APPROACHES TO PLANNING AND DESIGN OF HEALTH CARE FACILITIES IN DEVELOPING AREAS Volume 5 CROSS-NATIONAL ANALYSIS OF CASE STUDIES Edited by B. M. KLECZKOWSKI ‘formerly of the Division of Strengthening of Health Services, World Health Organization, Geneva, Switzerland C. MONTOYA-AGUILAR Division of Strengthening of Health Services, World Health Organization, Geneva, Switzerland N. O. NILSSON Architect, Gothenburg, Sweden WORLD HEALTH ORGANIZATION GENEVA 1985WHO Offset Publication No. 91 ISBN 924 170091 2 © World Health Organization 1985 Publications ofthe World Health Organization enjoy copytih protection in asordance with the prowisons of Proteol 2 ofthe Universal Copyright Convention. For its of reproduction ot {eanhaion of WHO publications in part or foorappixation shoud be sade othe Ofc of Hib’ Word ek Oxynraton, Geneva Sacto’. He Wort Heath Onanaton welcomes sich aplatons “he dsjnation employed an the presentation ofthe mater inthis pulsation donot imply the expression of any opinion whatsoever on Ine part of the Seeretanat of the World, Healt Organlation concerning he eal sia of any county, estoy, cy or aes of ots aihoiies, Cr concerning the deliabon ts ronders or bounds ‘efmonn of Spc ompani a of cran manufacture’ prods oes ot inpy dat they are endoned of recommended by the Werld Health Organization preference ots ofa Siilarnature that are oot enentoned. Ero and‘omisunes excepted ke act of roprieay products are dsungushed by ial capital later ‘the authors alone ae responsible for he views Gxpesed in this publication Iss om. PRINTED IN SWITZERLAND 5/4813 Pepe 200CONTENTS ‘Summary ‘Acknowledgements Introduction 2.0... 2 PART ONE: DETERMINANTS IN THE PLANNING OF HEALTH CARE FACILITIES ‘The place of facilities in national health systems 2. The national setting Low-income countries se oe Affluent developing countries... ee ee Socialist developing countries : 3. National machinery for the physical planning of health care facilities The structures involved in physical planning ‘The process of physical planning, ‘hnical tools for the physical planning of health care facilities ‘Type programmes and norms for design... . Type plans Norms for selected indicators Cost estimates : Guiding principles for the remodelling of existing buildings PART TWO; EXPERIENCE OF HEALTH CARE FACILITIES IN USE 1. Access, catchment areas, and sites : 2. Buildings: general design and its impact on functions, economy, and Aexibility Regional hospitals District hospitals Rural hospitals and maternity centres Large health centres Small health centres Rural health posts , and building maintenance 4, Basic installations and equipment, and their maintenance Fresh water supply Sewage and waste disposal systems Electricity supply ‘Ventilation, air-conditioning, and lighting Lifts Fire precautions Medical and other equipment | Means of communication 3. Construction materials and techniques Conclusions fae Annex 1. Evaluating health care facilities: The methods, 15 15 VW 18 21 a 2B 2 2 30 36 cy 38 41 43 43 3 62 65 67 n 85 87 87 88 89 89) 92. 92 93 95 97 101