educational facilities, drop-in treatment facilities, health education or community groups

in a multi-purpose room.

This project categorizes spaces into two types of activities:

1) Clinical Space: rooms required for primary health care staff to perform their core functions and

clinical support rooms (e.g. general waiting areas, exam rooms, counselling rooms, specialized care

rooms, labs, medical staff offices, and medical/clinical utility support rooms).

The term “clinical space” is not intended for counselling space for interviewing clients and/or

families for non-physically based condition treatment or education.

2) Facility Support Space: non-clinical rooms and areas for administration and community

activities and functional rooms. These are grouped as follows:

 Administrative Support Spaces – required to support the delivery of primary and allied health

care staff (e.g. reception, general waiting areas, work areas, staff facilities)

 Shared Spaces – shared by both core program and allied health staff to deliver programs (e.g.

interview, counselling and meeting rooms, kitchens)

 Cultural Spaces – special rooms required for the delivery of core health care programs that are

directly related to the culture of a specific patient/client group (e.g. traditional healing,

meditative or ceremonial spaces)

 Building Facility Support Spaces – rooms required for the facility to be functional (e.g.

garbage, storage, mechanical and electrical).

2.5.0 Primary Health Care Centre’s Focus

A primary healthcare centre provides a range of medical services including: consultations, treatment

diagnosis, minor surgery and health education. Sometimes it may also include day care for

physiotherapy and occupational therapy, and out-patients’ emergency treatment. In some cases there

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 may be in-patient short-stay beds. These centres can offer great flexibility and tend to serve an

average population of between 10,000 and 30,000 people. Primary Health Centres, sometimes

referred to as Public Health Centres are state-owned rural health care facilities in Nigeria. They are

essentially single-physician clinics usually with facilities for minor surgeries. They are part of the

government-funded public health system in Nigeria and are the most basic units of this system.

Apart from the regular medical treatments, Primary Health Care Centres in Nigeria have some

special focuses;

 Infant immunization programs: immunization for new-born’s under the national immunization

program is dispensed through the Primary Health Care Centres.

 Anti-epidemic programs: The Primary Health Care Centres act as the primary epidemic diagnostic

and control centres for the rural Nigeria. Whenever a local epidemic breaks out, the system’s

doctors are trained for diagnosis. They identify suspected cases and refer for further treatment.

 Birth control programs: Services under the national birth control programs are dispensed through

the Primary Health Care Centres. Sterilizations surgeries such as vasectomy and tubectomy are

done here.

 Pregnancy and related care: A major focus of the Primary Health Care Centre system is medical

care for pregnancy and child birth in rural Nigeria. This is because people from rural Nigeria desist

approaching doctors for pregnancy care which increases neonatal death. Hence, pregnancy care is a

major focus area for the Primary Health Care Centres.

 Emergency: All the Primary Health Care Centres store drugs for medical emergencies which could

be expected in rural areas. For example, antivenoms for snake bites, rabies vaccinations, etc.

2.6.0 Functions of Primary Health Care Centres

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The Government of Nigeria’s initiative to create and expand the presence of Primary Health Care

Centres throughout the country is consistent with the eight elements of Primary Health Care outlined

in the Alma-Ata declaration. These are listed below:

 Provision of medical care

 Maternal-child health including family planning

 Safe water supply and basic sanitation

 Prevention and control of locally endemic diseases

 Collection and reporting of vital statistics

 Education about health

 National health programmes, as relevant

 Referral services

 Training of health guides, health workers, local dais and health assistants

 Basic laboratory workers.

CHAPTER THREE

3.0 CASE STUDIES

The essence of this segment of the report needs no elaborate emphasis. In the words of Charles Wolf

Junior “Those who don’t study the past will repeat its error; those who do will find other ways to

err”. The reasons we reflect on yesterday, is to enable us have a comprehensive knowledge of today

and at the same time think about tomorrow. By doing this, we know the past work, understand and

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correct its short comings for a better future. In order to fully understand the principle behind

designing a building typology, an initial assessment of the existing building typology would have to

be done. The initial assessment will be in term of spatial, functional, equipment and operational

efficiencies and standards. Case studies are historical documents used for this purpose.

Historical information is gotten by first looking at the issue as a whole before considering them in

isolation. Through this process, we obtain a clear comprehensive knowledge of the subject matter we

are tacking and the circumstances that lead to the concept. An in-depth attempt is made at studying

and analyzing some existing primary health care centres to enable the understanding of the basic

techniques employed in the satisfactory design of successful health centres as well as to reveal

problems that must be addressed. The following case studies were selected because of the

opportunity each present for the evaluation of the different typology of primary health care centres:

3.1 Comprehensive Health Centre, Ibokun

3.2 Comprehensive Health Centre, Eleyele, Ile Ife
3.3 The Waldron Health Centre
3.4 Kentish Town Health Centre
3.5 Grindon Lane Primary Care Centre
3.6 Thetford Community Healthy Living Centre
3.7 Heart Of Hounslow

CASE STUDY 1

3.1 COMPREHENSIVE HEALTH CENTRE

Comprehensive Health Centre Ibokun is a government owned Health Centre in Obokun local

government of the State of Osun, Nigeria.

Location: It is located at Ibokun, Osun State.

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Function: The health centre caters for the primary health care needs of the people in Ibokun such as

maternity services, wound dressing, medical consultancy and every other primary medical service.

