CHARPTER ONE: INTRODUCTION

1.1 Background.
Amuria is a new district located to the north-eastern part of Uganda. The district had an
estimated population of 240,000 people (National Household Survey, 2005). The population is
predominantly rural with over 90% living in villages and IDP camps in the two counties. The
district has experienced prolonged insecurity for over 30 years characterized by extensive cattle
rustling (1956 to date); Civil strife involving UPA and NRA (1980- early 1990s); Kony invasion
(June 2003-March 2004) and more recently wide spread flooding (July– November 2007).

The prolonged insecurity has led to the collapse of peoples’ livelihoods and unacceptably high
levels of poverty. The recent baseline survey by Concern-Uganda showed that up to 95% of the
district population has at one time or other been displaced and are living in IDP camps
scattered all over the district. It is estimated that up to 64% of the households live below the
poverty line way above national average of 36% (National Census, 2002).

The population of Amuria district is currently increasing since the displaced persons are
returning back to their homeland Amuria. People who had fled the district due to the influence
of the LRA rebels are now re-occupying their home district since the rebels were evacuated.
The gradual re-occupation of the district has therefore led to the population growth.

The national census in 2002 estimated that the population of Amuria District is approximately
183,800. In 2008, the World Food Program, quoting the Uganda Bureau of Statistics (UBOS),
estimated the population of the district at about 275,000. It is calculated that the annual
population growth rate in the district is 7.0%. The estimated population in Amuria District in
2010 is approximately 315,900.

With the pronounced rate of population growth, the standards of living in the district have
increasingly deteriorated due to poverty hence leading to the outbreak of various epidemics
such as Malaria, cholera, typhoid, etc. Due to this, the district is unable to accommodate the
growing number of patients in the available fifteen health units currently existing. And of these
fifteen health units, Amuria town’s health centre is the largest in the district of the same name.
Patients from all over the district are sent to this, the largest in the district, in order to treat
ailments of any kind requiring more advanced treatment. (Nurse Akello).

Amuria Health Centre has been packed beyond capacity in recent weeks, with more people
occupying the floors than hospital beds. As the rains continue to fall, the rate at which people
contract malaria in Amuria increases. This is because during the rainy season, when streams rise
and lowland areas become flooded, mosquitoes breed in greater numbers.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 1

This health centre’s resources (Amuria has no official hospital) are stretched thin even outside
the rainy season. Besides that, the entire district of over 300,000 person’s shares just one
doctor based at the town health center for all its public health centers. He travels around from
village to village and is rarely in one place for more than a day; (Braving sward: Malaria in
Uganda’s Amuria). The mere fact that the doctor is based at the town health center also leads
to population growth in that unit and hence overcrowding it because of the limited space
available and therefore the need for more space. (Davey, Wotton et al, 2004)

1.2 Problem statement.

Currently some of the conventional methods widely used to mitigate the various diseases in
Amuria such as Sensitization of the population about the diseases, supply of mosquito nets. In
some cases, these methods are not able to mitigate the serious diseases experienced and need
intensive care and treatment, which is carried out at the health units more so the Amuria town
health. Due to this, the main health unit located at the town is overcrowded with patients
occupying the floor more than hospital beds. Therefore, there is need to design structures of
larger capacities to cater for the ever increasing number of patients.

1.3 Objectives
1.3.1 General Objective:

The aim of this project is to design a structure of a larger capacity and also other
structures for different departments in the hospital so that it can accommodate the
increasing number of patients in Amuria district health unit 4.

1.3.2 Specific Objectives:

Obtain Architectural drawings for the project.

To carry out a structural analysis and design of the different components of the
structures.

To obtain the structural design of the different blocks (structures).

To come up with a design that ensures patients safety and security

To design a structure that takes into keen consideration the comfort and convenience of
passengers and the other users

1.4 Justification
Upgrading of the health units is very necessary in Amuria because of the ever-increasing
population especially in rural areas. To care for this, there is need to appraise many health units
in rural areas by increasing the capacity.

