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Ashoka Medicover Hospital

Ashoka Medicover Hospital, Nashik designed by HOSMAC was inaugurated on 24th October,2018. The 300 bedded superspecialty hospital offers entire spectrum of services including diagnosis, treatment, surgery, preventive health care and rehabilitation across all specialities and sub-specialties of medicine.

How Indian Healthcare can set the Right Conditions for Research

How Indian Healthcare can set the Right Conditions for Research

Futurism, once considered a forte of science fiction writers, has become mainstream today. Universities offer advanced courses and a growing number of companies are building teams for the future. But what about the healthcare sector? Don’t we need more researchers to prepare us for the future? An HE report.

India has an advanced technological base. In 2014, Indian space scientists successfully placed a satellite in orbit on Mars. The budget for this extra-ordinary feat was just $72mn, less than the budget of the Hollywood movie Gravity. Even the image of women scientists celebrating the success in the Bangalore mission control room went viral. In fact, a Canadian scientist Catherine Mavriplis tweeted, “When was the last time you saw women scientists celebrate a space mission?”

While there is a lot of emphasis on R&D in space and technology, equal commitment to invest in critical sectors such as healthcare seems lacking. At 0.83% of gross domestic product (GDP), India is among the countries with the lowest investment in scientific research. Despite economic growth, Indian researchers face a lot of problems, including poor infrastructure, red tape, and disconnectedness from global trends.

A large proportion of medical device requirement in the country is met by imported products, with the US being the lead supplier. Twenty-three of the world’s largest medical technology firms have established sales and marketing offices in India. The domestic medical equipment sector is small and fragmented. With an estimated 700 manufacturers, most domestic players are focused on consumables. The higher end market remains to be dominated by global companies.

Financing of Research

In fact, a parliamentary panel has asked the Centre to increase budgetary allocation for critical healthcare research after it found “huge” mismatch between demand and allocation of funds for Department of Health Research (DHR) policies.

The panel recommended increased investments in health research to provide affordable and quality healthcare. They noted that in the USA, the budget of National Institute of Health, which functions like that of Indian Council of Medical Research (ICMR) under DHR, is 32 billion dollars per year.

Changing the Culture

Dr.CliveDr Clive Fernandes, Group Clinical Director of Wockhardt Hospital, points out, “There is a huge cost involved with no guarantee of ROI for healthcare research. Literally put, for research you require deep pockets. More money has to be poured as research is like aiming in the dark. There is no guarantee of success and, more often than not, the desired outcomes are never attained. This leads to a lack of interest in the funding of such projects.

“It is difficult to have start-ups in this field due to the same reason. No one would want to put their money where the chances of failure are greater than that of success. Research normally takes time and by time, I mean a long time. In this age of quick returns, there are very few entrepreneurs and companies who are willing to wait endlessly for the desired results.”

“One of the things that are easier said than done is accepting that, during the journey, there will be many more failures than success. Are we willing to accept failure? We have very few individuals and companies who have the mindset required for research and it shows, as the question itself reveals a lack of research culture,” he adds.

To put this in perspective, the world’s 12 biggest drug companies are making a return of just 3.2 percent on their research and development spending this year— down from 10.1 percent in 2010, according to Deloitte’s annual survey of pharma R&D investment.  At the same time, the average cost of launching a drug has soared to a record $2bn from $1.5bn in 2016 and $1.2bn in 2010, when the professional services firm launched its pharma survey.

More to be done to put Ideas into Practice

sujataInterestingly, K Sujatha Rao, former Secretary of health and family welfare, points out in her book, Do We Care? India’s Health System, that “In systems of good governance, policy making is participatory and inclusive. Research institutions are fostered to produce the required evidence and key stakeholders taken into confidence. This was seen when crafting HIV/ AIDs policies, were key population groups most vulnerable were considered during policy making.  But this was a rare example.

“By and large, policy makers have displayed a lack of conviction for such inclusion of target groups and have neglected to foster and nurture research institutions. Costly mistakes have been made such as disbanding malaria workers with multipurpose workers, reducing vigil and community-monitoring, neglecting primary care, opening up health markets without putting in place appropriate regulations, prioritizing immunization over comprehensive child health, or tackling the causal determinants of infectious diseases and so on.”

