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Healthcare Infrastructure Planning & Design in The FINDING APPROPRIATE SOLUTIONS TO INAPPROPRIATE PROBLEMS Healthcare Infrastructure Planning and Design in the Western Cape, South Africa Duncan Rendall Chief Architect Infrastructure Planning Western Cape Government: Health #IFHEcongress2018 South Africa: Geography Area: 1.2 million km2 (= UK, France, Germany, Belgium & Netherlands combined) Population: 55 million (UK population 66.6million) Constitutional Democracy #IFHEcongress2018 South Africa: Demography Gini co-efficient score: 0.63 Unemployment rate: 27.2% Australia Gini co-efficient score: 0.34 Unemployment rate: 5.3% Brazil Gini co-efficient score: 0.47 Unemployment rate: 12.3% Source: Gini co-efficient : The Organization for Economic Co-operation and Development (OECD) Unemployment Rate - https://tradingeconomics.com 80% of the population are dependant on Public health services #IFHEcongress2018 Western Cape Province - Geography Area: 129 462 km2 (England 130 279 km²) Population: 6.6 million (England ± 53 million) Capital City: Cape Town Population: 3.8 million ‘Second’ city: George Population: ± 120 000 #IFHEcongress2018 Western Cape Province - Demography Western Cape Deaths 2015 Population growth rate: ± 1,9% p.a. (National ave 1.2%) Unemployment Rate: 20.7% (National ave 27.2%) Health Demographic: Male life expectancy: 66.8 yrs (National ave 61.1 yrs) Female life expectancy: 71.8 yrs (National ave 67.3 yrs) Delivery of Health Services is a Provincial Responsibility Homicides from Firearms Quadruple Disease Burden: July Aug Sep over 3 months – Interpersonal violence 2016 94 88 124 306 – Non – communicable diseases 2017 140 163 176 479 – TB & HIV % increase year on year 49% 85% 41% 56,54% – Maternal & Child related illness Source: Western Cape Government Health 2018/19 Annual Performance Plan ‘Extreme South Africa’ Documentary Forensic Pathology Services autopsy case load has increased by Reggie Yates featuring Khayelitsha Hospital 25% in the last 5 years (unnatural deaths) #IFHEcongress2018 Healthcare Service Platform Primary Healthcare: – Home Based Services – Clinics (253 facilities) Level 1: District Hospital (33) Level 2: Regional Hospital (4) Klaarstroom Satellite Clinic, Eden District Oudtshoorn District Hospital, Eden District Level 3: Central / Academic Hospital (3) Specialist Hospitals: – Maternity (1) – Mental Health (4) – Rehabilitation (1) – TB (6) Forensic Pathology Services (17) Emergency Medical Services (59) Paarl Regional Hospital, Cape Winelands District Groote Schuur Central Hospital, Cape Town District #IFHEcongress2018 Key Infrastructure related Service Challenges: • Security • Project Delivery timeframes • Overcrowding #IFHEcongress2018 Security Perimeter Security and Access Control #IFHEcongress2018 Security Burglary and Theft… #IFHEcongress2018 Security Hanover Park CHC, Cape Town Gunshot mitigation measures… #IFHEcongress2018 Security: Solutions Layered approach • Non–institutional external perimeter fencing Khayelitsha Hospital, Cape Town (2012) • Forecourt with good line of Khayelitsha Hospital, Cape Town (2012) sight • ‘Hard’ edge with single point of entry • Strategically located security stations Kwanokuthula CDC, Plettenberg Bay (2012) Du Noon CHC, Cape Town (2015) #IFHEcongress2018 Security: Solutions ‘Buffer zone’ • ‘Positive’ secure spaces • Good visibility Hermanus CDC (2015) Du Noon CHC, Cape Town (2015) • Overflow waiting area • Hard and soft landscaping Khayelitsha Hospital, Cape Town (2012) Mitchell’s Plain Hospital, Cape Town (2013) #IFHEcongress2018 Security: Solutions Internally • ‘Antidote’ to external environment • Clear, simple layout & wayfinding Khayelitsha Hospital, Cape Town (2012) District Six CDC, Cape Town (2017) for ease of navigation • Lots of natural light • Views to external spaces • Artwork and Colour • ‘Invisible’ security e.g. CCTV Mitchell’s Plain Hospital, Cape Town (2013) Du Noon CHC (2015) #IFHEcongress2018 Project Delivery Timeframes • Rapid population growth • Ageing infrastructure • Changing service models • Operational needs • Limited Budgets Default = Prefab! #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) • ‘Relocatable’ structure • Cost-effective • Urgent #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) • 1 450m2 new build structure • Design commencement to construction completion – 18 months • Industrial steel frame • ‘Coldroom’ type internal wall panels #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) Walk-in patients Ambulance Drop-off General Layout #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5 #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5 #IFHEcongress2018 Project Delivery Timeframes Heideveld Emergency Centre, Cape Town (2014) Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5 #IFHEcongress2018 Over-crowding & Accelerated delivery Du Noon Temporary Clinic & Mfuleni Temporary CDC, Cape Town (2012 & 2016) • Temporary (3–10 yrs) • Cost effective • Urgent #IFHEcongress2018 Over-crowding & Accelerated delivery Du Noon Temporary Clinic (2012) Existing warehouse Approx. 600m2 31 Containers Inception to Completion - 7 months Fully re-deployable #IFHEcongress2018 Over-crowding & Accelerated delivery Du Noon Temporary Clinic, Cape Town (2012) Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Tempani #IFHEcongress2018 Over-crowding & Accelerated delivery Du Noon Temporary Clinic, Cape Town (2012) Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Tempani #IFHEcongress2018 Over-crowding & Accelerated delivery Mfuleni Temporary CDC (2015) 63 Containers Approx. 1 275m2 Inception to Completion - 15 months Fully re-deployable components + ‘warehouse’ becomes a multi-purpose sports hall for the City of Cape Town Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Consulting, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks #IFHEcongress2018 Over-crowding & Accelerated delivery Mfuleni Temporary CDC, Cape Town (2015) Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks #IFHEcongress2018 Over-crowding & Accelerated delivery Mfuleni Temporary CDC, Cape Town (2015) Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks #IFHEcongress2018 …IN CLOSING As much as we are trying to move to a more pro-active planning approach, our service environment will, in many instances, continue to change faster than we can build…….but we are making inroads Projects in progress (Current + 2 yrs): Capital Infrastructure: 134 projects ZAR1.2billion budget (AUD 120 million) (excl. equipment & furniture) Maintenance: 196 projects ZAR 820 million budget (AUD 82 million) Mosaic artwork from Mitchell’s Plain Hospital, Cape Town #IFHEcongress2018 THANK YOU [email protected] Mosaic artwork from Mitchell’s Plain Hospital, Cape Town #IFHEcongress2018 .
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