Description: Ibokun Health Centre is a rectangular shaped buiding with a central courtyard, it is

situated in a strategic location where the people of Ibokun and its environs can easily access it for

proper health care. The courtyard is at the centre of the building, and it helps to aid the ventilation

and lighting of the building. The exterior is painted green and white, it has a well defined entrance

with a porch. The entrance porch is ramped for easy access. The building has two entrances; the

main entrance which is at the front and can be clearly seen, and the other one which is at the left

side. The front door size is 1200mm while the side door size is 900mm.

Fig: Site plan of Ibokun Health Centre

( (Source: Author’s field work)

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Fig: Ground floor plan of Ibokun Health Centre
(Source: Author’s field work)

Fig: Approach view of Ibokun Health Centre

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Fig: Right side view Fig: Left side view

Fig: Right side view Fig: Lying Ward

(Source: Author’s field work)

Fig: Injection room Fig: Open courtyard with surrounding corridor

(Source: Author’s field work)

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MERITS

 The main entrance is well defined and easily seen.

 The entrance porch is ramped for easy access to all.

 The reception/records/consulting room is very close to the main entrance, and patients will not

find it difficult to locate them.

 The use of open courtyard in the building aids both lighting and ventilation.

 Provision of exit door at the side in case of emergency.

 The site is located in a relatively quiet environment, which is good for the health of the patients.

DEMERITS

 There is no proper zoning of spaces in the health centre.

 The security level in the building is close to zero, patients in the lying ward can also escape

through the exit door without being noticed.

 Although the entrance porch is ramped, but, the entrance door is raised and people on wheelchair

will find it difficult to gain access into the building.

 There is no defined parking space on the site.

26
 CASE STUDY 2

3.2 COMPREHENSIVE HEALTH CENTRE, ELEYELE, ILE IFE

Eleyele Health Centre was among the health centres built by the Federal Ministry of Health, and it

started operation in April 1984, it was affiliated to and put under the management of Obafemi

Awolowo Teaching Hospital Complex.

Fig: Site plan of Eleyele Health Centre, Ile Ife

(Source: Author’s field work)

27
 Fig: Ground floor plan of Eleyele Health Centre, Ile Ife

Fig: Front/Approach elevation of Eleyele Health Centre, Ile Ife

Fig: Right side elevation of Eleyele Health Centre, Ile Ife

(Source: Author’s field work)

28
 Fig: the approach facade
(Source: Author’s field work)

Fig: the emergency route Fig: the emergency entrance

Fig: Generator house Fig: Emergency entrance

29
 Fig: Main entrance Fig: Waiting area

Fig: Medical records Fig: Staff residence beside the health centre
(Source: Author’s field work)

MERITS

 The health centre building is easily accessible to all, introduction of ramps at all entrances makes

it accessible to all kinds of people such as the children, disabled, aged, etc.

 There is adequate ventilation and lighting due to the use of louver windows, which are highly

efficient in admitting fresh air and maximum light into a space.

 The use of open courtyard has helped to light and ventilate the inner spaces through the openings.

 Also, adequate lighting is provided. All spaces are arranged around an open courtyard, coupled

with the extensive use of louver window throughout the health centre building which is 100%

efficient in lighting up spaces. The louver windows make it possible to admit light into most of

the spaces naturally and this surely reduces the running cost.

30
 The roof along with the site is properly drained to avoid flooding.

 Safety precaution is considered, which is emphasized with the extensive use of terrazzo floor finish

throughout the building, terrazzo is non-slippery and easy to maintain. Also fire, extinguishers are

located in all strategic places to fight fire in case of fire outbreak within the health centre.

 Large and multiple entrances, with large corridors characterized the circulation spaces so as to

properly accommodate influx of different kind of people at a time and facilitate entrance and exit

in case of emergency.

 The introduction of fins in all the façade of the building to break the angle of the sun, the fins serve

the functions of shading device and aesthetics. Planting of grasses which is in good proportion

with the solid floor of road networks and parking lots to reduce solar radiation, planting of trees to

serve as wind breakers. All this add to the comfort of the staff and the patients.

DEMERITS

• The health centre building is not flexible, it is rigid. The internal partitioning walls are solid

walls which leaves no room for modification in case of future need.

• All the land has almost been used up which gives little/no room for future expansion.

• Spaces are not properly utilized, there are abandoned spaces.

• There is a dead end in part of the building which hider proper circulation in the part.

• Corridors are used as sub-waiting areas.

31
 CASE STUDY 3

3.3 THE WALDRON HEALTH CENTRE

The Waldron Health Centre provides joined-up and patient-focused primary healthcare, and is one of

the largest facilities of its kind in the UK. It is intended as a civic focus for the local community in

this relatively deprived part of south London, and its presence on a main road and alongside New

Cross train station makes it something of a local landmark. The building won the 2008 Building

Better Healthcare Awards in the Best Primary Care Design category.

