Healing and Therapeutic Spaces in Nairobi Hospitals: Case Studies of Kenyatta National

Hospital and Aga Khan Hospital

Namatsi S., Manguro & Omenya A.

Abstract
This paper is based on an empirical study of therapeutic spaces in some of the largest hospitals in Kenya.
Therapeutic spaces are the psychologically supportive spaces to the body, mind and spirit. They are critical
to the healing process of hospital patients.
Drawing from literature review the study focused on four parameters in the two hospitals namely: lighting
(natural and artificial); ventilation (natural, artificial and indoor air quality); views from patient rooms and
gardens; and acoustics (sound quality and noise control). Through literature review the study establishes
international benchmarks against which the performance of therapeutic spaces of the two institutions are
assessed. Both institutions perform relatively well against these parameters. However there are areas and
improvements that would assist the institutions to further improve room acoustics, daylight, indoor air quality
and open spaces; thereby improving the healing process of their patients. The study makes several
recommendations of retrofitting of the two institutions for improved performance.

1. INTRODUCTION 1.1 The Healing Process through Medical

Therapeutic architecture and the concept of
therapeutic environments have been majorly studied
over the past century with a prominence towards
expanding existing knowledge on patient comfort
and safety; alongside the physician and the visitor
experience.
Previously, the design of healthcare environments
was primarily focused on the physician’s efficiency
and performance rather than the patients comfort
and safety.
Currently, developed and integrated healthcare
systems are more concerned with the effects of
treatments and services towards the patient well-
being and satisfaction. With the goal of lowering
medical therapy costs without forfeiting quality.
This new approach has resulted in a significant shift
in both indoor and outdoor hospital space planning
and design.
Thus it is imperative to ensure that hospital designs
remain effective. Hence hospital design specialists
need to remain vigilant for any evidence that
validates the impact of therapeutic environments on
patients, visitors, and healthcare personnel.
1.1 The Process of Healing in a Hospital
Healing basically refers to the process of restoring
an individual’s health back to normal. Healing can
be either physical or psychological. Both of these
facets of a person's health must be considered.
Healing process ought to be through the Medical
Hospital and the Natural environment as discussed
below;
Hospital
The hospital's healing process is departmentalized.
Each department in a hospital contributes to the
healing process in a more advanced and helpful way.
They include: Outpatient, inpatient diagnostic, and
treatment, administrative, and service units which
basically make up the majority of hospital divisions.
When providing medical care to a patient, both
patients and doctors need to be at ease and in the
correct frame of mind. The patient must be
composed for a holistic approach to medical therapy.
And it is through, incorporation of good design of
hospital environments; enhancing the surroundings
alongside engaging hospital occupants in safe and
relaxed spaces, that the natural environment comes
in handy to support the medical process of healing.
1.2 The Healing Process through Natural
Environment in Hospitals
According to Cynthia McCullough, the integration
of environmental policies in hospital designs
towards supporting the medical healing process
contributes to the formation of therapeutic and
healing environments. Thus describing a therapeutic
space through Evidenced Based Design process as:
 A place to restore the mind, body, and spirit.
 A setting where dignity and respect are
ingrained into everything.
 A setting where events or situations such as
life, death, illness, and healing define the
moment and the building supports them.
1.3 Natural Environmental Parameters that
Affect Healing; Essential for creating therapeutic
spaces in Hospitals.
This study looks into the four fundamental
principles that are essential for creating a healing
and therapeutic environment in a hospital, along
with their impacts on well-being of patients, staffs
and visitors. They include:
Lighting; Natural Day-lighting and Artificial
Lighting
Ventilation; Natural and Artificial Ventilation
and Indoor Air Quality
Views in Patient Rooms and Gardens
Sound Quality and Noise Control.
1.4 Lighting [ Natural Day-lighting and Artificial
Lighting] and Healing.
(a) Ideal Natural Lighting Levels for Hospitals
Commonly, patients are always susceptible to
windows designs that take up at least 25% of the
outside wall, exterior wall, with a large number
preferring rooms that have at least two windows.
The bare minimum level of natural lighting in a
ward, tends to be 100lux, which also meets the
needs for the nursing staff. The acceptable
recommended level for nursing stations ranges
between 150-300 lux.
(b) The Benefits of Natural Light towards providing
a Therapeutic Environment in Hospitals
Reduces the length of in-patient Stays1
Speed up post-operative recovery.
Contributes to greater pain relief.
(c)Artificial lighting and Healing in Hospitals.
Artificial lighting allows for deep plan podiums on
a hospital platform, which are argued to maximize
space (Maynard et al, 2005). For instance; In a
Ward- the optimum lighting level between the
hospital beds is considered to be 100 lux and 300 lux
in the central ward area on the BED. Whereas for the
Out-patient-optimum lighting level for an
outpatient space ranges between 300 and 500lx.
Stichler, J.F., 2015. Hospitals of the Future. HERD: Health
Environments Research & Design Journal, 8(3), pp.6-8
2
Etheridge, D.W. and Sandberg, M., 1996. Building
ventilation: theory and measurement (Vol. 50). Chichester,
UK: John Wiley & Sons
3
Tang, P.C., Ash, J.S., Bates, D.W., Overhage, J.M. and
Sands, D.Z., 2006. Personal health records: definitions,
benefits, and strategies for overcoming barriers to
adoption. Journal of the
In summary, a combination of daylight and artificial
light in the right and appropriate measures, meet the
requirements and needs of a therapeutic space in a
hospital design.
1.5 Ventilation (Natural ventilation,
Mechanical and ventilation); Indoor Air
Quality and Healing.
Ventilation brings in fresh air from outside; outdoor
air, and distributes it throughout a building or room2
There are three techniques that can be cast-off to
ventilate a space or building: natural, mechanical
and hybrid ventilation (mixed-mode) ventilation.
(a) Natural ventilation and Healing in
Hospitals.
Natural ventilation techniques have been shown to
support thermal comfort in medical facilities by;
maintaining comfortable temperatures; Temperature
Ranges for Patient Comfort, and Staff Efficiency
ranges between 21 °C to 24 °C degree celcius and 70
°F to 75 °F for humidity levels.
Li et al, 2007 clarifies that there is a strong and
convincing evidence linking ventilation and air
movement in buildings to the spread of infectious
diseases.
He demonstrates this through observational cases,
such as the Butaro District Hospital by Mass
Design. Thus, Natural Ventilation lowers the rates
of nosocomial infections (hospital acquired
infections),like tuberculosis, hence boosting the
healing process for patients, and lowering
operational costs by minimizing the use of artificial
systems3. (Tang et al, 2006)
A- Exterior Circulation B- cross ventilation C- inoperable
vents D- industrial fans E- ultra-violet germicidal lights
Natural ventilation section
natural ventilation strategies in a patient ward at
Butaro Hospital.
American Medical Informatics Association, 13(2), pp.121-
126.
(b)Mechanical ventilation and Healing in Hospitals.
Artificial lighting allows for deep plan podiums on a
hospital’s platform that are argued to maximize
space. They provide task precision in surgical areas,
