NEW MATERNITY

AND
LABOUR WARDS

This Design Book new Maternity Turiani Hospital is realized

by the participation of the following persons and organisations:

St. Francis Turiani Mission

Hoogendoorn BV

Hospital

(Dick Hoogendoorn)

Initiator and Principal

Design engineer

Turiani, Tanzania

Jan Steenweg 14, 9761HJ Eelde,

Private Bag, Morogoro, TANZANIA

NETHERLANDS

turianihospital@yahoo.co.uk
dhoogendoorn@planet.nl
+255 23 26 200 18

+31 50 3093029

Foundation Vrienden van Turiani

Bert Oosterloo

Development

Technical working out

Regattaweg 84, 9731NA Groningen,

Regattaweg 102, 9731NA Groningen,

NETHERLANDS

NETHERLANDS

www.turiani-hospital.org

bert.oosterloo@hotmail.com

+31 50 3186941

+31 50 2308634

Estudio KAW (Ana Fernandez)

Dennis Hofman

Architecture

3D-drawings

Carrer Ciutat de Granada 82 bajos,

Lindenstrasse 2, 26844 Ditzum,

08005 Barcelona, SPAIN

GERMANY

anafernandez@estudiokaw.com

dennishofman@hotmail.nl

+34 6 54638911

+49 49029893814

Kutano BV (Henk Boldewijn)

Studio Spijker (Ilse Spijker)

Project Management

Graphic Design

Regattaweg 84, 9731NA Groningen,

Kraneweg 13-5, 9718 JC Groningen,

NETHERLANDS

NETHERLANDS

h.boldewijn@kutano.nl

info@studiospijker.nl

+31 6 55748584

+31 6 27135974

 Content

1

Introduction 5

5.

Why a new Maternity and Labour Ward?

Background information

General information

Appendixes
1. All drawings including technical drawings

T-FD-01 current site lay-out

Hospital services 10

T-FD-02 new site lay-out

Hospital management

T-FD-03 floor plan Maternity Ward

Hospital financial resources

T-FD-04 floor plan Labour Ward

T-FD-05 Elevation West and East faades

T-FD-06 Elevation East faade Labour Ward and end

Past situation

T-FD-07 along and cross sections Maternity Ward

Building process 15

T-FD-08 along and cross sections Labour Ward

Situation and description of the new buildings

T-FD-09 foundation Maternity Ward

Cost estimation

T-FD-10 foundation Labour Ward

T-FD-11 roof lay-out with trusses and concrete ring

Human resources development

3.

New Maternity and Labour Wards

11

13

Present situation

Maternity Ward

4.

Drawings 17

T-FD-01 current site lay-out

T-FD-12 roof lay-out

T-FD-02 new site lay-out

T-FD-13 covered walkways

T-FD-03 floor plan Maternity Ward

T-FD-20 trusses

T-FD-04 floor plan Labour Ward

T-FD-05 Elevation West and East faades Maternity

T-FD-06 Elevation East faade Labour Ward and end

T-FD-07 along and cross sections Maternity Ward

T-FD-08 along and cross sections Labour Ward

T-FD-13 covered walkways

beam both Wards

T-FD-50 cross section B-B Maternity Ward

2. List of constructions and materials

3. Bill of Quantity

Ward
faades both Wards

faades both Wards

Main entrance patients and visitors

1. Introduction

Why a new Maternity and Labour Ward?

St. Francis Turiani Mission Hospital is the only hospital in the Mvomero
District and responsible for implementing the national policy, focused on
the improvement of the health care services for the District communities.
One of the targets of this policy is:
To provide good, safe and easy to reach reproductive care services for
women based on the Millenium Development Goals of the United Nations
like reducing child mortality rates and improving maternal health

Millenium Development Goals of the United Nations

Waiting women at the old Female Ward

Early recognition of complications in pregnancy, delivery and post-natal

care and reduce of maternal and neonatal death is one of the priorities
of the hospitals strategy. Therefore training and exchange of new actual
knowledge and skills is important. And also proper facilities to deliver this
care in a professional way.
Together with the Female ward, the Maternity and Labour wards are the
oldest buildings and in a bad shape. Because of a breakdown of the roof,
the Female ward was renovated in 2010.
In 2012 the hospital became a Council Designated (or district) Hospital
and Maternal care will be delivered without costs for the patients. This
will result in an increase (double or triple) of the number of patients.
The project New Maternity and Labour wards is the realization of the first
project of the Masterplan of 2007 of the hospital and is executed
with the support of the Foundation Friends of Turiani in the Netherlands.
Before the workout of the project in chapter 4, background information
about Turiani Hospital is described in chapter 2 and a description of the
project in chapter 3, enough to inform stakeholders, governors and donors.
Chapter 5 (appendix seperate available) gives an overview of all (technical)
drawings, list of constructions and materials and the Bill of Quantity.