Project Team

 Design Team Buschow Henley

 Lead clients Lambeth, Southwark and Lewisham LIFT

 Key stakeholders Lewisham Primary Care Trust, four GP practices,

Guy’s

& St Thomas’ ante-/post-natal care, King’s Dental Health Trust and community

dentistry

 Contractor Wilmott Dixon

Project summary

 Project type and location New build, urban

32
 Source: Department of Health (2013)

 Gross internal floor area 6000 m2

 Activities in the building

- 4 GP practices

- Health visitors

- School nursing

- District nurses

- Reproductive and sexual health services

- Chiropody

- Speech and language therapy

- Physiotherapy

- Community dentistry

33
 - Community midwifery

 Procurement type LIFT

 Construction period 2006–2008

Source: Department of Health (2013)

Description: Commissioned by Lambeth, Southwark and Lewisham LIFT, the centre brings

together four GP practices, Guy’s and St Thomas’ ante-/post-natal care, King’s Dental Health Trust

community dentistry, sexual health services, a suite for community use, and a range of other

services. The centre is a light, airy and easily navigable building. The consulting rooms, which are

designed to be flexible and adaptable to different types of service in future, wrap over three floors

around two landscaped courtyards. The needs of the local population play a strong part in the ethos

of the building: a community café greets the visitor on arrival, and bookable flexible-use suites on

the ground floor give local and community groups the opportunity to meet. In addition, part of the

building encloses some long-established allotments, providing shelter from the elements for this

important community activity. Staff members are also well catered for, with generous office space

34
and a number of open terraces which allow for an attractive working environment and views across

the capital.

The client’s objective was to change people’s perception of healthcare facilities. The architects

sought to offset its “civic” scale with the warmth and richness of a lacquered timber façade.

Fig: Consulting room

Source: Department of Health (2013)

MERITS

 Generally, the building shows consideration to the impact on patients, staff and neighbours’

well-being in its material quality and appearance.

 The design balances functionality with humanity, and scale with intimacy.

 As a result of the scale of the building housing so many services, the design makes it easy for

people to find their way around without getting confused or having to follow signs.

 Introduction of courtyards to enhance lighting and ventilation in the building.

DEMERIT

35
  The potential interference of noise from the railway line due to the proximity of New Cross

train station.

CHAPTER FOUR

4.0.0 DESIGN CRITERIA

Introduction

The proposed primary health care building for Obokun Local Government Area, Osun state is

expected to be unique one. It is also expected to be a landmark and main focal building within

Iponda town, which is proposed to be located in order to emphasize the significance of the primary

health care centre to the public.

4.1 Project Goals and Objectives

The aim of this study is to prepare a program for the design of a primary health care centre that will

provide functional and adequate spaces for the current and future needs of Obokun Local

Government Area, Osun State.

The objectives are to:

a) Carry out case studies on primary health care centre.

b) Assess the brief and requirements of the client.

c) Assess the reaction of users (the patients and the health workers) to the existing facilities.

d) Assess/analyse the site and the environmental factors.

e) Propose a scheme that enunciate and encompass the client’s and users’ requirements.

4.2 Functional/Spatial Criteria

4.2.1 Spaces, sizes and their relationship

The following facilities will be housed by the proposed primary health care building:

A) ADMINISTRATIVE UNIT

36
Entrance hall

Cashier’s office

Medical records

General office

Staffs lounge

Seminar room

Office spaces for: Medical director, P.H.C. Co-ordinator, Matron, Secretary, Community Health

Officer, Health Assistant.

B) DIAGNOSTIC/TREATMENT UNIT

1) Pharmacy

Waiting

Pharmacist’s office

Dispensary

Storage facilities

2) Radiology

Waiting

X-ray room

Dark room

Radiologist’s office

Radiographer’s office

Changing rooms (male & female)

Storage facilities

3) Laboratory

37
 Waiting

Specimen collection

Staffs work room

Laboratory technologist’s office

Storage space

4) Physiotherapy

Waiting

Nurse station

Physiotherapist’s office

Storage space

Exercise area

C) ACCIDENT AND EMERGENCY UNIT

Ambulance bay

Waiting area

Triage room

Mini theatre

Scrub room

Dressing

Casualty ward

Doctor’s office

Plaster room

Resuscitating room

D) CLINICS

38
 1) Out-patient Department (O.P.D.)

Waiting area

Nurses’ station

Dressing room

Injection room

Consulting rooms (plus examination areas)

Treatment rooms

Storage facilities

Paediatrician’s office

Toilet

E) COUNSELING/GROUP ACTIVITY UNIT

 Interview rooms for:

1) Speech and language therapy

2) Smoking cessation clinics

3) Remembrance discussions

4) Weight loss clinics

 Group rooms for:

1) Family therapy

2) Child protection work

3) Child psychology work

 Store (for consumables and portable equipment)

F) MATERNAL HEALTH UNIT; MATERNITY WARD

Waiting area

39
 Consulting room/Examination room

Reception area

Nurses’ station

Records

Storage space

Toilet facilities

Maternity ward

Sterilizing area

Delivery room

Labour room

G) OBSERVATION WARDS

General ward – Male

Lying-in ward

Nurses’ station/Work room

Toilet/shower

General ward – Female

Lying-in ward

Nurses’ station/Work room

Toilet/shower

Paediatric ward

Lying-in ward

Nurses’ station

Toilet/shower

40
4.2.1 Spaces, sizes and their relationship

When dealing with the issues of equipment and operational requirements for the building
complex, it is important to note that theses may vary for different spaces in the building. However,
for ease, it will be briefly looked into as regards this project, touching the main three space
classifications
 General services

Electrical and mechanical services that will be used in the building will include, provision for
alternative source of power (generator or inverter) apart from the public line supply, connection
to the nearest existing power line and split a/c unit installations. Internets networking of
computers stations, firefighting and alarm system as well as intercom services are to be provided.
Mechanical ventilation and or air conditioning of high standard are required and a safety system
must be able to allow the public and staff to leave the building safely. Lifts/stairs should be
comfortable enough for transportation, better provisions for the disabled. Comfortable lobbies
and waiting spaces. Regular supply of power for adequate machine operation e.g. lifts Accesses
(vehicles and pedestrians) must be clearly defined and also no obstruction, with better and well-
coordinated accesses, security will be so efficient and properly monitored. Communication
means must be well enhanced, ports for telephones provided in each room in case of
emergencies, fire outbreak, robbery in order to alert the users of the building.
 Administrative offices

Alarms should be located in offices, these spaces should produce the feelings required

and should create a sense of privacy, the modern way of furniture arrangement and best

choice in proper use of interior materials for interior finishing.