and their ability to be regulated provides excellent
opportunities for mood changes within interior
spaces like theatres.4
In summary, Natural ventilation provides user
comfort in common areas to support therapeutic
spaces, in hospital environments, it reduces energy
costs and facilitate reduction in Hospital acquired
infections like transmission of Tuberculosis through
aeration of spaces whereas, the presence of artificial
ventilation in hospital spaces especially in
specialized rooms as surgical rooms, pharmacies
and other intensive care spaces provide for certain
functions that natural ventilation simply cannot
achieve. Therefore, to attain this therapeutic spaces
in hospitals, a healthy balance in which natural
ventilation strategies take a bigger role in ventilation
strategies within hospital environments and artificial
ventilation only supports special functions should be
considered towards providing for ventilation in
hospital environments.
1.6 Natural Environments; Views and Open
Garden Spaces
Numerous studies have noted that views to nature
and open garden spaces tend to positively impact the
patients wellbeing; by providing room for positive
distraction and comfort.
Ulrich, 2008 notes that the healing benefits of views
of nature are expressed as a collective series of
positive emotional, psychological, and
physiological transformations5
It is therefore important to design healthcare
facilities to take use of nature, views, and other
environmental aspects to assist in pain control since
patients’ report feeling less pain when exposed to
natural sights such as gardens rather than having
blank walls in their hospital rooms.
4
Maynard, G. A., McAlister, M. B., Angelbeck, J. A., Schaffer,
J., Russell, R. L., Ortolord, E., & Wenz, B. (2005). Hospital
water point-of-use filtration: a complementary strategy to
reduce the risk of nosocomial infection. American journal of
infection control, 33(5), S1-S19.
5
Ulrich‐Schad, J.D. and Qin, H., 2018. Culture clash?
Predictors of views on amenity‐led development and
1.7 Quality of Sound and Noise Control towards
Healing in Hospitals.
Sound in its various forms partakes a significant
impact on patients, staff, and visitors in hospitals.
Numerous studies on sound in hospitals examine it
in terms of noise and speech privacy versus speech
intelligence6. (Anjali,2004).
Noise; which is commonly referred to as "unwanted
sound" in the scientific literature, can be harmful to
the health of patients and employees.
Patients exposed to high noise levels, tend to
recover slowly as opposed to patients exposed to
low noise levels and soothing sounds. For
constant background noise in hospital rooms, the
World Health Organization (WHO) recommends
35 decibels by day and 30 decibels by night, with
wards not to exceed 40 dB for peaks, at midnight.
Speech Intelligibility, Audibility and Privacy; is
vital for communication in hospitals, both between
staff members and between patients. There is a need
to achieve speech privacy by minimizing the
audibility and intelligibility of their conversation to
unauthorized listeners while still maximizing speech
intelligibility amongst persons in the hospital. This
can be achieved through:
Sound control measures in terms of department
and service location with more noise-prone
departments such as outpatient and Workshops
being located away from critical units such as the
ICU and Pediatric departments.
The second strategy for reducing noise levels in
hospitals is sound control, i.e. installing sound-
absorbing acoustical ceiling tiles of high
performance reduces sound propagation,
shortens reverberation times, and enhances
speech clarity, and this in turn has a positive
impact on the patients’ health and well-being,
stress reduction and safety.
community involvement in rural recreation counties. Rural
Sociology, 83(1), pp.81-108.
6
Anjali, T., Scoglio, C de Oliveira, J.C., Akyildiz, I.F. and UhI,
G., 2004. TEAM: A traffic engineering automated manager
for DiffServ-based MPLS networks. IEEE Communications
Magazine, 42(10), pp.134-145.
2.DESIGN VARIABLES VERSUS
PRINCIPLES OF ENVIRONMENTAL
DESIGN PARAMETERS TIED TO HUMAN
COMFORT TOWARDS HEALING AND
THERAPEUTIC SPACES IN HOSPITALS.
The human comfort for hospital buildings is
achieved as a result of effective implementation
of the four environmental strategies parameters
into building planning process.
In hospital designs, a change in natural
environmental will result in a shift of how the
four environmental parameters (Lighting,
Sound Quality, Views and Gardens and
Ventilation) are applied. As such, there needs
to be a mutually beneficial relationship between
nature and architecture in order to achieve
therapeutic spaces in a hospital design.
Therapeutic Spaces must take into account the
outdoor conditions and indoor thermal comfort
of its occupants.
The Design variables to be discussed include
 Site Planning
 Unit Planning
 Structure, natural materials, Color and
Built form
 Openings of the Building units
Therefore, for Healing to occur and be boosted
in hospitals there must be a connection
between the Environmental design principles
and the design variables. For instance;
 A connection between Lighting and the
design variables towards healing
 A connection between Ventilation and
the design variables towards healing
2.1 Choice of Site
For proper ventilation purposes in wards and
the office spaces in hospitals, hospital sites
ought to be predominantly exposed to the
prevailing winds. Natural ventilation supports
thermal comfort in medical facilities wards and
offices by; maintaining comfortable
temperatures and lowering the rates of
nosocomial infections thus boosting the healing
process for patients.
2.1.1 Unit Layouts and Spacing of Units (Wards
and Office Spaces)
Ward structures should not block winds. This
typically denotes an open, well-spaced layout,
as shown in Figure 2
Figure 2: Unit plan configuration with minimal wind obstruction
impact.
2.2 Unit planning
(a) Unit Form
All rooms and spaces should be well ventilated
for good indoor air quality alongside thermal
comfort. Internal partitions ought to be reduced
to a minimum for the purposes of minimizing
hindrance to internal air movement therefore
open plan spaces particularly in wards are
recommended. Single banked and H-forms are
recommended, since they correspondingly
allow for space intermediary thus creating
courtyards that cushion levels of noise as well
as provide for good views for positive
distractions of the patients, thus boosting up the
patients’ recovery process.
(b) Orientation
North-south orientation is required to manage
natural sunlight, lessen glare, and prevent
buildup.
(c) Courtyards
Hospital courtyards should be more open to
prevailing breezes and less enclosed to
promote air movement towards and away from
the wards for illness prevention. Also, the
courtyards should mainly serve as healing
gardens to the patients, and thus have a good
impact on the patients' stress levels and
anxiety, pain tolerance, and lengths of stay in
hospital wards.
2.3 Structure, Natural Materials, Colors. Art and
Built Forms.
The hospital Interior walls should be majorly
painted white-vibrant color. This is because the
bright colors give patients an intuition of not
feeling to be in a closed setting. This speeds up
their healing process. The bright color also
diffuses light into the building.
The hospitals should also be installed with
acoustic ceilings which are responsible for
reducing noise levels inside the wards and
office spaces as well as improving speech
intelligibility since the acoustic ceiling
predominantly absorbs the unwanted noise.
2.4 Openings of the building units
For louvered windows, it is recommended that
the sill height not exceed 0.80 meters8. (Givoni,
1969).
(b) Types of Windows
Adjustable Louvered windows that open to a
few degrees beyond the horizontal line tend to
be the best window type for wards. This is
because they can be adjusted to direct
incoming air toward the area of occupation.