“We don’t have enough evidence to frame a policy on. Further, there is no money in research. A clinician earns ten times more than a researcher and our system of education is also for passing exams and cramming,” Rao told HE.

Shared Vision is key to Changing System

AbhijitAbhijit Nadkarni, Co-director of Addictions Research Group of Sangath, seconds her views. He notes that the major challenges for mental health research in India are the shortage of funding, the focus of research in clinical settings (as against public health perspective), almost non-existent training programmes in graduate and undergraduate courses, shortage of leaders who can advocate for sustained and strategic investment in mental health research.

Nadkarni stresses that government invests in control and management of communicable diseases, maternal and child health, control of nutritional disorders and some major non-communicable diseases like cancer, cardiovascular diseases, and diabetes.

According to a  2016 study about correlation between public investment, intellectual property rights, drug pricing policies and innovation in global life-sciences, India ranked among the lowest (in the bottom five). This is due to weak intellectual property protection, lack of data protection for biologics, low investment in R&D and price regulations.

So, in order to have a world-class research ecosystem, what should the government do? “We should strengthen research training, invest in public health research and increase research funding,” he explains. “Further, we must give universities autonomy to raise research funding through other sources. Promotions of academics should be based on research outputs and not the duration of tenure. We must promote links with universities abroad and groom research leaders who have a larger vision and not just their personal research outputs.  Lastly, India must also develop a national research agenda with clear time-bound milestones linked to national health priorities, funding, and outputs,” he concludes.

Is Evidence Based Diagnosis Cost Effective?

Is Evidence Based Diagnosis Cost Effective?

Evidence based medicine is a concept of medical healthcare where evidence in the form of tests and diagnosis is used to make a factual conclusion. Cost for healthcare in India is done on the basis of an individual service/test/diagnosis manner as opposed to a package manner. The recent case pertaining to MAX Hospital charging 13 lakhs for treatment of dengue is an example of individual costing gone wrong.

So with this in mind, we decided to ask the industry experts for their views on whether “evidence based medicine is cost effective?

Dr. Rajendra Patankar, Chief Operating Officer, Nanavati Super Speciality Hospital

Dr. RajendraThese days all standard healthcare practices are evidence-based. It’s an over generalized misconception that doctors or hospitals like to prescribe extra investigations for financial benefits. I believe that with ethical and patient centric health care practice guided by evidence-based medicine, we always ask for what is appropriate and required. The patient is always made aware of the tests and investigations are done only with their consents.

It’s an obvious fact that correct treatment is based on correct diagnosis. The second part of the story is the essentiality of documentation in every clinical practice. Not only the diagnosis but also the follow up (both in case of recovery or deterioration) needs to be scaled and documented both for clinical and medico-legal purposes. Now, let us assume the patient is willing to undergo non-evidence based medical treatment. In this situation, are doctors not indemnified, if the patient worsens.

Technology has given us an extra edge and we should build our skills to utilize the same. Also I would urge the society to restore their faith in the healthcare system and avoid generalization.

Narendra Karkera, Director, HOSMAC

KarkeraThis issue needs to be addressed from 2 points, consumer and availability. There is a shortage in purchasing power of the consumer i.e many patients are unable to keep up with the gradual rising cost of healthcare yet there is no shortage in terms of availability of such services, particularly in urban areas.

The concept of ‘general practitioners’ is virtually non-existent in the modern time. This inflates the cost of healthcare for the patient. GPs and super specialities have very different roles; GPs perform small checkups and prescribe medication whereas super-speciality doctors are highly evidence-based due to company policy, red tape and legislation. The highest individual cost here comes from the investigative side i.e the tests, scans and diagnosis.

Healthcare does not mean medical care. For instance, consuming clean water plays a key role in healthcare. If there is a water-based infection in an area, then no number of hospitals will solve the problem at the source. Similar nuances exist in other of these interconnected disciplines including food consumption, education and academic fees, societal/cultural practices etc. which inflate the cost. In such a system, evidence-based diagnosis further adds to the tremendous fees of medical care.