In addition to that, health is a very precious thing Amuria and Uganda at large therefore its
Good practice to upgrade all the health units in Uganda to avoid complications in life.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 2

Because of the wars in the past, some of the health unit structures were damaged and are not
in use. Now that there is peace in the district, such health units need to be upgraded after a
careful study of the rate illness and also the population growth rate in the district.

Engineering students need to be trained to design fresh structures.

1.5 Scope of the study

This project shall cover the Architectural and structural design; design drawings of the hospital
in Amuria district. It will also involve cost estimation and the preparation of the bills of
quantities.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 3

CHARPTER TWO: LITERATURE REVIEW

2.1 Introduction
This chapter provides information which was acquired from recent design reports, published
books and other secondary information which would enrich the documented detail of this
topic, and enhance the purpose of carrying out this design. In this chapter, disadvantages of the
conventional methods of design of hospitals are identified with what the contribution of this
design project will achieve in solving these problems.

A hospital is an institution for health care, often but not always providing care for inpatients
and outpatients. Today, hospitals are usually funded by the government, health organizations
(for profit or non-profit), health insurances or charities, including direct charitable donations. In
history, however, they were often founded and funded by religious orders or charitable
individuals and leaders. Hospitals are nowadays staffed by professional physicians, surgeons
and nurses, whereas in history, this work was usually done by the founding religious orders or
by volunteers.

During the middle ages, the hospital could serve other functions, such as almshouse for the
poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which is
also the root for the English words hotel, hostel, and hospitality. The modern word hotel
derives from the French word hostel, which featured a silent s, which was eventually removed
from the word. (The circumflex on modern French hôtel hints at the vanished).

There are very many hospitals worldwide. Most of them are "general hospitals" set up to
diagnose and treat most major medical conditions. Nearly 20% of the hospitals in the nation are
"specialty" hospitals that specialize in diagnosing and treating particular disorders. A general
hospital may not be able to offer the latest and most cutting edge treatments or be staffed by
the highly trained specialists. If you suffer from an unusual disorder you might be best served
by seeking out a hospital that is devoted to treating people with similar conditions. (Henry
Dahut, 2008)

There are many hospital departments, staffed by a wide variety of healthcare professionals,
with some crossover between departments.

For example, physiotherapists often work in different departments and doctors often do the
same, working on a general medical ward as well as an intensive or coronary care unit.

Below is a list of the main departments you'll come across when you visit a hospital. Some of
these units work very closely together, and may even be combined into one larger department.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 4

Accident and emergency, Anaesthetics, Breast screening, Diagnostic imaging, Discharge lounge
etc. (John Huddy and Michael T. Rapp. Irving)

2.2 TYPES OF HOSTPITALS

2.2.1 GENERAL HOSPITALS

The best-known type of hospital is the general hospital, which is set up to deal with many kinds
of disease and injury, and typically has an emergency ward to deal with immediate threats to
health and the capacity to dispatch emergency medical services. A general hospital is typically
the major health care facility in its region, with large numbers of beds for intensive care and
long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay
laboratories, and so forth. Larger cities may have many different hospitals of varying sizes and
facilities.

Types of specialized hospitals include trauma centers, children's hospitals, seniors' (geriatric)
hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems
(see psychiatric hospital), certain disease categories, and so forth. (Auteur of the book “The
design of hospitals”)

2.2.2 CLINICS

A medical facility smaller than a hospital is called a clinic, and is often run by a government
agency for health services or a private partnership of physicians (in nations where private
practice is allowed). Clinics generally provide only outpatient services.

2.2.3 TECHING HOSPITALS

A teaching hospital (or university hospital) is that who combines assistance to patients with
teaching to medical students.