(a) Location of Openings

The placement of windows and other openings

should be in such a way that, they prevent dead
air pockets both on the design and in the
section7.
Louvered windows
Low sill heights allow for diffused ambient
natural lighting during the daytime while giving
low level comfort ventilation to patients resting
on low beds or sitting in low chairs.

3. ANALYSIS OF THERAPEUTIC SPACES variables within the building design as they

IN TWO AGA KHAN AND KENYATTA
HOSPITALS IN NAIROBI
3.1 Parameters for the case studies
The paper identifies and validates
environmental strategies used in hospital
design to support healing, as well as how they
affect the healing process in a hospital. The
critical factors were identified through a critical
analysis of the literature review; The
parameters that influence the healing process
in hospitals, in respect to the design variables.
A focus is placed on how the selected four
principles of natural environment elements
(lighting, ventilation, sound quality, and
views) have been merged into the hospital
design by examining the following key design
pertain to the hospital environment;
 Site Planning; Choice of site, Unit
layouts, Spacing of units and
Vegetation/Plants.
 Unit Planning; Unit form, Orientation,
Courtyards and Verandas
 Structure and Materials, natural
colors, art and built forms; walls,
roofing, surface finishes, color and art.
 Openings of the Building Units;
Location of opening, Window types.
This paper explores how these
elements have performed within the
cases relative to inferences drawn from
the critical literature on designing
hospitals with natural healing
environments.