Arjun Arkal Rao, PhD candidate in computational biology, UC Santa Cruz

ArjunThe Indian system is a little flawed but has potential to be way better than the USA. A lot of the extra tests and choices of extra tests in the USA are guided by the insurance plan held by the patient as well. Insurance is an integral part of healthcare affordability. If you don’t have insurance and have a serious medical problem,you’re going to get bankrupt. If you have insurance and you’re on the network you pay a nominal amount. Out of network, you’re going to have a hard time. When my fiance had an allergic reaction to shrimp, she spent 4 hours in an ER where a nurse gave her 1 bottle of saline, 1 shot of antihistamines, and the bill after insurance was almost $1.3k. This is after paying almost $360/month as an insurance premium. After being here 5 years, I think the Indian way isn’t ideal and can be fixed, yet it is definitely better than here.

Ravindra Karanjekar, CEO and Executive Medical Services and Quality, Jupiter Hospital

RavindraGood clinical examination and seeing what is not obvious was certainly the hallmark of Indian allopathic and other ancient medicine. However in recent years the medico-legal cases have increased and the judiciary is asking for evidence on the procedures and tests. This evidence is given to support your diagnosis in a provable manner in a court of law.

Clinical acumen comes only with experience. However, the cost of this evidence is much higher and to be borne by the patient. And doctors are getting into habit of creating proof for their diagnosis

This is leading to increase health care costs. We need to balance these cost some wherever.

Dr. Joy Chakraborty, Chief Operating Officer, Hinduja Hospital

Dr. JoyWith the advent of consumerism and increasing level of patient expectations, healthcare providers and physicians are questioned regarding treatment protocols, adequacy of treatment coverage and justification for treatment. This is a relatively new phenomenon and indicative of a trust deficit which severely deteriorates the doctor-patient relationship. As a result doctors employ defensive strategies which leads to a further rise in evidence based medicine.

It is needless to say that evidence based medicine, if properly practiced, can bring about an authentic treatment flow for the patient. When the patient has to pay for several investigative procedures out of his/her pocket it leads to unaffordable healthcare. This leads to an ineffective scenario in healthcare delivery.

It is not that evidence based medicine is ineffective, but if it is not backed by suitable affordability then it becomes ineffective for the patient.

How to Create Hassle-free Parking at your Hospital?

How to Create Hassle-free Parking at your Hospital?

Metro cities worldwide are famous for the population density. With a higher population comes an exponential increase in automobile traffic, greater probability of accidental and regular patients, and the ever-growing problem of parking. Hospitals, as a structure, are one among the many that fall at the intersection of all these problems of urbanisation.

However, a hospital is more accountable for immediate social good and immediate mass welfare than a mall, a school or any other business entity. In fact, healthcare along with education are the only single-industries which directly influence a country’s growth factor. Schools however are rarely frequented by unexpected individuals and overall schools have the ability to group up several students and staff members in the convenience of automobiles. Hospitals don’t have this luxury. Being five minutes late to class is a better alternative than being five minutes late to the hospital. After all, board exams are not as much of a matter of life and death as, literally, life and death. But what happens if the parking and traffic flow isn’t mapped? The hospital would be in a state of utter chaos.

So we decided to take a closer look at the traffic flow and parking in hospitals.

“Firstly, there are two kinds of parking planning projects, namely, greenfield and brownfield. So to provide adequate parking space, even the future is taken into consideration. In a city like Mumbai, where each square-foot is valuable, parking is a challenge. There are restrictions on basement parkings too, so you have to go with a multi-level car park.” says Prassanna Wategoankar , Senior Manager Architectural Services, Hosmac India.

“There are a few parameters to consider before the planning actually starts. Hospital bed size and speciality, site location and size, expected number of staff and patients are the key factors. Once these parameters are fixed, the next step is the planning of the space around these parameters. The government has basic guidelines and requirements for this. In case a hospital has an Accident and Emergency department, the plan not only accommodates more ambulances despite bed size, but it also provides more parking spaces for visitors.

Additionally, higher priority is given to emergency cases and disabled individuals.” says Yunus Basheer, Traffic Engineer, MinConsult. “When it comes to drawing out an effective plan, there are some logistical concerns. Having a single traffic flow system is ideal as it ensures swift and neat movement within the parking spaces. Slope gradient is another key factor that comes to play in hospital parking. Slopes in a hospital slightly increase the time taken to cover distance and when it comes to every second making a difference, it cannot be taken lightly.” Yunus adds.