2.3 ARCHITECTURAL VIEW

A hospital may be a single building or a campus. (Many hospitals with pre-20th-century origins
began as one building and evolved into campuses.) Some hospitals are affiliated with
universities for medical research and the training of medical personnel.
Modern hospital buildings are designed to minimize the effort of medical personnel and the
possibility of contamination while maximizing the efficiency of the whole system. Travel time
for personnel within the hospital and the transportation of patients between units is facilitated
and minimized. The building also should be built to accommodate heavy departments such as

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 5

radiology and operating rooms; while space for special wiring, plumbing and waste disposal
must be allowed for in the design. However, the reality is that many hospitals, even those
considered 'modern', are the product of continual, and often badly managed growth over
decades or even centuries, with utilitarian new sections added on as needs and finances
dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals: "built
catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit
for the purpose they have been designed for. They are hardly ever functional, and instead of
making patients feel at home, they produce stress and anxiety." (Choral no. 17, Johannes
Passion, J.S. Bach)

Some newer hospital designs now try to re-establish design that takes the patient's
psychological needs into account, such as providing for more air, better views and more
pleasant color schemes. These ideas harkens back to the late 18th century, when the concept
of providing fresh air and access to the 'healing powers of nature' were first employed by
hospital architects in improving their buildings. Another major change which is still ongoing in
many parts of the world is the change from a ward-based system (where patients are treated
and accommodated in communal rooms, separated at best by movable parturitions’) to a
room-based environment, where patients are accommodated in private rooms. The ward-
based system has been described as very efficient, especially for the medical staff, but is
considered to be more stressful for patients and detrimental to their privacy. A major
constraint on providing all patients with their own rooms is however found in the higher cost of
building and operating such a hospital, which causes some to charge for the privilege of private
rooms.

2.4 DESIGN GUIDELINES

The design synthesis is aimed at making a safe, strong and stable structure according to
BS8110. The design will be based on limit state design which involves application of statistics to
determine the level of safety required during the design process. According to BS8110, to
satisfy the ultimate limit state, the structure must not collapse when subjected to the peak
design loads for which it was designed. A structure is deemed to satisfy the ultimate limit state
criteria if all factored bending, tensile and compressive stresses and shear are below the
factored resistance calculated for the section under consideration.

ISO2394 “general principles for verification for safety of a structure” outlines the design used in
limit state design.

Serviceability limits state; serviceability state is that state such as for cracks and stresses. And
structure must remain functional for its intended use to satisfy the serviceability limit state
when the constituent elements do not deflect beyond certain limits of vibrations and cracking.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 6

The general specifications for road and bridge works 1992, is used by the ministry of works and
transportation to set the minimum bridge width where one lane is used for rural bridges as for
the one under consideration.

Generally designing process for bridges consist of determining load to be resisted and designing
the structural superstructure and the substructure to carry and transmit the load with safety
and convenience. A number of loads are considered these include;

2.4.1 Loads
The loads on a structure are divided into two types: dead loads and live or imposed loads. Dead
loads are those loads which are normally permanent and constant during the structure’s life.
Live loads, on the other hand, are transient and variable in magnitude, as for example those
due to wind and human occupants.

Recommendations for the loadings on buildings are given in the British Standards BS 6399: Part
1. Design loads for buildings, and Part 2. Wind loads

2.4.1.1 Dead loads

Dead loads include the weight of the structure itself, and all the architectural components such
as exterior cladding, partitions and ceilings. Equipment and static machinery, when permanent
fixtures, are also often considered as part of the dead load.

Once the sizes of all the structural members, and the details of the architectural requirements
and all permanent fixtures has been established, the dead loads can be calculated quite
accurately; but first of all, preliminary design calculations are generally required to estimate the
probable sizes and self weights of the structural concrete elements.

For most reinforced concretes, a typical value for the self weight is 24݇ܰ݉ିଷ , but a higher
density should be taken for heavily reinforced concretes

2.4.1.2 Imposed loads

These loads are more difficult to determine accurately. For many of them, it is only possible to
make conservative estimates based on standard codes of practice or past experience. Examples
of imposed loads include: the weights of occupants, furniture, or machinery; the pressures of
wind, the weight of snow.

Although the wind load is an imposed load, it is kept in a separate category when its partial
factors of safety are specified, and when the load combinations on the structure are being
considered.