7 8
Etheridge, D.W. and Sandberg, M., 1996. Building
ventilation: theory and measurement (Vol. 50). Chichester, Givoni, B., 1969. Man, climate and architecture. Elsevier;().
UK: John Wiley & Sons
4. THERAPEUTIC SPACES AT KENYATTA NATIONAL HOSPITAL
Location of the wards at Kenyatta
National Hospital in relation to the surrounding
Spaces. A-alternative entrance, B-mortuary entrance, C-school of
medicine, university of Nairobi, D-Inpatient
wards, E-old hospital, F- KMTC, G-Main entrance, H-outpatient
emergency, I-private section, K-public
parking
4.1 Site Planning
a) Choice of Site
The adopted organizational principle for
Kenyatta National Hospital is linear, with the
creation of courtyards. This site planning
principle resulted to the creation of both open
and closed courtyards. The wards are located
in the center of the site plan, which has an
effect; in that, buildings located in the direction
of the prevailing wind, block the wind that is
getting into the wards. This results in low-
velocity winds, which reduces the
effectiveness of cross ventilation in the
hospitals' wards. This in turn hinders good
thermal comfort levels in the wards. Hence, it
is a disadvantage to the patients, since Natural
ventilation supports thermal comfort in medical
facilities wards and offices by; maintaining
comfortable temperatures and lowering the
rates of nosocomial infections
thus boosting the healing process for
patients. The temperature recorded at KNH,
was 25.3 °Which is above the comfortable
Temperature Ranges for Patient Comfort,
and Staff Efficiency; between 21 °C to 24 °C
degree celcius and 70 °F to 75 °F for
humidity levels. This clearly does not fall
into the therapeutic setting of spaces for
patients in a hospital.
b) Unit Layouts and Spacing of Units (Wards
and Office Spaces)
KNH has adopted a compact planning approach
to the departments, with all buildings spaced
between 2m and 12m apart, limiting airflow and
natural lighting to the lower floors i.e. the ground
floor of the hospital ward. Lighting level
around the staircase area ought to be below
the recommended natural lighting level,100
lux for a hospital setting.
While this is done to maximize the use of the
site, open garden spaces have been limited as
a result of this planning. Thus, leading to limited
views to outside and limited garden spaces for
pleasant and positive distraction for the
patients.
The compact nature of the buildings, particularly
the inpatient building which has a deep plan
4.2. Unit Planning.
a) Unit form
Also, the site is highly tarmacked with less
green areas and less vegetation in the
courtyards, thus resulting to glare towards the
East and West facing facades of the in-patient
wards; the site lack vegetation needed to filter
the unwanted light away from the
ward interiors. Unwanted light slows down the
healing process for patients. Less than 15 %
of the ward zone is typically green.
conglomeration of all inpatient, accident and
emergency, and administration departments to
high levels of wind distraction, resulting in
inadequate ventilation in these departments.
As a result, air can't get to all spaces because
the deep plan makes it hard for wind to flow into
the interior spaces. Hence, making it hard for
cross ventilation to occur and also natural
lighting to get into all the patient rooms and staff
offices. In turn, this lengthens the patients’
hospital stays as it slows down the healing and
recovery process for patients.
At KNH, the orthopedic inpatient wards are
double banked and situated parallel to the to the
administrative and support areas.
The building's choice of layout, significantly
impedes light penetration to the corridor during
the day. To the deeper corridors lighting
levels were below 100 lux.
The choice of layout for KNH, affects cross
ventilation as well. In that, the air that gets into
the patient wards through the windows,
especially the ones on the lower floors, are
obstructed by the service and support areas,
and instead, the air gets out of the building
through the doors. This lowers cross ventilation
levels. As a result, the air becomes stagnant,
increasing the chances of respiratory HAI
transmission when doors to Wards and offices
are closed.
During a better time of day, the office doors
were mostly closed, as observed. As a result,
there was no cross ventilation between the
offices and corridors. This in turn hinders good
thermal comfort levels in the wards. Hence, it is
a disadvantage to the patients.
 b) Orientation
The orientation of the wards in KNH is north-
south and east-west. The wards facing north
and east experience oblique winds.
Nonetheless, the west and south facing wards
are poorly ventilated since they face away off,
from the predominant winds. They are
ventilated by the wind that flows through the
east and north-facing rooms, which is
ineffective due to its low velocity. Thus
negatively affecting the indoor thermal comfort
for the occupants.
c) Courtyards
The wards at Kenyatta National hospital are
organized around four introverted, closed
courtyards. The spaces between the
courtyards are circulation spaces, consisting
of verandas, elevators, and staircases.
Nonetheless, the courtyards have few trees
and vegetation, resulting in poor views from
the wards. These courtyards do not support
healing for the patients. In addition, the
phytoremediation effect of plants and trees
is not felt in the wards due to the absence
of plants in the courtyards. Thus the
healing process is slowed down.
d) Incorporation of nature; Trees and
plants
The courtyards of the in-patient wards at KNH
have relatively little greenery; Less trees and
planters. These courtyards do not serve as
healing gardens.
A view of trees and planters help patients
recover faster by reducing diastolic blood
pressure and stress. Also, trees and plants
have an effect on indoor air quality, and this
may be one of the causes of poor air quality in
the hospital wards at KNH.
Moreover, noise levels have upsurge along
the lane next to the wards, due to the absence
of trees. Trees act as sound buffers. There are
high noise levels, mainly during lunch hour
due to human traffic. This lane close to the
inpatient wards entails the greatest noise
levels, ranging from 58 to 69 decibels. This
causes disturbance to the patients, who are
majorly on the ground, first and second floor;
hence slows down their recovery process.
“Unwanted sound,” can be detrimental to the
patient and staff health. For constant
background noise in hospital rooms, the
World Health Organization (WHO)
recommends 35 decibels by day and 30
decibels by night, with wards not to exceed
40 dB for peaks, at midnight.
4.3 Openings
a) Location of the Openings
The Kenyatta National Hospital ward building
entails sliding windows on the North-South
elevations, together with the East-west