Walkway between Male and Childrens Ward

2. Turiani Hospital
background information

General information
St. Francis Turiani Mission Hospital is situated in Bwagala, just 3 km from
Turiani village and about 120 km from Morogoro town. It is the only hospital in the Mvomero District and registered as Voluntary Agency hospital.
The hospital has all departments characteristics for a rural hospital and
has a capacity of 180 beds divided over seven wards:
-- Female medical and surgical ward with 40 beds;
-- two Male wards: medical and surgical with 48 beds;
-- two Children wards with 48 beds;
-- Maternity ward with 18 beds and Labour ward with 6 beds;
-- Former Isolation ward, now in use as Post-natal ward with

20 beds.

Turiani Hospital is established in 1962 by the Missionary Sisters of

Precious Blood to provide health care services to the population in the
Mvomero District (circa 370.000 inhabitants). Also many people from
neighbouring districts like Kilosa, Kilindi and Morogoro rural area attend
the hospital. Therefore the hospital serves approximately 400.000 people.
The economic condition of the community surrounding the hospital is of
low income. The main tribes are the Wazigua and the Wanguu, mostly
farmers. The area is fertile for cultivation. Sugarcane and rice are grown
increasingly as cash crop.
There is also a considerable number of Maasai and Mangti who herd
cattle in the dry lowlands. Nearby is the Mtibwa Sugar estate which
attracts 1.500 2.500 migrant labourers during harvesting season from
August to May every year.

Hospital services
From the Five Year Strategic Plan of the hospital, 2012:
Vision statement
Our vision is to aspire for quality health services to all
Dira yetu ni kuwa na huduma bora ya afya kwa watu wote
(in Swahili)
Mission statement
Our mission is to provide holistic, high quality, affordable and sustainable
health care to the community in accordance with catholic medical ethics
Dhima yetu ni kutoa huduma bora ya afya ambayo ni nafuu na endelevu
kwa jamii kwa kufuata misingi ya huduma za afya ya Kanisa Katoliki
(in Swahili)
Core values
1. Integrity
2. Collaboration
3. Accountability
4. Respect and dignity
5. Excellence
6. Professionalism
7. Improving lives
8. Working together
9. Working together with patient
The hospital receives seriously sick patients in the Out Patient Department (OPD); less serious patients visit the surrounding dispensaries and
health posts. The total number of inpatients is circa 12.000 and
outpatients 58.000 (2010).
The top ten diseases are: malaria, respiratory tract infection, pneumonia,
anaemia, diarrhoea diseases, urinary tract infections, protein energy

10

malnutrition, tuberculosis, ear infections, eye infections.

Next to curative services, the hospital provides preventive services
like: Mother Child Health (MCH) clinic and Community Based Health
Care (CBHC) like mobile eye clinics, maintaining village health posts
and establishment of treated mosquito nets. Also dental care and
physiotherapy are present in the hospital. Prevention and treatment
services to HIV/AIDS patients is implemented according the national
policy on HIV/AIDS.
When the CDH status of the Hospital is fully incorporated, expected in
2013, maternal care will be for free (running costs will be paid by the
Government). Expected is an increase of the number of deliveries in
the Hospital from 2686 (2010) to more than 4000 in the coming period.
Due to remoteness of the villages a number of mothers arrive in the
second stage or with obstructed, prolonged labour necessitating
obstetrical emergency. Often the Maternity and Female wards are so
overcrowded, that expecting mothers and female patients have to sleep
on the floor.

Hospital management
The hospital is owned by the Diocese of Morogoro and since 2011
managed by the Mgolole Sisters Convent, settled in Morogoro. A board
of Governors advise and assist the Diocese and the hospital management.
The members are representatives of the Mgolole Sisters, the Catholic
Diocese of Morogoro, the Ministry of Health, the community in the catchments area and the Hospital staff.

Hospital financial resources

Buildings Rehabilitation and extension in the past

The financial resources (2011) of the hospital consist of the following:

Also in the nineties the hospital was active in professionalism and grow.

-- service fees: outpatients and inpatients fee, on the average

The quality of the buildings and the condition of the hospital compound

about 52% of the recurrent budget;

were a serious obstruction for further development. Thats why the first

-- staff & bed grants: from the Ministry of Health and Social

Masterplan (1991) was constructed addressed to a phased rehabilitation

and extension of the hospital buildings in relation with spatial ordering

Welfare, about 25% of the recurrent budget;

-- basket fund: to be spent on preventive health care activities,

of all hospital wards and departments. In the plan also sanitation and

drainage of the compound were incorporated.

circa 12% of the recurrent budget;

-- MSD Medicine grant, NSSF & NHIF: circa 8%;

-- donations from overseas for capital development and other

The first three phases of this Masterplan (1991) are executed:

projects: circa 2%;

-- other hospital incomes: circa 1%.