4.3.0 Technological and Environmental Criteria

4.3.1 Structure

41
The technology to be employed for the building will be the structural grid system associated with

health building designs. The grid will be formed using reinforced concrete column for efficient

support of the building to be able to achieve the preferred height of the building

4.3.2 Material/Finishes

The materials to be employed in the design of this building will range from steel, concrete, sandcrete

block, timber, aluminium, glass etc.

Table: shows materials that will be used for floors and other coverings

Material Features

1 Polished slate terrazzo
Impressive cool and elegant appearance for use in
staircases and lobbies.
Liable to become slippery when worm. Edges of stair
tread may have in-laid strip of carborundum. Main
circulation route may have carpet flooring
Provision must be made for contraction joints

2 Sandstone, riven slate Texture more liable to staining and involves cleaning
and other stone work difficulties may be used as a feature in entrance steps.
Tends to be harsh in appearance and noisy unless
balanced by soft heavily textured fabrics

3 Mosaic & decorative tiles Used as a feature in limited defined areas usually as
centre piece, effect depends greatly on the quality of
workmanship. Hard wearing with long life cycle,
which may or may not be advantageous if a change in
style is required

42
 4 Wood

5 Wood block parquet and Warmer in appearance but need greater attentions and
hardwood strips protection used where the area of floor and extent of
traffic is limited

6 Carpets May be laid (o pad or underlay directly over floor

screed or as cover to other flooring. Either broadloom
or body carpet joined in strips may be used, the latter
facilitating easy replacement
4.3.3 Walls

Buildings are usually made up of walls; the wall may be exterior or interior. They may also be load

bearing walls or non-load bearing walls. In this design, load and non-load bearing walls will be used.

Building from the early1900’s have relatively massive exterior wall with multiple layers of thick

absorptive materials separating the exterior surface from the interior finishes. The articulation of the

exterior façade promoted drainage away from wall openings, these designs incorporated secondary

waterproofing barriers or built-in flashings for long term performance. Current trends in exterior

wall design have led to increasingly thin, lightweight veneers with little separation between exterior

surfaces and interior finishes. In many cases, secondary barriers and through-wall flashings are

absent from the design and surface water flows over exposed joints and wall openings. As a result,

the occurrence of exterior wall leakage problems has increased, including consequential degradation

from such leakage, such as deterioration or corrosion of hidden wall components and damage to

interior finishes, within the first few years of service. Several factors affect the choice of doctor.

Unity of design within the areas generally, particularly where the space is irregular, interrupted by

doors, openings, corridors, desks.

4.3.4 Types of wall surface

43
Dry lining: in the form of panels, sheets or strips, facilitate quick erection and easy replacement of

individual sections, permit access to services and equipment without obvious breaks in the wall and

may be aligned with doorways and other openings. The panels may be formed from sheets of

veneered wood, laminated plastic, metal or glass, including mirrored glass, or from glass or marble

or other stone. Similar effects may be achieved with areas of plastered surface framed with

mouldings or architraves. Continuous surfaces formed from plastered wall or exposed wall

construction have the merit of linking area together, particularly where there are other more

dominant or elaborate features super-imposed. The background of a continuous surface provides a

balance, particularly where the area is small and broken up by furniture and fittings. To avoid

variation in appearance, the quality of work should be high and the surface must be designed to resist

and markings e.g. by use of textured, wipe able or easily redecorated finishes.

 Plastered applied by trowel in 2-3 layers or by spray with smooth, textured or sculptured

finishes. Smooth plaster provides a bone for painting or wall coverings

 Exposed wall construction of fair faced brickwork or stonework, or concrete with smooth

or impressed surfaces created by the formwork.

 Combined methods such as tiles bedded on plaster or cement rendering, plaster skin on

performed plaster or beard.

4.3.5 Performance requirements of interior walls

(i) Must serve primary purpose of defining spaces with visual and acoustic requirement in mind.

(ii) The walls must be meet requirement of separation of space for fire control and safety

(iii) Must be easy to dismantle or relocate in the case where a variation in spatial

arrangement might be desirable by the users.

44
 (iv) Must be stable enough to carry suspended loads like beds, machines, shelves, cabinets or

simple household equipment.

(v) Must have the ability to resist the acoustic characteristics of adjoining levels.

4.3.6 Performance requirement of exterior walls

(i) Exterior walls should have well placed openings that take full advantage of the views

provided by the scenic landscape, and give occupants a general sense of togetherness with

other users of the court in a controlled manner

(ii) It should be made of material that can withstand the vagaries of elements nature that can

quicken weathering on the exposed surfaces

(iii) Must be clear expression of the designers’ intentions in symbolizing the particular

type of building within prevalent cultural and local context

(iv) Must provide enough openings to adequately allow in daylight

(v) These walls must be constructed of materials that are easy to maintained repair without

damage to other component of the building structure.

