SOM ConstructionGuidelinesHealthFacilitiesREPORT 12 WEB

S O M A L I A

Report 12

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3 ROOMHEALTH POST

3 ROOMMODULARHEALTHFACILITY

4 ROOMMCH /

HEALTH CENTRE

2.0m wide covered verandahceramic tiles

Room 01ceramic tiles



2.0m

wid

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open to skycourtyard

open to skypaved walkwayprecast concrete pavings



CONSTRUCTIONGUIDELINES FORHEALTH FACILITIES

2Authors: Austen Davis

Moyiz Ebrahimjee (Architect)

Ali El-Amine (Engineer)

Joseph Aduda (Architectural Assistant)

This document was written by and produced with the financial assistance of the European Union. The views

expressed herein can in no way be taken to reflect the official opinion of the European Union.

3Acronyms ..................................................................................................................................................... 4

cHAPTEr 1: InTroducTIon ...................................................................................................5

cHAPTEr 2: THE modulAr HEAlTH cEnTrE ........................................................................7 2.1 Health Centre: Floor Plan ................................................................................................................... 7 2.2 Health Centre: Elevation .................................................................................................................... 8

cHAPTEr 3: THE PrImAry HEAlTH unIT (PHu) or HEAlTH PosT ........................................9 3.1 The PHU: Floor Plan ........................................................................................................................... 9 3.2 The PHU: Elevation ............................................................................................................................ 10

cHAPTEr 4: THE HEAlTH cEnTrE - oPd ................................................................................11 4.1 The OPD Block: Floor Plan ................................................................................................................. 11 4.2 The OPD Block: Elevation .................................................................................................................. 12

4.3 The Maternity: Floor Plan ................................................................................................................... 13

4.4 The Maternity: Elevation. ................................................................................................................... 14

cHAPTEr 5: THE HEAlTH cEnTrE IPd .................................................................................15 5.1 The IPD: Floor Plan ............................................................................................................................ 15 5.2 The IPD: Elevation ............................................................................................................................. 16

cHAPTEr 6: sHowEr Block ..................................................................................................17 6.1 Shower Block: Floor Plan ................................................................................................................... 17 6.2 Shower Block: Elevation .................................................................................................................... 18

cHAPTEr 7: ToIlET Block .....................................................................................................19 7.1 Toilet Block: Floor Plan ....................................................................................................................... 19 7.2 Toilet Block: Elevation ........................................................................................................................ 20

7.3 Latrine (Pit) Block: Floor Plan ............................................................................................................. 20

7.4 Latrine (Pit) Block: Elevation .............................................................................................................. 21

cHAPTEr 8: wAsTE dIsPosAl ...............................................................................................22 8.1 Incinerator: Floor Plan ........................................................................................................................ 22 8.2 Incinerator: Elevation ......................................................................................................................... 23

Annex (diskette) Bill of Quantities and detailed drawings

Contents

4ANC Ante Natal Care

BoQ Bill of Quantities

EPHS Essential Package of Health Services

HC Health Centre

HP Health Post

IPD In-Patient Department

JNA Joint Needs Assessment

MCH Maternal and Child Health Clinic

MoH Ministry of Health

NEZ North East Zone

NGO Non Governmental Organization

NWZ North West Zone

OPD Out-Patient Department

PHU Primary Health Unit

RHC Referral Health Centre

SCZ South Central Zone

UN United Nations

UNICEF United Nations Childrens Fund

UNOPs United Nations Organization for Project Services

Acronyms

5The Somali health sector has been characterized

as under-funded, fragmented and ineffective.

Government, UN, NGO and community providers

struggle to provide services with limited and

unpredictable inputs and a lack of centralized and

strategically directed financing or direction/policy.

In the South Central zone, NGOs and local community

organizations typically run health facilities broadly in line

with three tiers of service provision. In the 2 Northern

zones government is also a main provider of primary

health care services.

Health posts (HPs) are the lowest tier of service

provider: They typically consist of one or two semi-

trained staff without formal salaries or supervision

operating out of a 1 -2 room facility or a local house or

shop (no formal facility).

Maternal and Child Health Centers (MCHs) are

the inter-mediate tier of service provider: they are

highly variable. They have from 1 12 staff some

with professional nurses and midwives, others with

no professional higher than an auxiliary (especially in

rural areas). The range and quality of services varies

enormously with some MCHs seeing 3,000 patients a

month and others seeing less than 50!

Hospitals are the highest tier of service provision: they

are also highly variable with 10 hundreds of staff

and most with a medical doctor and some professional

nurses or midwives. However, even hospitals lack

professional staff and especially the diversity of

technical staff necessary to run a full hospital service.

With the extreme diversity of facilities and the variability

in range of services extent of support and type of

support offered (UN agency, NGO, government) it is no

wonder there is little uniformity in the quality and range

of services offered between facilities and within a tier

of service level.