How much scrutiny goes into the parking lot of a hospital? After all it’s just a waiting room for your transport isn’t it? Well a lot, as explained by Dr. M.D Marker, Medical Director, BMJH, Vasanthnagar and Girinagar, Bangalore. “During a conference with the traffic police of Bangalore and other BBMP members, I was once asked – “The main road is only 30 meters wide and you have 500 parking spaces. What if all 500 people decide to leave the hospital together?” As baffled as I was, I tried my best to give a satisfactory answer to the committee. There’s a tough round of prodding by the local officials and police forces once the plan has been proposed and the parking area plan is thoroughly scrutinized.”

Dr. Marker adds “Planning the parking flow is essential for any hospital as it gauges the traffic flow within and from outside to inside in a facility. The government parameters are already in place and we follow the same guidelines when it comes to planning our facilities. Traffic flow must be unhindered especially to the emergency care centres and this is absolutely crucial. This process can be aided by using signage, pointer arrows and other navigational tools. “

But what about old hospitals trying to grow? According to Prassanna “The biggest challenges are always faced while planning the parking of the brownfield. Due to permanent structure which have a maximum height and other immovable physical factors, multi-level parking and latest trends are harder to accommodate. The existing parking conditions must be altered in such a way that it makes the most of the available resources. In this case, numbers are often sacrificed due to a lack of space.”

Apart from all the guidelines and physical limitations, there’s also a lot of added though that goes into it. As Yunus says, “A key factor for nailing down parking in hospitals is creating a stopping area for ambulances where paramedics can quickly gain access to the patient. This stopping area cannot affect the flow of traffic and must be at a closer location as opposed to the other departments in the traffic flow because of the time factor. Along with all these measures, certain other nuances must be considered. These include walking time to-and-from buildings to parking for both patients and their aides, ease of access of the vehicle within the parking lot area alignment and keeping the parking area as secure as possible from a design perspective.”

Meanwhile, Dr. Marker expresses parking-related concerns of a different kind. “Some hospitals are in the business of using hospital parking as an income booster by charging patients and their attendants for each vehicle parked. This is wrong on so many levels: economic, social and human. At BMJH we never charge for parking as we consider this to be fundamentally wrong and don’t see any growth opportunity by adding unnecessary costs to the patient.” Another unforeseen aspect is that of staff behavior and trends he highlights. “In our hospital, doctors and staff members often opt to cycle to work. In this case safety of the vehicle becomes very important. Vehicles such as a hearse van and the ambulances also have to be kept away from the visitor’s or patient’s parking area for a more effective utilisation of these resources.” says Dr. Marker

Planning the parking space is a much bigger feat than what it sounds like, especially in the case of a hospital. It’s vital to ensure a smooth flow of traffic and give ambulances plenty of area to operate. Even slope gradients and walking time are considered along with meeting staff requirements and government laws. It’s not easy to plan the parking area of a hospital and only the ones who work within the established procedural framework know how important and essential it is to the delivery of healthcare services.

What makes Hospitals more Efficient: Patient-Centric or Patient-Centric Design?

What makes Hospitals more Efficient: Patient-Centric or Patient-Centric Design?

When a hospital is designed, who are the first people kept in mind by the architects? Who benefits the most from planning the design and physical space? Here’s what leading industry experts have to say.

Many researches have already established a direct relationship between physical environment and human development;  after all the average human being spends around 80% of their time indoors. Doctors, nurses hospital staff and patients are no exception to this. In fact the staff is the only link which bridges the gap between the customer satisfaction, employee satisfaction and profitability. Additionally, everyone wants to operate in an environment which is friendlier and smarter.

Having said that, the most important question is – “Who is a hospital built for?” Is it built for the doctors, the nurses, and the large number of staff or is it built for the patients who visit the hospital?  Is it built as a second-home for doctors or as a live-saving hotel for patients?

Here’s what leading hospital design experts from the industry have to say:

Bhumika Jeswani – Lead Architect with Apollo Hospitals

Bhumika“Design does not have a bias towards employees or patients. The ultimate aim is to provide an optimal healing environment which is enabling staff to care for patients effectively and achieve improved healthcare outcomes for patients. Employees, unlike patients, get acquainted with the facility hence do learn to manoeuvre with ease. Patients and visitors prefer corridors which are more accessible from a greater number of spaces and have minimum turns.