elevation. A sample wall per ward room is
43.3%, compared to the 20% required for
adequate lighting.
Nonetheless, the percentage is too high,
resulting in glare during the morning and
evening sun. The openable windows are only
found on the East facing wall, while the interior
windows are fixed and glazed. As a result,
ventilation occurs solely through the doors.
This prevents optimal cross ventilation.
In the wards and offices, the sill height is 1000
mm, which is within the zone of occupation for
patients on beds and those seated in chairs.
However, it is excessively high for the cases of
low beds and chairs.
b) Windows
KNH's windows are sliding. Sliding windows
have the disadvantage of only providing 50%
openable area for direct airflow.
c)Doors
The doors in the wards at Kenyatta National
Hospital are made of wood with glass infill to
allow light and visibility.
The door sizes at KNH meet the
recommended standard in hospitals, which is
1.8 x 2.3 meters.
Nonetheless, the doors do not have
permanent vents, as a result, this means that
cross ventilation occurs only when the doors
are open. This leads to Poor indoor air quality
in the wards and rising transmission risks
respiratory HAIs that are airborne.
4.4. Structure and Materials, Natural
Materials, color, art and built form
Structure-KNH is built with heavy stone
blocks on the walls and a concrete roofing with
bitumen for waterproofing.
Walls: The walls of both the outpatient and
inpatient buildings are made of masonry
blocks, which block harsh winds but allow
direct sunlight to enter the wards and office
spaces through the windows. The 200mm
thick wall entails low absorption levels for heat
and high resistivity.
Roofs: The roof at the KNH inpatient building
has white acoustic ceilings which are
responsible for reducing noise levels inside
the wards and office spaces as well as
improving speech.
Surface Finishes: The interior walls at KNH
wards are cladded with white textured paints
which are of Low-odor. That is, they don’t give
off fumes or odors, hence are safe for patients.
The low-odor paint, also prevents the growth
of mildew and mold, alongside improving
indoor air quality.
Basically, the vibrant bright color of the
building materials brightens up the hospital
wards; thus gives life to patients and speeds
up their recovery and healing process. This is
because the bright colors give them an
intuition of not feeling to be in a closed setting.
The bright color diffuses light into the building
A-Main Hospital Building E-Heart & Cancer Centre
B-Consulting Clinics and East Tower Block F-Material Management Division
C-Doctors Plaza
D-Princess Zahra Pavilion
5. THE AGA KHAN HOSPITAL, NAIROBI
A BLOW UP OF AGA KHAN UNIVERSITY HOSPITAL SITE
Agha Khan University hospital is located along
the 3rd Avenue, Parklands, Nairobi.
The hospital is adjacent to Nairobi City Park. It
was designed by the Symbion group and
completed in 2009. The Cancer Center at the
Jimmy Sayani Building has a palliative care
wing that provides palliation services to
patients, particularly cancer patients. The key
strong points for the hospital are:
 Has large open spaces with
gardens and water feature for
patients and their families to
unwind. The courtyards at Aga wards and offices to improve the indoor thermal
khan serve as healing gardens. comfort of the patients, visitors and staff. The
 It is easily accessible due to its wards and offices experience cross ventilation,
proximity to Nairobi Business a Natural ventilation technique, that supports
District. thermal comfort in medical facilities wards and
 Provides palliative care to offices by; maintaining comfortable
patients, particularly cancer temperatures and lowering the rates of
patients. nosocomial infections thus boosting the healing
5.1 Site Planning process for patients. Temperatures recorded
at Aga khan was at 22.2 ° which falls under the
a) Choice of Site comfortable Temperature Ranges for Patient
Aga Khan University hospital is located Comfort, and Staff Efficiency.
adjacent to Nairobi City Park which is an open The site provides for enormous green spaces
site; with an access to prevailing breezes that with roughly 25 percent of the acreage being
are directly tapped into the hospital design; planted with grass, trees and creepers.
Such vegetated areas have been positioned all-
round the main building and predominantly the
patient care wards, with trees lowering glare
and boosting natural lighting to indoor spaces;
the vegetation at Aga Khan hospital allows for
infiltration of light, while still retaining pleasant
green open spaces for users to enjoy and for
patients’ positive distraction.
The hospital is also sandwiched between two
busy roads; the Limuru road and 3rd Parklands
avenue road, which source high noise levels
to the surrounding of up to 75 decibels. The
hospital has dealt with this noise issue by
planting many trees that act as buffers and
also, locating critical areas like the ICU
department away from the main roads. This in
turn provides for a healthy healing and
therapeutic environment for the patients.
5.2 Unit Planning
a) Unit form
The inpatient department section, which houses
the wards, has a narrow H-plan that allows light
to enter the wards. Also, all inpatient wards
overlook at the scenic view, the court and
landscaped outdoor space constructed with
natural materials. This enables the patients
connect with nature, thus boosting their healing
process.
Ward plan layout for the Female and Male Surgical wards at
Aga Khan University Hospital. Source; Author,2022.
b) Unit Layouts and Spacing of Units (Wards
and Office Spaces)
The hospital units feature an open plan
arrangement with sufficient spaces in between
departments where the gardens and the
vegetated sites exist.
This enables maximizing of views by the
patients and staffs in the wards and offices.
Noise is minimized; the trees in between
provide for noise buffering from the main road
where the noise levels opt to be up to 75dB.
The hospital units have been designed with
longer facades facing north and south to absorb
more wind and provide for thermal comfort of
the occupants. To resist direct sunshine, all
buildings have deep extensive verandahs that
scatter light and prevent major walls from
heating up during the day. This provides
indirect sunlight for natural day illumination as
well as natural ventilation via cross ventilation
of air.
The hospital’s design is purposefully consistent
in its use of organic patterns.
One of the patterns used in the design of Aga
khan hospital is the 8-pointed star, or the
octagram.
Patients connect with this natural pattern and
benefit subtly from its stress-relieving
properties. Also, these patterns create a sense
of balance and rhythm, which enhances the
interaction of people in these spaces.