Recognizing the extremely dilapidated state of much

of the Somali health infrastructure, The Joint Needs

Assessment (JNA) for Somalia determined the need

for the development of standardized blueprints for

health facilities as an important technical task to allow

a move towards the standardization of services offered

within a particular tier of service delivery. Standard

building guidelines also offer the potential for costing

construction and infrastructure elements of health

system development and therefore are an important

component of planning for a future health system.

In a workshop in 2007, representatives from the health

sector came together and agreed to try and establish

operating norms and standards for what levels of care

each tier should follow. The UNICEF health systems

strengthening programme developed a process of

extensive consultation and review and eventually

produced an Essential Package of Health Services

(EPHS).

Introduction1

6The EPHS defines the range of services (and therefore

supplies and staff competencies) necessary to offer at

each tier level. Projecting from the range of services

and staff required, it is possible to define the level of

facility needed to house each tier of service provision.

This also means we can develop standard blueprints

for health facilities at each level. The EPHS defines a

standard:

The new names of EPHS facilities have been

changed to disconnect levels of service provision from

political administrative boundaries/unit names (districts/

regions) so that facilities can be planned for according

to need and not political calculus. And to highlight

the need for real change as in each case, significant

changes in focus are prescribed for each tier of service.

This cannot be created piecemeal and is essential

to start generating real performance and returns on

investment I the health sector.

This report presents concepts for standard health

facility design at each tier of service. The design

concept is modular. In consultation with health

authorities we agreed a basic PHU/HP. The PHU

building is used as part of the MCH/Health Centre and

this HC facility is used as part of a referral centre etc.

so that any building can be upgraded to a higher tier of

service and to keep overall construction costs and the

types of buildings required as simple (and cheap) as

possible.

All buildings have been designed to use simple but high

quality building techniques with simple roof structures

and external corridors etc.

While all designs are simple relatively cheap and

locally appropriate, it is not expected that all facilities

will follow specifications to the letter. All facility

blueprints need to be adapted to the site and conditions

of the site at hand rural MCHs may have to be

constructed on relatively small sites. Rural facilities

will need to take into consideration soils, water supply,

drainage and ventilation. However basic designs,

floor layout plans and indicative Bills of Quantities are

developed for each structure and these BoQs can be

modified to allow adaptation to the local site and needs.

Furthermore, innovations are encouraged (for example

in areas where there is more regular rainfall throughout

the year, constructors may wish to include submerged

tanks to collect roof run-off). Lastly these plans can

be developed over time as experience grows with

construction and planning.

This report presents basic floor plans and elevations

however there are a large range of detailed drawings

to guide constructors that should be printed out on A3.

In addition there are BoQs that can easily be adapted

to promote professional construction in any setting

adapted to the local constructions challenges (soil

type, drainage, water availability, ventilation, coastal/in-

land). The detailed booklets for each building type are

available on diskette or through the health coordination

bodies and at MoH offices.

Previous Tiers of Service Standardized EPHS Tiers of Service

Health Post (HP) Primary Health Unit (PHU)

Maternal and Child Health Centre (MCH) Health centre (HC)