Better physical environment will result in patients being stress free and comfortable. This will also positively impact the rating of care provided by staff. Better work environment for staff means reduced errors and better outcomes for patients. Thus, physical environment works as a link which develops a symbiotic relationship between patient and employees which benefits both.”

Swati Rane – Founder and Medical Planning Expert at Healthcare Synergy Consulting and PhD Scholar from Tata Institute of Social Sciences

“The prime aspect of hospitals is that they are only concerned with the beds.  How many beds can be installed and what are the profit margins; are the two most important factors for private hospitals. Hospital structures are more profit-centric as opposed to patient/employee centric.

swati raneThe hospital is designed according to the ‘form follows function’ principle. But, what is of utmost importance, is this question – ‘Who is going to be at the hospital?  So I believe, the design should be employee-centric.

An employee-centric design is necessary to ensure the output of work is patient-centric. If a hospital is designed keeping in mind the patient’s requirement, the room size etc, and doesn’t consider the requirements of the caregivers, taking away any rest and recuperation area; then the work output is affected. If the design is patient-centric and the employee’s responsible for providing care are tired and exhausted, then the patient-care itself is affected. Doctors and nurses are currently frustrated by their jobs as it is and the workspace design doesn’t help.

The most important thing is to ensure during planning and designing the hospital has a team of users, composed of doctors and nurses. Planning a hospital without taking inputs from doctors and nurses is like planning a house without taking inputs from the residents and it’s near impossible to follow the ‘form follows function approach.”

Aditya Kashikar – Senior Project Manager at Imperial College Healthcare NHS Trust

“In the UK, we focus on hospitals being more patient-centric. However, it is a combination of both, say 60% patient-centric and 40% employee-centric. If a hospital is patient-centric the time taken to recover by a patient is far lesser. At the same time, the operating staff must be able to manage the services. So it’s a marriage between both these aspects.

AdityaIf employees are not considered right from the pre-planning stage then the day-to-day processes and space management techniques completely miss the point. We follow basic guidelines and international stipulations which constantly change and are upgraded, so the space is flexible.

In the UK, we have different stakeholders involved from the first stages of planning a hospital. These include doctors, nursing staff, GMs, CEOs, patient representatives and operational estates and facilities colleagues. There is an amalgamation of basic requirements and business needs which leads to a lot of coordination between different elements of the hospital. When a single stakeholder is left out, the effect it has on the business and its functioning is huge.”

Nandini Bazaz – General Manager – Architecture at HOSMAC Pvt Ltd.

“If there was a hierarchy of importance given to design, it will generally follow a client first, patient second and employee third structure. In India, planning is done according to features which economically feed the clients.

Nandini BThat being said,hospital design always weighs more on the patient side as opposed to the employee side. There’s a lot of neglect in India with regards to staff facilities and utilities. Clients usually don’t want to spend money on that and this occurs in both public and private hospitals. In some cases, staff members literally beg the architects for more consideration to their needs and requirements. We, at HOSMAC, push ourselves to accommodate all the employees and give them facilities for rest and recreational purposes. From an architect’s perspective, we design spaces from the people in the building and staff comfort is essential to us. My experience abroad in healthcare and that India has a stark difference. Internationally, doctors, nurses and staff members enjoy certain spaces and recreation as opposed to here, where break rooms and doctor’s lounges are almost unheard of.”

What Actually Works Best

These problems have given rise to an ever-increasing number of health care activists, trade union formation and joint strikes against individual or multiple institutions such as the recent events in Kerala.

Simple proven solutions to a widespread problem have been proven by research and application. Adopting a similar structure, international health care stakeholders have accelerated growth by cutting costs and ensuring higher job satisfaction and retention. A couple of examples include :

– In 2016, Royal Australasian College of Physicians conducted a study to improve non-clinical workplace solutions using a Human-Centred Design process, involving ‘Hear, Create and Deliver’ stages. Using extensive employee engagement and design experts, innovative solutions were created that focussed on creating the optimized functional workspace which helped hospitals save money on resources and resource management.