2.4.1.3 Load combinations

a) Load combinations for the ultimate state

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 7

Various combinations of the characteristic values of dead load ݃௞ , imposed load ‫ݍ‬௞ , wind load
‫ݓ‬௞ and their partial factors of safety must be considered for the loading of the structure. For
the ultimate limit state the loading combinations to be considered are as follows;

1. Dead and imposed load

1.4݃௞ + 1.6‫ݍ‬௞
2. Dead and wind load
1.0݃௞ + 1.4‫ݓ‬௞
3. Dead, imposed and wind load
1.2݃௞ + 1.2‫ݍ‬௞ + 1.2‫ݓ‬௞

The imposed load can usually cover all or any part of the structure and, therefore, should be
arranged to cause the most severe stresses. Load combination 1 should also be associated with
a minimum design load of 1.0݃௞ applied to such parts of the structure as will give the most
unfavorable condition.

For the combination 1, a three-span continuous beam would have the loading arrangement
shown below in order to cause the maximum sagging moment in the outer spans and the
maximum possible hogging moment in the centre span

1.4݃௞ + 1.6‫ݍ‬௞ 1.4݃௞ + 1.6‫ݍ‬௞

1.0݃௞

A C

Figure 2.4.3a. Loading arrangement for maximum sagging moment at A and C

Figure 2.3.1b. shows the arrangements of vertical loading on a multi-span continuous beam to
cause (i) maximum sagging moments in alternate spans, and (ii) maximum hogging moments at
support A.

BS 8110 allows the ultimate design moments at the supports to be calculated from one loading
condition with all spans fully covered with the ultimate load 1.4݃௞ + 1.6‫ݍ‬௞ as shown in part (iii)
of figure 2.3.1b.

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 8

Figure 2.4.3b.

1.4݃௞ + 1.6‫ݍ‬௞ 1.4݃௞ + 1.6‫ݍ‬௞ 1.4݃௞ + 1.6‫ݍ‬௞

1.0݃௞ 1.0݃௞ 1.0݃௞ 1.0݃௞

(i) Loading arrangement for maximum moments in the spans

1.4݃௞ + 1.6‫ݍ‬௞ 1.4݃௞ + 1.6‫ݍ‬௞ 1.4݃௞ + 1.6‫ݍ‬௞

1.0݃௞ 1.0݃௞ 1.0݃௞

(ii) Loading arrangement for maximum support moment at A

1.4݃௞ + 1.6‫ݍ‬௞

(iii) Loading for design moments at the supports according to BS 8110

b) Load combinations for the serviceability limit state

A partial factor of safety of ࢽࢌ = 1.0 is usually applied to all load combinations at the
serviceability limit state. In considering deflections, the imposed load should be arranged to
give the worst effects. The deflections calculated from the load combinations are the
immediate deflections of the structure. Deflections due to the creep increase of the concrete
should be based only on the dead load plus any part of the imposed load which is permanently
on the structure. (Kong and Evans)

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page 9

CHARPTER THREE: METHODOLOGY

3.1 Architectural design

At this stage, i will obtain the architectural drawings; I will draw these structures with the help
of a computer programme (Archicad). These will include the drawing of the main hospital block
and another drawing which be used for the different departments within the hospital vicinity.

3.2 Feasibility study of the site.

This study will involve the visit to the site location. The survey will be focused on the soil
properties and, more specifically, on its ability to support the structure. Such a venture will help
me determine the most appropriate foundation both technically and economically. To do this a
shear box will be used.

The shear box allows a direct shear test to be made by relating the shear stress at failure to the
applied normal stress. The objective of the test is to determine the effective shear strength
parameters of the soil, the cohesion (c’) and the angle of internal friction (ϕ’). These values may
be used for calculating the bearing capacity of a soil and the stability of slopes.