(vi) The exterior walls must be solid enough to cater for the security requirements of residents of

the structure

(vii) These walls must be able to withstand fire outbreak long enough to allow the safe

evacuation of occupants and possibly valuable property

4.3.7 Ceiling

The ceiling to be used will serve multiple purposes. The ceiling will house air ducts pipes, wiring

and equipment, including fittings built into the ceiling. Mostly, this is required for environmental

control, communication, fire and security, and other functional requirements of the health care

building and spaces below the ceiling but the void may also be used for services from or to the floor

45
 above. Whist the ceiling framework is made as light as possible, the strength of hanger and/or

structural members providing support must be sufficient to carry the weights of equipment

(including variation) and maintenance access and gangways. Clearance must be allowed for

maintenance work and servicing and for the removal of components. The depth of ceiling void may

be determined by structural members of floor(s) above,

4.3.8 Performance requirement of ceiling

(i) Ceiling systems of any building should be designed in a visually attractive manner

(ii) All ceiling must be designed with adequate sound absorbency in place

Method of construction

- Tiles or panels fixed to supporting grid in public circulation areas and corridors of conference

centers and the likes- these are usually asbestos or mineral wool backing to provide the

necessary fire resistance

- Integrated ceilings with grid or panels incorporating lighting, ventilation other functional

requirement within the design. May be elaborated to form a decorative feature with distinctly

profiled or extended lighting panels molded to individual design

- Open grids – allowing access to ceiling void – in function and exhibition rooms

- Continuous ceilings of plaster applied to metal lathing or plastic board. Typical finishes include

line of gypsum plaster or gypsum vermiculite asbestos mixes: the latter used to improve

acoustic and fire resistance properties. Mouldings, covings and other features may be added.

Generally restricted to small offices or direct application to soffit where there is a separate

engineering service floor.

46
4.3.9 Lighting

Lighting is an important element in architectural and interior design. It can be used externally

to display the character of the building, to reveal views of the interior and draw interest, including an

inviting entrance. Functionally, external lighting may also serve to emphasize features of the door, to

reveal or conceal surfaces, apparently heighten or diminish spaces, create patterns and textures and

provide Colour and contrast. Illumination is used to draw attention to sigh, direction and hazards.

Variety can be produced in several ways:

 The intensity of light can be varied

 Materials with different light, reflecting or transmitting properties may be employed

 Light positions and the distribution of light from fittings can be changed

 Colours can be introduced in the light source, shading and or surrounding

Light sources

Internal light sources to be used are primarily:

 Incandescent due to high temperature radiation (filament type)

 Fluorescent from ultra-violet radiation of energized mercury vapour acting on the surface

coatings (fluorescent type)

 Incandescent lamps tend to produce a warm light with a high proportion of red-yellow

colouring and are generally preferable for near positions.

 Fluorescent lighting is more efficient has a longer life and produce less shadow and contrast. It

will be used in work area, reception desk, corridor (recessed ceiling light) and other situations

as concealed background illumination.

Fittings

47
 Light may be of a direct or semi direct type, they could be suspended low over tables,

counters, desks or equipment for background illumination and in work areas. Indirect light may be

used to supplement other sources, along corridors around perimeter areas, spot lamps are most

effective illustrating features, works of art and notices, and permanent supplementary lighting may

be used during the day time in Operating rooms, treatment rooms, seminar rooms and

consulting/examination room to improve distribution of natural light.

4.3.10 Roofing

The roof is the aspect of the building that is most subjected to failure. This is because it is the

most exposed element of building and an assemblage of different products. Suggested material is

aluminium long span roofing sheet. Structures that provide a simple and economic method of

covering large area without an internal or immediate support. And where reinforced concrete slab is

to be used, folded slab or flat slab will be used.

4.3.11 Service Required

These are mainly air conditioning, mechanical, electrical and water services necessary for the

building. They are distributed horizontally and vertically.

Ventilation

Apart from natural ventilation, air-conditions in buildings helps to maintain optimum internal

atmosphere required for human comfort and also for the machines and other equipment in the

building that need constant cooling. Due to the fact that natural ventilation has problems of heat loss

and heat gain within and outside the building, it would not be able to meet up with its conditions,

which is must satisfy. The conditions are having

i. A relative humidity of between 40-50%

48
 ii. The planning and distribution of these services is of utmost importance especially in high rise

buildings, consideration should be given to distribution and encasement of these services,

both horizontally and

iii. Maintenance of optimum temperature required for human comfort

iv. Adequate fresh air supply to ensure that vitiated air (e.g. odour of human perspiration) does

not become noticeable.

Electrical services

Electrical services and outlets depend to a large extent on the nature and level of work to be

performed. Also it’s lighting apart from natural lighting (day-light) should be designed to meet

specific practical purposes. In a situation where power supply is unstable a silent generator is needed

for the building and this could either be placed at the rear end of the site.

Fire

In case of fire outbreaks, the planning or the site has to take into consideration access for fire

fighting vehicles. Underground or over-heat water storage (tanks) should be made available in site to

cater for the irregular supply of water and at least 4 fire hydrants should be present or be within the

site premises. Fire or smoke detectors and alarm systems are also necessary within the building.

These are either automatically or manually operated. However, a public address is needed in the

whole building to in room and direct occupants about the location of the fire and how to evacuate the

building. There is also the fire righting devices, which use either manually or automatically operated.