Phase 1:

Male medical wards, the first wing of Childrens ward and

In total the budget is in 2011: 1.183.981.648,65 Tsh = 581.772,-

Mother and Child Clinic, completed in 1997.

The position as CDH is officially authorized, but the financial input

Phase 2:

Male surgical ward, second wing of Children ward, half

(running costs) availed by the Ministry of Health and Social Welfare

of the OPD, technical workshop, garage, stores, laundry,

is still on its way (December 2012).

kitchen and Operation Theatre (OT), completed in 2001.

Phase 3:

second half of the OPD, Pharmacy, external wall,

Human resources development

completed in 2003.

The hospital has circa 150 employees and is active in sending staff

In 2004 the hospital realized with the help of the Dutch helping organiza-

members for upgrading courses, seminars and workshops sponsored

tion CORDAID a sheltered canteen to deliver catering services to staff,

by several organizations in and outside Tanzania. With support of the

patients and visitors.

Foundation Burns Turiani Groningen (NL) the hospital receives on-going

In 2007 an old building was renovated to Private ward, but not used.

training for nurses and medical staff focused on hygiene, infection

This building will be used for housing new students and staff of the future

control, wound and burn care. To motivate and to hold current staff

Nursing School.

and to create attractive conditions for recruitment of new staff, in 2014

In 2010 the provisional renovation of the Female ward was completed

the hospital want to start an own Nursing School as leg up to become

on own strength.

a teaching hospital. The first preparations started in 2012 with support

In 2012 renovation of the Isolation ward to (temporarily) post-natal

of the Friends of Turiani and in cooperation with St Kizito Hospital in

Maternity ward is done.

Mikumi. Other issues, also mentioned in the latest strategic plan (2012)

The financial resources for renovation and new buildings were very limited,

are: improvement of staff housing, revision of the hospital terms, quality

which resulted in a lower quality then the buildings realized as part of the

improvement of services and completion of the exercise of writing job

1991 Masterplan.

descriptions and career planning.

11

Old Labour Ward

12

3. New Maternity
and Labour Wards

The project New Maternity and Labour wards consist of the replacement
of the Maternity and Labour by three new buildings: I Maternity (pre-natal
care), II Labour and III Maternity (post-natal care). The present buildings are
in a bad condition and dont have enough capacity to provide a proper quality
and quantity of maternal care.

Past situation
With the help of Misereor (Germany) the hospital wards are renewed in
the nineties except the Female, Maternity and Labour wards. Misereor
stopped her support and new donors had to be found.
In 2007 a Masterplan was designed with the help of the Friends of Turiani.
Priority was given to the renewal of the Female and Maternity buildings
and first concept plans were made.
In the meantime the roof of the old Female ward collapsed; renovation
was done in 2009 / 2010 and the building is again suitable for use for
several years.
Between 2009 - 2011 the transition to Council Designated Hospital and
the change of leadership from the CPS Sisters to the Mgolole Sisters
slowed down the progress of the project.

Present situation
Renewal of the Maternity and Labour has priority in the new strategic plan
(2012) of the hospital. Together with the new management a step by
step plan was made. And post-natal patients are temporarily moved to
the renovated Isolation ward to relief the pressure of the overcrowded
Maternity.
In October 2012 it became clear, that private Dutch founders want to
donate a substantial part of the new Maternity, so a real start can be
made in the building process. An additional application to the Dutch
helping organization Wilde Ganzen will be submitted at the beginning of
2013. The communication with the Spanish helping organisation Manos

13

Nurses inside old Labour Ward

14

Unidas for the third building (Maternity post-natal) is also in progress.

connected by a covered walkway; patients can be easily moved from

The final design and Bill Of Quantity (BOQ) are ready at the beginning

one building to another. The patients routing and Hygiene and Infection

of 2013.

Control are important leading factors.

Proposed is the conduction of a (short and long term) maintenance plan

for the new buildings including water supply, sanitation, electricity

Both new Maternity wards have space for 32 beds (8 x 4-bed rooms),

(perhaps solar energy). A professional building engineer will be employed

a nursing station including space for admission of patients, treatment &

by the hospital to coordinate all renovation / building / maintenance

education room, 2 sluices, 2 sanitary blocks and storage. The women will

activities.

have more privacy and rest, because of the 4-bed rooms. Patients, who
need extra (medium) care (with pre-eclampsia, premature babies, etc.)

Building process

can be nursed separate. The nurses stations is situated so that the nurse

1. Preparation and Planning (Plan Of Action) of the new buildings and

glass walls.

in charge has an overview over all the patients rooms divided by partly

situation on the hospital compound.

