Proposed Improvements: Health Center Station in DRC

Standard Plan – Health Station

Many communities working through the Tuungane program use their grants to address public health needs.  We present four construction options for them: a regional health center, a maternity clinic, a dispensary, and a health center station. The health center station (Poste de Sante) is the smallest and least expensive option.  The health programs that come with this construction provides a nurse, a lab technician, and an office manager.  The clinic is open during business hours and dispenses prescriptions, lab tests, and referrals to larger health centers.  The current design for a health center station provides 4 interior spaces: a waiting room, an office and archive, a consultation room and a treatment room.  These spaces are complimented by a modest veranda at the front of the building that serves as an extension of the waiting area.  This plan is simple, logically laid out, and “gets the job done.”  That’s about it.

Cost Consolidation

Our standard construction documents call for a masonry structure with iron sheets.  The cost for such a health center station then comes in at around $20,000.  Unfortunately, under the revised Tuungane strategies, communities are now allocated only $15,000 and $19,000. Grants are given in these amounts in order to promote coordinated efforts between neighboring communities.  However, in the event that a community is isolated from its neighbors or it does not share the same goals, the only option is to downgrade the existing design in order to cut costs. Concrete block is replaced with mud brick, and iron sheets with thatch.  These choices can limit the life of the building and the sustainability of the health services that it is built to provide.

With some adjustments to the standard design however, not only can a health station of quality materials be achieved within the community’s budget, but it can improve the lives of the community members.  This can be achieved through consolidation of the existing plan and the incorporation of local construction methods.

The needs of the health center station list treatment and consultation rooms that require security, clean surfaces, and privacy.  In addition to these spaces, the plan shows two waiting rooms: the large interior space and the exterior veranda.  These two spaces are not only redundant, but the amount of material used for their construction is the same as for the treatment and consultation rooms.  To consolidate costs around the essential spaces, the secondary waiting spaces can be “lightened” by pulling them out of the main construction to engage the surrounding landscape.  A clay slab or brick patio surface can be used for these exterior spaces.  Further, screen walls can be built to help define the corridors and waiting areas while providing shade and protection from winds.  Bamboo and thin wooden sticks are often used throughout central and east Africa in wall construction.  By using such details, the community can not only lower construction costs by donating materials, but they can also incorporate their own building expertise and aesthetics into the design of the building.

Finally, the pitched roof of the original design can be inverted to consolidate water catchment to a single axis.  Water can be diverted to one side of the building to provide running water to the treatment room (which would achieve World Health Organization standards).  In the event that a water system is already available, rainwater can be diverted to a garden for irrigation of traditional medicinal herbs.

Standard Plan – Health Station

Cost Consolidation

Proposed Plan and Section

Proposed Health Station with rain water irrigation system

Decorative screen walls would use more wood than the original design; and precise measurements for the gravity-fed irrigation system would be needed.  However, the amount of concrete and the number of doors and windows would be cut by 30%.  Such consolidations of materials and reformatting of the standard plan could bring the cost of a health center station within the financial reach of a single community. I will soon be going to the field to review the existing health station designs and to talk with the local staff members.  In the mean time, I have presented these thoughts to my colleagues in the IRC health department and to construction managers from other projects within the Bukavu office.  So far, they have been accepted as clear improvements over our standard design.  After defining exact material quantities and a budget, the final step will be a formal presentation to the health ministry here in Bukavu for formal approval.