Under the automatic device, the automatic sprinkler systems (Wet Risers) is used and under the

manual device systems such as the used of water hose reels, portable extinguishers such as sand

buckets, halo-generated hydrocarbons and carbon di-oxide. Extinguishers are installed and located at

49
strategic parts or along corridors, staircases and lifts of the building. These chemicals are non-toxic

and do not damage or contaminated the materials.

Water supply

Water supply should be either from public water mains or form a borehole (which from time to time

will be heated) to cater for inadequate water supply from the public mains.

Drainage

Drainage of the water from the site depends on the topography of the site and since on treatment is

required; it is discharged into the public sewer. But rain water from the roof is collected and passed

through pipes which are sized to accommodate maximum possible flow rates and discharged into the

solid waste disposal, suitable located and grouping of appliances allows for easy collection and

treatment (if necessary) and discharge through underground drain pipes with man holes for

inspection and clearing. For convenience and economic purposes most of these services are grouped

together encased in pipes and allowed to run through what is called service ducts.

4.4 Legal and Planning Regulations

Building setbacks and the use of land law under the town and country planning regulations will be

adhered to. As for the construction of this building, a building permit has to be obtained from the

Town Planning Authority of the Local Government accompanied with all necessary drawings,

details of plans and all sides’ elevation will be submitted for approval.

4.5.0 Site Consideration

Choice of site should be based on its location. A through site analysis should be carried out to

determine the topography, nature of the soil other factors that might influence the design and

50
construction of the building. Development on site should be in accordance with the town planning

regulations, e.g.

(1) Set Backs

Set back in the area under consideration stipulates that building should have a minimum set back of

3m from the three sides of fence and 6m from any side or bordered by a major road. This is

important in that the total area available for development can be known.

Permissible height

There is really no permissible height in the community as long as the funds and technology are

available; the client is free to go as high as possible especially since there is no airport or aerodrome

area.

Parking

Parking provision for staff and public should be made in line with staff requirement and planning

regulations. Some of the useable left over space after designing is used as parking lot. A car space

should not be less than 2.5.0 meters dimension. The entrances, exists and circulation pattern of staff,

public and emergency should be properly worked out taking into consideration.

(a) Ease of accessibility for staff, visitors and patients into and around the building core;

(b) Security and privacy required by certain functions of the building.

Flexibility and subdivision

The degree of flexibility and subdivision of internal space influences location of the building core.

This is very important especially when changes occur in to organizational structure and the activities

of building.

Ramps

51
Here, the number of ramps and also its size for vertical transportation within the building is very

important. It depends on the population (staff and patients), the number of floors of the building, the

required waiting time and materials to be moved. Ramps are also very necessary for easy movement

of the disabled. Services: - The planning and distribution of these services is of utmost importance,

consideration should be given to distribution and encasement of these services, both horizontally and

vertically. The following services should be taken into consideration.

(a) Ventilation

(b) Electrical

(c) Fire

(d) Water supply

(e) Drainage + Sewage disposal

4.6 Behavioral Criteria

This is related to how the psychological and sociological well-being of user is affected by the

building design and its environment. The way and manner the users of the spaces created are made

to behave by virtue of the design interaction with the design elements, the environment cannot force

anything, and they can only create the circumstances where the most likely tendency is to behave in

a particular way. Behavioural criteria are also issues that concerned with occupants’ activities and

satisfaction with the physical environment. There are several factors that should be considered in the

design of a primary healthcare building. These include:

 Location of the building

The location of the building in relation to the people it serves is crucial, it should be

convenient. If it serves a wider public than can walk to the building, it should be adequately served

by public transport, and have appropriate facilities for those using private transport.

52
  Circulation

The entrance to the building and the circulation within it should be designed with due

consideration for wheelchair users, parents with small children, people with visual, audio or

ambulatory disabilities, and the physically frail who constitute a large proportion of the users of

primary care. Everyone should be able to arrive at, move around and leave the building without

unnecessary effort, anxiety or embarrassment.

The pattern of circulation should be obvious to the visitor and should not rely on complicated

signs. Staffs also need to work efficiently, moving easily from one place and activity to another.

 Effective Zoning

To facilitate the translation of planning principles into the design, group activities within the

building into the following three zones:

 Public zone: where callers are received and wait.

 Clinical zone: where patients meet clinical staff.

 Staff zone: where staffs meet one another and work in private.

Grouping spaces into these zones controls contact between staff and callers, ensures privacy,

minimises unnecessary movement and increases security.

53
 Fig: Relationship and zoning diagram for a health centre. (Source: Metric handbook planning

and design data).

Diagrammatic representation of the zoning concept

The idea of creating zones within the building is represented diagrammatically in the figure

below. The optional spaces represent those facilities that are not provided in every building and may

or may not fall outside the public, primary and community care (clinical), and staff zones.

1. Public zone

The public zone comprises the main entrance, reception and waiting area, public WCs and

health information points. This zone should be located at the front of the building. The public zone

should have a non-clinical character, relevant and inviting to the community that it serves; who it is

hoped will develop a sense of ownership for it. The public zone, made up of the main entrance,

reception and associated spaces, should be:

• Open and welcoming;

• Visible from outside the building, to aid building legibility;

• Naturally lit, with good views of external spaces.

Most buildings will include one or two waiting or foyer spaces, which may be double-storey

to provide views to suites located at different levels. These “reference spaces” are useful, as they aid

orientation and way finding. They should provide easy access to WCs, baby changing, vending and

car park payment machines.