2. Preliminary design and final design.

The new Labour ward has space for 12 delivery beds (2 x 6-bedrooms),

3. Appointment by the hospital of a local technical engineer to manage

male and female changing rooms, tea- or restroom for personnel, nursing

the building process.

desk & office including admission, 2 sluices, 2 sanitary blocks, 2 baby-

4. Technical workout, Bill of Quantity and tendering.

resuscitation rooms and storage. There is more space around the beds,

5. Building new Maternity ward (I).

divided with curtains. From the nurses station and the rest room,

6. Building new Labour ward (II).

the nurses in charge have an overview over all the delivery beds.

7. Building covered walkways between new buildings and Operation

Theatre.
8. PM Renovation or demolishment of the old Maternity ward and
building new Maternity ward (III), when financial resources are

In future the present Isolation ward (temporarily post-natal care) will

be changed in Women Waiting Home with own cooking and washing
facilities for women, waiting for their delivery.

present.
9. Providing a long term maintenance plan for the new buildings.

Cost estimation

Situation and description of the new buildings

For the cost estimation see the calculations (Appendix 5.3).

The three new buildings are in line with the present Male and Children
wards. They are connected to the main hospital route of Inpatients and
close enough to the Operation Theatre in case of emergency (like
Caesarean sections). The new three buildings have a surface of 500 m2
each including the covered verandas. In the centre the buildings are

15

Hospital compound

16

DRAWINGS
NEW MATERNITY
AND LABOUR WARDS

Aerial view 1970s

18

TEMPORARY
MATERNITY WARD

HOUSING

CHURCH

TECHNICAL
DEPARTMENT

NURSING
SCHOOL
MORTUARIUM

DENTAL
CLINIC

MALE WARD
SERGICAL

MALE WARD
MEDICAL

LABOUR
WARD

MATERNITY
WARD

OPERATION
THEATRE

CHILDREN
WARD

STAFF HOUSING

CHILDREN
WARD

NURSES
HOSTEL

SEMINARY
HALL

LABORATORY

NURSING
SCHOOL
FEMALE WARD

K A W
www.kaw.nl
h.boldewijn@kaw.nl
T +31 50 3695870

TURIANI HOSPITAL
DIOCESE OF MOROGORO

FINAL DESIGN
BUILDING I, II, III

T-FD-01
current site lay-out
CURRENT
SITE LAY-OUT

Scale

1 : 500
Date

21-12-2012

19

20

25,00

13,00

17,00

20,10

14,00

10,00

28,00

28,00

III

II

MATERNITY WARD

LABOUR WARD

MATERNITY WARD

K A W
www.kaw.nl
h.boldewijn@kaw.nl
T +31 50 3695870

TURIANI HOSPITAL
DIOCESE OF MOROGORO

FINAL DESIGN
BUILDING I, II, III

T-FD-02
new site lay-out
NEW
SITE LAY-OUT

Scale

1 : 100
Date

21-12-2012

21

22

floor plan Maternity Ward

23

24

floor plan Labour Ward

25

26

Elevation West and East faades Maternity Ward

27

28

Elevation East faade Labour Ward and end faades both Wards

29

30

along and cross sections Maternity Ward

31

32

along and cross sections Labour Ward

33

34

0,10 0,30
0,20 0,12

2,30

10,00

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

2,40

38,00

28,00

II

LABOUR WARD

MATERNITY WARD

2,40

2,065

2,40

0,20

2,40

0,20 0,20

SECTION THROUGH COVERED WALKWAY 1: 50

0,20
0,20

NEW COVERED WALKWAYS

NEW COVERED WALKWAYS
CONCRET SLABS OVER EXISTING PATHS

K A W
www.kaw.nl
h.boldewijn@kaw.nl
T +31 50 3695870

TURIANI HOSPITAL
DIOCESE OF MOROGORO

2,20
2,40

0,20
0,20

FINAL DESIGN
BUILDING I, II

Scale

covered walkways
COVERED
WALKWAYS

T-FD-13

1 : 500
1 : 50
35
Date

21-12-2012

St. Francis Turiani Mission Hospital

Private Bag, Morogoro, TANZANIA
Tel:+ 255 023 26 20018 / Fax: +255 023 26 05257
E-mail: turianihospital@yahoo.co.uk
Foundation Friends of Turiani
Regattaweg 84, 9731 NA Groningen, NL
Tel: +31 50 3186941 / Mob: +31 (0) 6 54 25 15 37
E-mail: w.boldewijn@kutano.nl

January 2013

Henk Boldewijn, architect

Tel: +31 6 55 74 85 84
E-mail: h.boldewijn@kutano.nl