District Hospital Referral Health Centre

Regional Hospital Hospital

Referral Hospital

7The modular Health Centre is depicted in the 2 drawings that follow

PINK = HEALTH POST/PRIMARY HEALTH UNIT

PINK + GREEN = BASIC OPD

PINK + GREEN + BLUE = OPD + maternity services

PINK + GREEN + BLUE + YELLOW = FULL HC OPD/IPD

2.1 Health Centre: Floor Plan

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3 ROOMHEALTH POST

TOILET BLOCK

SHOWERBLOCK

3 ROOMMODULARHEALTHFACILITY

4 ROOMMCH /

HEALTH CENTRE

REFERAL HEALTHCENTRE


Proposed sketch layout for afull scale MCH master planwith 8 bed Inpatient ward




2.0m

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staff roomceramic ti les


8bed inpatient wardceramic tiles

open to skypaved walkwayprecast concrete pavings

shw

rsh

wr

cesspool

septictank

ladiesceramic tiles

gentsceramic tiles

open to sky walkwayprecast concrete pavings


FURTUREDEVELOPMENT

gentsceramic tiles

whb

whb

ladiesceramic tiles

WC

WC

WC

WC

dhobisinks


TheModularHealthCentre2

82.2 Health Centre: Elevation3 ROOM

HEALTH POST

SHOWERBLOCK

TOILETBLOCK

FUTUREDEVELOPMENT

SHOWERBLOCK

TOILETBLOCK

3 ROOMHEALTH POST

FUTUREDEVELOPMENT

3 ROOMMODULAR HEALTH

FACILITY

3 ROOMMODULAR HEALTH

FACILITY

4 ROOMMCH / HEALTH CENTRE

4 ROOMMCH / HEALTH CENTRE



Perspective Viewfrom front Courtyard

Perspective Viewfrom rear side

9ThePrimaryHealthUnit(PHU)orHealthPost3

3.1 The PHU: Floor Plan

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+0.15

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A 02

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100mm diaPVC RWP

100mm diaPVC RWP

60x60x5cmprecast concretepaving slabslaid to falls

100mm diaPVC RWP

100mm diaPVC RWP

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A B C D

A B C D

ConsultationRoom

ceramic tiles

Storeceramic tiles

Covered verandahceramic tiles

beam above beam above beam above

beam

abo

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beam

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step up step up step up

step

up

step

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ConsultationRoom

ceramic tiles

5cm

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k co

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es

Ground Floor Plan scale 1:100

Indicative Construction Cost (see BoQs): 14,500 USD

The PHU is the lowest tier of service provision. The

building is produced as a single block with a simple

A-frame roof and covered external passage. The block

has 3 rooms which can be used inter-changeably. One

room is designed to serve as a store and will have

no windows (most likely the middle room with less

external walls for lighting.

This building is to be incorporated into a full health

Centre and will then serve as one wing of the U-shaped

compound. The building is envisaged to have the

central room as main stores and the end room (left)

as another temporary store with dispensing window

to serve as a dispensary. The end room to the right

would be the lab and is well lit with maximum number

of windows.

PINK = HEALTH POST/PRIMARY

HEALTH UNIT

3.2

The

PHU:

Ele

vatio

n

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TheHealthCentre-OPD4Indicative Construction Cost (see BoQs): 22,000 USD

In upgrading a PHU to an MCH OPD it is envisaged there is a need to add 2 blocks

GREEN Main Consultation Block

BLUE Maternal and Reproductive Health Block

4.1 The OPD Block: Floor PlanThe OPD block has 4 standard rooms and a covered external passage. All rooms are designed to be used for

consultation. The PHU building is now converted for use as a laboratory and medical store with dispensary.

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A A

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100mm diaPVC RWP

line of roof overhangabove

100mm diaPVC RWP

0.00(ground level)

+0.30(ground floor level)

hw timber fascia boardpainted

+3.30(ring beam level)

GI corrugated roofingsheets 15o degreesroof pitch

textured paint finish toexternal plastered walls

sliding aluminiumwindow to schedule

30X30cm box frame withsteel wire mesh for

ventilation of the roof

0.00(ground level)







30X30cm box frame withsteel wire mesh for

ventilation of the roof




A B C

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pitch = 15.0 deg. B CA

elevation 01scale 1:100

pitch = 15.0 deg. B CA

elevation 02 scale 1:100


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Pers

pect

ive V

iew

4.3 The Maternity: Floor Plan


The maternity block is designed to house an observation room and a delivery room. The third room (not inter-

connecting can be used inter-changeably (i.e. for ANC services).

This block can also be used to house a surgical theatre.

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100mm diaPVC RWP

line of roofoverhang below

100mm diaPVC RWP

100mm diaPVC RWP




beam abovestep up

beam abovestep up

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Covered verandahceramic tiles

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TheHealthCentreIPD5Indicative Construction Cost (see BoQs): 21,000 USD

YELLOW = HEALTH CENTRE/IPD

5.1 The IPD: Floor Plan

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100mm diaPVC RWP

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0.00(ground level)







0.00(ground level)






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8bed inpatient wardceramic tiles

A B

staff roomceramic tiles

step

up

step

up

elevation 02 scale 1:100

B A

elevation 01scale 1:100

A B


The ward is to be added to all Health Centres or MCHs

to allow them to offer Basic Emergency Obstetric Care

and minimal in-patient services (depending on a full

compliment of professional staff).

The ward is generic it has room for 6 beds, a staff room

and a storage room or isolation room.

More wards can be added to the HC as it grows or as

it is upgraded to a Referral Health Centre (RHC) (see

expansion plans 2.1, 2.2).

16

5.2 The IPD: Elevation

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scale 1:100

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elevation 04

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60x60x5cm precastconc. paving slabs laidto falls



Side / Front Perspective Front / Rear Perspective

17

ShowerBlock6Indicative Construction Cost (see BoQs): 7,000 USD

The shower block is a wash place for people, clothes etc intended for all facilities with an in-patient capacity.

6.1 Shower Block: Floor Plan

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A

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line of roof overhangabove



0.00(ground level)


aluminium windowsto schedule


dhobi sinks



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shwr shwr

gentsceramic tiles

ladiesceramic tiles

whbwhb

A B

A B

1

2

1

2

Ground Floor Plan (Shower Block)scale 1:100

dhobisinks

dhobisinks

scale 1:100elevation 01

A B

scale 1:100

AB

elevation 02

18

6.2 Shower Block: Elevation




dhobi sinks

step60x60x5cmprecast concretepaving slabs laid to falls gents front side

perspective

19

ToiletBlock7The toilet block should be seriously considered for all

levels of facility (even PHUs). The numbers of toilet

blocks will necessarily rise or fall depending on patient

volumes and IPD facilities/volumes.