2. Clinical zone

This zone accommodates the core patient/client contact spaces, most of which will be

generic. Public access to this zone will be from the public zone. Ideally, it should have direct staff-

controlled access to the staff zone. Public access to individual patient/client contact spaces will be

54
controlled by staff. The clinical zone should inspire confidence through order, cleanliness and

efficiency.

3. Staff zone

The staff zone may include:

 Admin areas;

 Rest rooms;

 Changing areas;

 Training spaces.

The staff zone should generally only be accessible to staff. Most staff areas can be shared by

different groups of staff, including community-based staff. They should therefore be easily

accessible to staff from the main entrance (or staff entrance, where provided).

Admin areas should be designed on the basis of open-plan working. Staff rest rooms should

provide good-quality environments to encourage their use and promote staff interaction.

Accommodation for staff training may be located in the staff zone, although it is useful if this

is also accessible from the public zone.

All buildings will require some level of facilities management (FM) services, which may be

provided by directly employed staff or through contracts with third parties. Certain services,

especially laundering, catering and some maintenance, can be contracted off-site. However, most

buildings will require central space for sorting and storing incoming supplies and outgoing waste.

These spaces should be located together, near the service or staff entrance to the building.

 Privacy and Confidentiality

Privacy and confidentiality are important aspects of the relationship between a patient and staff

members. Two places where these aspects suffer from poor design are:

55
  The reception desk, where one side of a telephone call can be overheard by people waiting,

and

 Clinical rooms during consultations and treatments, where personal topics must be discussed

freely and in confidence without fear of being seen or overheard; there should be no waiting

outside doors.

 Security and supervision

Movement of the public about the premises should be supervised by reception staff without

disrupting their work. Supervision also promotes security within the building. Sub-waiting areas

should be avoided unless they will be managed and supervised by staff.

Staffs need security against personal assault; the equipment and facilities need security

against theft and vandalism. The degree and types of security needed depends on the location and on

the nature of the services being provided.

 Environment

The building should be comfortable, welcoming, with good natural lighting and ventilation;

and it should be easy to maintain and keep clean.

 Running costs

Staff salaries are the largest component of the running costs so the design should facilitate

efficient staffing. Energy-efficient, long life and low-maintenance approaches should be adopted for

the building.

 Flexibility and growth

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 Designs should provide for the flexible use of some spaces from day to day; and for the

inevitable changes in the demand for services and the pattern of delivery during the life of the

building.

Provision for extending it should be considered, as should the installation of hard standings

and temporary building services connections for special, mobile diagnostic units.

CHAPTER FIVE

5.0.0 SITE AND ENVIRONMENTAL ANALYSIS

5.1.0 Location and site selection for project

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 Fig: Map showing the 36 states in Nigeria, including Osun state.

Nigeria lies within the tropics. This region lies between latitude 23 027’ north to 23027’ south of the

earth surface. Within this area the sun is perpendicular at noon at least one day of each year. For all

the points, in this region, the sun is almost vertically overhead during the entire year. The peculiar

characteristics of the tropic include high amount of sunshine, high amount of rainfall, high humidity

levels, almost uniform weather throughout the year and high temperatures. Architectural design in

the tropics must take into consideration the peculiar climatic features of the region.

Site Location

The Primary Health Care Centre is being proposed to be located in Iponda town in Obokun

local government area, Osun state, Nigeria, Africa. Its geographical coordinates are 7o 44’ 0” North,

4o 43’ 0” East. Obokun local government covers a total land area of 527km 2 (203sq mi), and a total

population (according to 2006 census) of 116,511.

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 Fig: Map showing Obokun Local Government Area, including the neighbouring ones.

The site is located at a few distance away from the existing Iponda Health Centre. There is a major

road in front of the site, the major road links Ilesa to Ibokun. The site is flanked by a fallow land to

the right, and an uncompleted building to the left. Also, located at the other side of the road which is

directly opposite the site, is a fallow ground and electric poles running along the front. Presently,

there are no structures on the site. It is an uncultivated bushy land. Some of the trees would be

retained while many would be removed from the site.

5.1.1 Site Selection Criteria

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 The Primary Health Care Centre is expected to serve Iponda town and its environs. Hence, in

selecting the proposed site, the following factors were put into consideration

1. Accessibility: The site is easily accessible from the roads leading to Ilesa and Ibokun. Also the

site is accessible by public transport.

2. Sufficient Spaces: There is ample space on the proposed site that can conveniently take the

primary health care building, parking lots, the ancillary facilities and any future expansion.

3. Less congestion: The land is ideal because, it is elevated and less congested in order to have an
ample supply of fresh air.
4. Pollution: The site is free from any kind of air pollution. There is no industry close to the site.
Also, there is no sound pollution.
5. Its environmental impact on the surroundings and existing developments in the area.

6. Availability of facilities such as electricity, access road, water supply, telephone and other

utilities.

Fig: showing the availability of access road and electricity

Source: Researcher’s field survey (2016).

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7. Even though the presence of the main road in front of the site could be a source of noise

pollution, this will however, be minimized by providing a buffer zone between the road and the

building. A well landscaped environment will help to minimize any anticipated acoustic

problem.

8. Landscape features: The site is covered with grasses and trees. Some of the trees will be useful

for landscaping and shading devices while others will be removed during the clearing of the site.