Main principles

A square prism of soil is laterally restrained and sheared along a mechanically induced
horizontal plane while subjected to a pressure applied normal to that plane. The shearing
resistance offered by the soil as one portion is made to slide on the other is measured at
regular intervals of displacement. Failure occurs when the shearing resistance reaches the
maximum value which the soil can sustain.

This test is carried out on a set of three similar specimens of the same soil under different
normal pressures, the relationship between measured shear stress at failure and normal
applied stress is obtained.

The test specimen is consolidated under a vertical normal load until the primary consolidation
is completed. It is then sheared at a rate of displacement that is slow enough to prevent
development of excess pore pressures. Test data enable the effective shear strength
parameters c’ and ϕ’ to be derived.

3.3 Structural design

This includes the following process;

The interpretation of the architectural drawings

Structural analysis

Structural design and detailing

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page

10

Structural drawings

3.4 Bills of quantities

This gives the cost of the proposed establishment.

3.5 Detailed project report

This is the last part of the project and it involves all the data about the activities carried out and
how they were undertaken by the designer

REFERENCES:
1. Dewberry, 2000; Dewsberry and Goggin, 1996; Maxwell and van der Vorst, 2003

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page

11
 2. Reinforced and pre stressed concrete by Kong and Evans
3. Cynthia A. Leibrock. New York: John Wiley & Sons, Inc., 1999.—Innovative design
solutions in key areas such as lighting, acoustics, color, and finishes

4. Davey, Wootton et al (2004) "Design of the Surreal World", submitted to the European
Academy of Design (EAD) 2005 conference, 29–31 March 2005: University of the Arts,
Bremen, Germany.
5. John Huddy and Michael T. Rapp. Irving, Texas: ACEP 2000. A Practical Guide to Planning
for the Future. (American College of Emergency Physicians).
6. Oyeko Pius, 2001, Structural design of a 4 storeyed reinforced concrete structure,
incorporating prestresed concrete elements on plot No. 132 sixth’s street Kampala.
7. Charles E. Reynolds, James C. Steedman, 1988, Reinforced Concrete Designer’s
Handbook tenth Edition
8. Cooper et al, 2002; Davey et al, 2002; Davey et al, 2003).
9. Sherwin et al, 1998; Sherwin and Bhamra, 2000
10. Chanakya Arya; Design of structural elements; concrete, steelwork, masonry and timber
design to British Standards and Eurocodes
11. Joseph E. Bowels, P.E, S.E, 1996, Foundation Analysis and design Fifth Edition.
12. Terzaghi K and Peck B.R, 1967, Soil Mechanics in Engineering Practice, Second Edition,
John Wiley and Sons, Inc.
13. Design of a suitable foundation for the proposed new complex department of food
science and technology. Was Patrick (1998)
14. Hospitals, The Planning and Design Process, 2nd ed. by Owen B. Hardy and Lawrence P.
Lammers. Rockville, Md.: Aspen Publishers, 1996.
15. American Society of Civil Engineers. (2005). Minimum Design Loads of Buildings and
Other Structures, 2005 Ed., American Society of Civil Engineers, United States of
America.
16. Braving the Swarm: Malaria in Uganda's Amuria District
17. http://www.demotix.com/news/345748/braving-swarm-malaria-ugandas-amuria-
district
18. http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=suicide&part=A4878
19. http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi?book=suicide&blobtype=pdf
20. http://www.dege.biz/UgandaReportFebruary2007Final.pdf

APPENDIX: SCHEDULING OF ACTIVITY

Months

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page

12
Activity Aug Sep Oct Nov Dec Jan Feb Mar April May

Proposal formulation

Literature review

Site visit

Final Proposal writing

Proposal presentation

Data collection

Data analysis

Report writing

Final Project Presentation

BUDGET
ITEM Rate Amount

Transport 300,000/=

Bearing Capacity test. 150,000/=

Stationary 50,000/=

Detailed drawings 58,000/=

Architectural 100,000/=
drawings

Sub total 658,000/=

Contingency 10% 65,800/=

Grand total 723,800/=

Final Year Project Proposal by OBONYO francis…………………………………………………………………… Page

13