– Institute of Patient-Centred Design Inc, is a non-profit healthcare organization that advocates a patient-centric design approach. IPCD conclaves are attended by major stakeholders in the healthcare industry to ensure maximum client satisfaction and profitability which in-turn fosters a healthy workplace environment for the employees.

Clearly, Indian healthcare has a long way to go in terms of catering to the needs of the employee or the customer. Neither is the hospital staff on the winning side, nor are the sickly patients who come to be treated. There are several factors – including higher demand than supply, income disparities and accessibility – in the mix, but the same mix also features extremely rich business owners. No one doubts their hard work in bringing in health care, or them championing a noble cause or even the fact that it is a money sucking industry. The only issue is quality, particular in terms of employee standards and patient standards, which seems to be lacking. Furthermore, designing a hospital with inputs from board members who have a working experience in a hospital along with an active participation of both patients and employees during its working, can go a long way towards ensuring a constant quality and functionality check.

While working on this piece, I asked the experts a simple question – “Is the design language of a hospital built around an employee or a patient?” What I heard was quite shocking, but really not unbelievable. Without a stronger healthcare network which brings in qualitative infrastructural and aesthetic development, the Indian healthcare design model is bound to be stuck in an infinite abyss of unmotivated staff and forever growing number of patients.

Designing for Rural Public Healthcare

Designing for Rural Public Healthcare

Ikyatha Yerasala talks to experts from the healthcare and design industry, who share the key considerations to be kept in mind while designing a rural public healthcare facility..

The state of rural Public healthcare in India is often deplorable. A staggering 70 per cent of our people live in rural areas and have no or limited access to hospitals and clinics. The 71st National Sample Survey (NSS) conducted in 2014 revealed that out of the total hospitalisation cases in rural areas, 42 per cent were said to be in public hospitals. According to a report by Hindustan Times, with healthcare in rural areas often being inaccessible to the population there, many people are opting for alternate therapy, falling prey to quacks or end up relying on public health services which are inefficient. Improving our public health infrastructure is something India is in dire need of. Designing a healthcare facility for rural areas involves focusing on many aspects – from sustainability to infection-control and privacy. Experts in the field of healthcare design share their views on the key considerations to be kept in mind while creating a rural public health facility…

Infection Control-and Privacy

Creating an infection-resistant environment is of utmost importance. Talking about how this can be done, Architect and urban designer Arun Mathai who works at Hosmac, Middle East, says, “Considering the adjacencies of departments, segregation of clean and dirty areas, movements of public and staff, delineation of public access and access-controlled areas right at the design level are important. It’s crucial to understand the transition from the non-sterile to sterile areas. Rooms such as ICUs, Surgical suites, etc. follow the same hierarchy while transitioning from a non-sterile to sterile zone. Access to a sterile space is generally regulated by the introduction of a transitionary space or ante-room. Gowning or change areas also indicate the same kind of transitionary spaces. Since these considerations are design-based and moreover functionally critical, they are applicable and required even when it comes to a facility that caters to the rural populace.” He goes on to add that one should avoid overlaps in clean and soiled movements. “Apart from the basic design methodology, steps are also taken to maintain clean environment through the use of better air filtration systems, Individual air handling units catering to the sterile zones exclusively and pressure differences into the sterile areas to maintain a higher level of infection- control.”.

Reducing infection risk is not rocket science, it is often common sense, with good evidence to support it, states Upali Nanda, Associate Principal and Director of Research at HKS, Inc.  “The tenets of creating infection-resistant environments are pretty universal- you want to use surfaces that are easily cleanable, make sure you have a minimum of crevices and difficult to clean spaces, good education around cleaning protocols, a robust air flow system that separates out the clean from the contaminated air, a clear separation of clean and soiled supplies, and careful planning of visitor and patient pathways so there is no risk of cross-contamination,” she says.