5.2.0 Site Analysis

The analysis of the site is done based on the following categories; physical, infrastructural,

ecological, cultural, aesthetic, acoustic and climatic analysis.

1 Based on the physical analysi: the proposed site is made up of clayish laterite and loamy

soil, which will be good for construction purposes. Vegetation on the site is savannah type,

which is noted for predominantly tall grass and short to medium sized trees. Most of the trees

are deciduous. This shall be used for landscaping purposes and shading.

2 In terms of infrastructure: the proposed site is bounded by accessible road on the south-

west side; there is also presence of electric poles and lines along the road in front of the site.

There are no permanent or temporary structures on the proposed site.

3 Acoustic Analysis: The main source of noise pollution is from the vehicular road in front of

the site. Creating a buffer zone between the road and the building would prevent this;

locating the building at a reasonable distance from the road.

4 Aesthetically: the proposed site being located along the road will aid the view of the primary

health care centre and its visibility from any point or angle of the road will not be impeded.

5.2.1 Climatic Characteristics

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 Iponda has two main seasons: the wet season (May – October) and the dry season (November –

April). Each season is characterized by a specific prevailing wind. The wet season brings with it

South-West prevailing wind i.e. South-West trade wind which originates from the equatorial rain

belt blowing from the high pressure zone which occurs over the Atlantic during the period. The dry

season on the other hand is accompanied by harmattan: a dust-laden wind blowing from the North-

East as North-East trade wind.

5.2.2 Design Considerations

There are some factors that are to be considered before starting proper. These factors are discussed

in this chapter.

5.2.3 Design Goals:

(i) Form

- Create a design that will accommodate the users and their various activities in the health

centre.

- To create a design that will consider the comfort of the users.

- To create a simple form design

(ii) Functions

- To avoid conflict in traffic flow within the building and the external environment

- Provide design that provide individual’s need without difficulty

- Provides design that provides undisrupted flow of activities.

(iii) Zoning

To facilitate the translation of planning principles into the design, group activities within the

building are categorized into the following three zones:

 Public zone: where callers are received and wait.

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  Clinical zone: where patients meet clinical staff.

 Staff zone: where staffs meet one another and work in private.

Grouping spaces into these zones controls contact between staff and callers, ensures privacy,

minimises unnecessary movement and increases security.

5.2.4 Design Proposal

5.2.5 Conceptual Analysis and Philosophy

This is basically the principal idea that governs a design in the production of a design. This

makes it possible for designers to have the same concept for a work, but with different approach in

its interpretation. Most time, some designers have a religious obsession for their design philosophy

that eventually gives them a peculiar character thereby giving them an identity. Personal beliefs and

experiences of the architect may determine the design concept. These beliefs and experiences may

be a production of the environmental factors that exists within that area or problems deduced from

the design brief. The primary objective in the design approach is to provide comfortable space,

everyone should be able to arrive at, move around and leave the building without unnecessary effort,

anxiety or embarrassment. The circulation and zoning will be determining factors that will influence

the concept of this development. The conceptual development refers to the idea or wisdom behind the

organization of the spaces within the building (building concept) and the arrangement of the various activities

on the site (site concept). The following must be considered before generating or adopting any concept

whatsoever in the design of a health care facility;

i. Phasing i.e. building in phases,

ii. Form of the building, and

iii. Affinity of spaces.

As a result of this, the building takes a simple form which allows for proper zoning and

circulation. The plan is made up of four rectangular wings planned around a central diamond, which

63
encloses a courtyard garden. The building is simple in layout with a legible plan that is very easy to

understand and navigate.

REFERENCES

Architectural Press, second edition (1999). METRIC HANDBOOK Planning and Design
Data.

Boerma, W.G.W. (2006). Coordination and integration in European primary care. In R.B.
Saltman, A. Rico, & W. Boerma (Eds.), Primary care in the driver's seat? Organizational
Reform in European Primary Care (1st ed., pp. 3-21). Berkshire, UK: Open University Press.
Dennil, K. (1999). Aspects of Primary Health Care. Cape Town: Oxford University Press.
Department of Health (2013). Health Building Note 11-01: Facilities for primary and
community care services.
Directorate General of Health Services (2002). Guidelines for Primary Health Centres.
[Brochure]. India: Ministry of Health & Family Welfare.
Emeka E. O. and Masemote G. M. (2011). Functioning and Challenges of Primary
Health Care (PHC) Program in Roma Valley, Lesotho. South Africa: Tshwane University of
Technology & National University of Lesotho.

Muldoon, L.K., Hogg, W.E., & Levitt, M. (2006, September/October). Primary care (pc) and
primary health care (phc): What is the difference? Canadian Journal of Public Health, 97(5),
409-411.

Rifkin, S.B. (1986). Lessons from community participation in health programs. Health Policy
Plan, 1, 240-9.
Saltman, R.B., & Figueras, J. (1997). European health care reform: Analysis of current
strategies. Copenhagen: World Health Organization.
Vuoir, H. (1984). Primary health care in Europe - problems and solutions. Community
Medicine, 6(3), 221-231.
World Health Organization (1978). Primary Health Care. Report of the International
Conference on Primary Health Care, Alma-Ata, USSR. 6-12 September 1978.
World Health Organization. (2002). The European health report. Copenhagen:, Denmark

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WHO Regional Office for Europe.

APPENDIX I

FLOOR PLAN

SITE PLAN

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APPENDIX II

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PERSPEECTIVE

SECTIONS

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ELEVATIONS

SITE ANALYSIS

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