b) Orientation
The main building which houses both the out-
patient and in patient adopts a North-south
orientation on the longer facades thus reduces
heat gain from direct sunlight. The East-West
facades, on the other hand, are shaded by
verandahs, which reduces heat buildup on
them.
Light levels both in the Male and female
surgical wards range between 410lux and
417lux at noon hours, which are way above
the recommended natural lighting level for a
ward and office setting. Thus the space falling
under therapeutic spaces.
5.3 Courtyards
Aga khan hospital entails two courtyards that
are filled with greenery. Also, one of the two
courtyards has a covered walkway that not
only provide visitors with sheltered seating
areas but also allows patients to come out of
their rooms and spend time outside in the fresh
air. Nature, in this sense, provides a natural
healing system while also boosting patients'
immune systems. Furthermore, the shaded
promenade allows patients to connect with
nature by interacting with birds, flowers in
bloom, and the natural cycle.
The courtyard serves as a healing garden, with
a fountain in the center that emits the soothing
sound of running water. The smell of flowers,
the sound of running water, and even the feel
of the wind is used in these areas to conduct
physiotherapy. The vegetation and courtyards
also allow for noise buffering.
Incorporation of nature; Trees and plants
The site provides for enormous green spaces
with roughly 25 percent of the acreage being
planted with grass, trees and creepers.
Through observation; the garden spaces
within the Aga khan hospital are popular with
patients seeking pleasant, positive distraction
and connection with nature.
5.4 Structure and Materials, Natural
Materials, color, art and built form
Structure- The buildings at Aga Khan
University hospital are cladded with bricks
which allow the building blocks to blend in with
nature, and the surrounding landscape. This
helps create a feeling that is domestic in
nature to the patients. Thus, boosts their
healing process, since it psychologically
creates a homey feeling to their minds.
The bricks are also effective at sound
absorption. They do contribute to the building's
aesthetics too; most importantly, they
preserve the integrity of the design's natural
elements.
Roofing- The roof at Aga Khan hospital entails
white acoustic ceilings which are responsible
for reducing noise levels inside the wards and
office spaces as well as improving speech
intelligibility.