In this report we have detailed a toilet block served by

running water and septic tank (toilet block) and a more

simple option for pit latrines draining into a pit.

7.1 Toilet Block: Floor Plan


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60X60cm precastpaving slabs

+0.000(grond floor level)

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+0.000(grond floor level)





GI corrugatedroofing sheets

door to schedule

WC WC WC WC

Ground Floor Plan(toilet block) scale 1:100

step up

whb whb

step uplobby

2

1

ladiesceramic tiles

gentsceramic tiles

lobby

step

up

step

up

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scale 1:100

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scale 1:100

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AB 1 2

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elevation 01 elevation 02

elevation 03 elevation 04

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7.2 Toilet Block: Elevation

Rear Side Perspectiveof Toliet Block

Front Side Perspectiveof Toliet Block

7.3 Latrine (Pit) Block: Floor Plan


80234

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textured paint finish toexternal p lastered walls

door to schedule




door to schedule

textured paint finish toexternal plastered walls textured paint finish to

external plastered walls

opening wi thmosquito gauze


15cm dia.metalvent pipe


100mm diaPVC RWP

15cm wide PVCrain water gutters

building line below


edge of undergroundpit walls

1

ladiesceramic tiles

gentsceramic tiles

A B

2

scale 1:100

Ground Floor Plan(latrine block)

latrine latrine latrine latrine

scale 1:100scale 1:100elevation 03 elevation 04

AB

scale 1:100scale 1:100elevation 01 elevation 02

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1 2

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slop

e

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e

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scale 1:100

Roof Plan showingslopes (latrine block)

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7.4 Latrine (Pit) Block: Elevation

60X60cm precastpaving slabs step

removabe slabfor pit emptying



Front Side Perspectiveof Latrine Block

handledoor to schedule

window toschedule

removabe slabfor pit emptying

handle60X60cm precastpaving slabs

step



Rear Side Perspectiveof Latrine Block

22

WasteDisposal8Indicative Construction Cost (see BoQs): 700 USD

Medical waste is a serious issue. During construction

of any level of facility plans must be made for medical

waste disposal. For larger facilities producing large

quantities of dangerous medical waste an incinerator

is highly recommended despite the additional costs of

construction.

All facilities will need a waste pit to burry medical waste

and this pit should not be open to the public/playing

children.

8.1 Incinerator: Floor Plan

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1265

12

110mm wide fire clay brick wallfor the main body of incinerator

primarycombustion chamber

110mm wide outer fire claybrick wall of the incinerator

3mm thick MS plate ash door on30x30x3mm MS angle frame,oil painted to approval.



3mm thick MS platebox tunnel

fire clay bricks asthe base for the incinerator



150x230mm RC lintel tosupport bricks above

primarycombustion chamber


flue and secondarycombust ion chamber

flue and secondarycombust ion chamber

MS hinges to siteEngineer's approval

loading door of 3mm MS platewelded on 30x30x3mm MSangle frame, oil painted.

3mm thick MS plate cover with114mm dia, 3mm thick MS pipewelded on 30x30x3mm MS angleframe to house the chimney


scale 1:25Floor Plan at 02

scale 1:25Floor Plan at 01 scale 1:25Floor Plan at 03

scale 1:25Floor Plan at 04

23

8.2 Incinerator: Elevation

114

4m h

eigh

t

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516

733

1751

516

114

+0.000(floor level)

+1.090(6course brick leve l)

+1.300(incinerator top level)



+0.075(incinerator base level )

150mm dia,3mm thick MSpipe chimney welded ontothe chimney base plate

40x100x5mm MS channelsection as the top frame

loading door handle

loading door of 3mmMS plate welded on30x30x3mm MS angleframe, oil painted to approval.





150mm dia,3mm thick MSpipe chimney welded ontothe chimney base plate

loading door of 3mmMS plate welded on30x30x3mm MS angleframe, oil painted to approval.




typical side elevation scale 1:25 rear elevationscale 1:25

front elevationscale 1:25

More detailed and scaled drawings are available with BoQs on the attached diskette. Drawings should be printed

on A3 format paper

chimney rain cap

the gaps between the brick jointsas well as the gap between theinner wall and the outer wallcan be filled with refactory cement

2 coats of anti-rust paintto inhibit corrosion to allthe mild steel surfaces

2 coats of anti-rust paintto inhibit corrosion to allthe mild steel surfaces

Completed Incinerator

Documents

SOM ConstructionGuidelinesHealthFacilitiesREPORT 12 WEB