Giving more insight into the guidelines to be kept in mind while designing a public health facility, Gayathri Krishnamurthy, a freelance architect who works for Karnataka Health System Development and Reform Project shares, “The key drivers of design are: maintaining efficient circulation, separation of anti-septic areas and requisite privacy for different user-groups. Certain functions such as the OPD, the laboratory, records, waiting areas and pharmacy are overlapping. The flow of uses (medical, nursing and administrative staff, in-patients, out-patients and visitors) has to be designed according to the sequence of functions within the healthcare facility. Functions have to be zoned in a way that minimizes unnecessary cross circulation and interference between user groups. Areas such as the OT and the Labour rooms have to be kept well-isolated from other public functions in order to minimize the risk of spread of infection in and out of these rooms. The special nature of activities in these zones also imply that their finishing and interior treatment have to be designed to enable maintenance of their anti-septic nature.”

Privacy

Privacy is a critical concern where women and their use of the facility are concerned, mentions Gayathri. “Privacy is especially important in labour and post-delivery rooms. They need to be kept secure and private from the public areas. The internal circulation of the facility should be visually well-connected in order to enable administrators and staff nurses to keep an eye on various activities and respond to situations immediately.”

Material used

The material used for construction is another key factor to be kept in mind. “It should be locally sourced as much as possible, while also being appropriate for the function of the building. This will help in designing a low maintenance building,” reveals Gayathri.

Healthcare architect Pradeep Kulkarni, who has designed a plethora of hospitals, too endorses the idea of ‘going local’ and adds, “It’s better if the material and technology used is local. The people there will be adept at handle local material and it will make them proud that they’re contributing to the area.” Adds, Arun, “Going local can prove to be more economical and contributes to the local economy.”

Location

As for the location of the facility, Arun opines that it would depend on the kind of facility that is proposed. “If it’s a primary health centre (as would be the case in a rural setting), the location would mean easy accessibility for the users of one specific rural jurisdiction. A higher tiered hospital or a hospital with specialties and super-specialties will need to be accessed by more number of villages or towns and hence the location should be thus suited. From the design stand point, a PHC is the first point of treatment in rural areas and should be available easily to the population. The idea being that immediate care be provided before being transferred to a hospital with specialty, should the need arise.”

Climate Responsiveness and Sustainability

As for the location of the facility, Arun opines that it would depend on the kind of facility that is proposed. “If it’s a primary health centre (as would be the case in a rural setting), the location would mean easy accessibility for the users of one specific rural jurisdiction. A higher tiered hospital or a hospital with specialties and super-specialties will need to be accessed by more number of villages or towns and hence the location should be thus suited. From the design stand point, a PHC is the first point of treatment in rural areas and should be available easily to the population. The idea being that immediate care be provided before being transferred to a hospital with specialty, should the need arise.”

Since healthcare facilities are service intensive, it’s vital that these services are designed to help the building function in an optimum manner and at the same time, reduce the environmental impact without any compromise on the function. Adds Gayathri, “Energy demand of the building is often driven by lighting and other domestic uses. Energy conserving fixtures should be used to reduce this. Relying on renewable sources for energy is relevant. Solar hot water system should be used to meet domestic hot water requirement. Solar photo-voltaic systems that can meet a substantial portion of the energy requirements of the building can be installed on the roof top or in an open space nearby. Appropriate land development practices like use of site topography, plantation as per local climatic conditions, hard landscape, etc. are encouraged. Water conserving fixtures and faucets should be installed to reduce the potable water use as well as waste water generation.  Rain water harvesting infrastructure should be planned asking with the water supply and plumbing layout.”

Talking about sustainable building materials, Arun says, “They would be predominantly locally sourced like bricks and use of alternative basic building materials like concrete made with flyash, flyash bricks, bamboo, hempcrete, etc. Recycled building materials also provide to be the best form of sustainable building. Adherence to green building codes would be  recommended as it provides a better indication of sustainable materials used, renewable energy sources etc. Good construction practice also contributes to the sustainability in design and construction.”

Safe sanitation practices are important too.  “Segregation of waste at source and its disposal in a scientific way should be done in order to avoid or reduce polluting the surrounding environment. Bio-medical disposal facilities should be integrated into site and building design, following applicable bye-laws/ standards,” adds Gayathri.

Designing for a rural public health facility means focusing on local materials, sustainability and ensuring infection-control, among many other aspects that need to be given attention. India is no less than the West when it comes to the wealth of knowledge possessed by healthcare architects and designers in the country. It would be extremely satisfying to see their knowledge being put to good use for the betterment of our rural public health system.