Surface finishes -the interior walls of the
wards at Aga Khan hospital are painted white
in color. The vibrant bright color of the wall
brightens up the hospital wards; thus gives life
to patients and speeds up their recovery and
healing process.
The guard rails for the staircases are made of
brown wood; giving a feeling close to nature.
The curtains were a dull brown color.
Flooring –Entails Light tones and warm colors
for the flooring colors. These colors comprise
5.4 Openings
According to Figures 5-33 and 5-35, the
wards have windows that are 1500 mm high
with a 900 mm sill height that run the entire
length of the wall. Above them, are the
recessed clerestory windows which allow for
more light to enter while also creating a shelf
that can be used to shade the bed closest to
the window from glare.
Clerestory windows increase daylight
penetration in the ward.
of a mix of beige, white, cream and light grey.
The flooring materials give a feeling close to
nature.
Art- The hospital's visual art consisted of
photographs of landscapes, animals, plants,
and people along the corridors. The doctor in
charge of the female surgical ward, who was
interviewed confirmed that these Photographs
were mainly chosen due to their positive
subject matter that would improve the health
of patients.
Aga Khan hospital private rooms are
purposefully created to evoke a sense of
comfort. This is exemplified by the visitor
lounge area, which was designed to provide
psychological support.
These rooms' windows are properly sized and
proportioned to let in natural light and allow for
good views from the courtyards into the wards.
According to Ulrich, patients in rooms with a
view of nature have shorter hospital stays,
complain less, and require less pain
medication than those who look out onto a
brick wall.
Comparative lighting levels at Kenyatta National Hospital male orthopedic wards and Aga Khan
University hospital male surgical wards, at noon time. On date 24 th and 25TH October,2022
respectively.

175lx 417lx
Comparative lighting levels at Kenyatta National Hospital and Aga Khan University hospital staircase
areas, at noon hours. On date 24th and 25TH October,2022 respectively.

17lx (Emergency stairs) 416lx

Comparative Noise levels at Kenyatta National Hospital and Aga Khan University hospital staircase
areas, at noon hours. On date 24th and 25TH October,2022 respectively.

60db 50db
 7.0 RECOMMENDATIONS AND CONCLUSION
7.1 Recommendations
The paper makes recommendations ought to be specific for each case; Case 1 –Kenyatta National
Hospital and Case 2-Aga Khan University Hospital; with an aim of creating healing and
therapeutic spaces in hospitals.

RECOMMENDATIONS
Natural Healing Case 1-Kenyatta National Hospital Case 2-Aga Khan University Hospital
Parameters
In terms of site planning, KNH should consider a Incorporate Adjustable Louvered windows that open
layering approach of departments that is open, to a few degrees beyond the horizontal line since
informal and in which the departments will be well they to be the best window type for wards. This is
spaced to allow for maximum ventilation; optimal because they can be adjusted to direct incoming air
cross ventilation into the wards. Currently spacing toward the area of occupation.
for buildings and departments at KNH is between Additionally, in comparison to other window types,
Natural 2m and 12 apart, of which this limits air flow into the louvered windows have a substantially higher
Ventilation lower floors i.e. the ground floor of the in-patient effective openable area, which increases the amount
ward building. Thus no good thermal comfort levels, of floor space that is effectively ventilated.
into the ward and office spaces. An image of a ward perspective window at Khoo
However, with the incorporation of open and well Teck Puat Hospital, Singapore; with adjustable
spacing of buildings, natural ventilation in the wards louvers.
and office spaces will be highly boosted. Hence
creating a therapeutic setting for patients, staff and
visitors.
In terms of Unit planning, the patient wards at KNH
should partake the single banked forms in the ward
spaces, so as to allow for good ventilation.
Longer facades should also be oriented
predominantly in the North-south direction, with
many openings being on the North and south
facades, just like the way Aga Khan has done it, on
its main building which houses the wards. This is to
ensure favorable winds and optimal cross ventilation
into the spaces. Good natural ventilation ensures
good thermal comfort of the patients and staff .

KNH should partake low sill heights commencing at
450mm for the windows; Low sill heights give low
level comfort ventilation to patients resting on low
beds or sitting in low chairs.
Current sill height for the ward windows at KNH
hospital is 1000mm, which is even way above the
recommended maximum sill height for louvered
windows;800mm, as it is noted by Givoni, 1969.
KNH should partake openings that are large, sun-
shaded by the sun, and have low sills, commencing
at 450mm. Ideally, more than half of the North and
South walls should entail operable and transparent
glass windows. However, the amount of glass in
Natural Lighting these walls shouldn't exceed 20% of their total area,
of the wall.
Also, Low sill heights allow for diffused ambient
natural lighting during the daytime. Good lighting
gives life to patients. Current sill height for the ward
windows at KNH hospital is 1000mm.
Openings on the East and West façade of KNH
should incorporate a sun shading technology with
Low E-glass to mitigate solar gain and patient
discomfort,
The KNH site should incorporate a high level of plant
growth to act as Noise buffers, along the lane next
to the wards, where noise levels are high mainly
Sound Quality during lunch hour due to human traffic ranging from
and Noise 58 to 69 decibels. This causes disturbance to the
patients; who are majorly on the ground, first and
second floor; hence slows down their recovery
process. “Unwanted sound,” can be detrimental to
the patient and staff health. For constant
Should partake low sill heights commencing at
450mm for the windows; Low sill heights give low
level comfort ventilation to patients resting on low
beds or sitting in low chairs.
Current sill height for the ward windows at Aga Khan
hospital is 900mm, which is even way above the
recommended maximum sill height for louvered
windows;800mm, as it is noted by Givoni, 1969.
Aga Khan hospital should also partake openings that
are large, sun-shaded by the sun, and have low sills,
commencing at 450mm. Ideally, more than half of
the North and South walls should entail operable and
transparent glass windows. However, the amount of
glass in these walls shouldn't exceed 20% of their
total area, of the wall.
Also, Low sill heights allow for diffused ambient
natural lighting during the daytime. Good lighting
gives life to patients.
Current sill height for the ward windows at Aga Khan
hospital is 900mm.
Add more trees on the Aga Khan hospital site to
ensure the site has a very high good level of plant
growth,
 background noise in hospital rooms, the World The trees at Aga Khan hospital provide for noise
Health Organization (WHO) recommends 35 buffering from the main roads where the noise levels
decibels by day and 30 decibels by night, with wards ought to be up to75dB.
not to exceed 40 dB for peaks, at midnight.
Therefore, high plant growth along the lane next to
the wards opt to allow also for noise buffering from
the most unwanted sounds.

KNH should incorporate open gardens and

Views and courtyards, in and out of the inpatient ward building,
Gardens to provide areas that support patient comfort in the
hospital. Currently, the courtyards at KNH within the
wards are closed.
Also the site should incorporate a high level of plant Aga Khan hospital should ensure that its site has a
growth to offer shades, particularly in open areas; very high good level of plant growth,
the gardens and trees provide for good views. These areas serve as healing gardens to the
Incorporate water feature elements, especially in the patients, and do have a good impact on the patients'
outpatient and in-patient section. The presence of levels of stress and anxiety, pain tolerance, and
water features in the gardens allows users to enjoy lengths of stay in hospital wards.
Views and the visual and acoustic benefits of water. Thus
Gardens creating a therapeutic feeling to the patients.

A water feature zone at KhooTeckPuat Hospital

Incorporate feature walls too, along corridors and in

the general wards to allow for positive distraction.
Though,
the private wing at KNH has tried to incorporate this
to some extent thus creating some extent of
therapeutic feel to this wing.
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Appendices

Data logger readings for Lighting levels, on 24th & 25th October,2022, Respectively.

Data logger readings for Temperature & RH, on 24th & 25th October,2022, Respectively.