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#IFHEcongress2018
Healthcare Infrastructure Planning and Design in the Western Cape,
South Africa
FINDING APPROPRIATE SOLUTIONSTO INAPPROPRIATE PROBLEMS
Duncan RendallChief Architect
Infrastructure PlanningWestern Cape Government: Health
#IFHEcongress2018
Area: 1.2 million km2
(= UK, France, Germany, Belgium & Netherlands combined)
Population: 55 million(UK population 66.6million)
Constitutional Democracy
South Africa: Geography
#IFHEcongress2018
Gini co-efficient score: 0.63Unemployment rate: 27.2%
AustraliaGini co-efficient score: 0.34Unemployment rate: 5.3%
BrazilGini co-efficient score: 0.47Unemployment rate: 12.3%
Source:Gini co-efficient : The Organization for EconomicCo-operation and Development (OECD)Unemployment Rate - https://tradingeconomics.com
South Africa: Demography
80% of the population are dependant on Public health services
#IFHEcongress2018
Area: 129 462 km2 (England 130 279 km²)Population: 6.6 million (England ± 53 million)
Western Cape Province - Geography
Capital City: Cape TownPopulation: 3.8 million
‘Second’ city: GeorgePopulation: ± 120 000
#IFHEcongress2018
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
Quadruple Disease Burden:
– Interpersonal violence
– Non – communicable diseases
– TB & HIV
– Maternal & Child related illness
July Aug Sep over 3 months
2016 94 88 124 306
2017 140 163 176 479
% increase year on year 49% 85% 41% 56,54%
Western Cape Deaths 2015
Homicides from Firearms
Source: Western Cape Government Health 2018/19 Annual Performance Plan
‘Extreme South Africa’ Documentary
by Reggie Yates featuring Khayelitsha Hospital
Western Cape Province - Demography
Forensic Pathology Services autopsy case load has increased 25% in the last 5 years (unnatural deaths)
#IFHEcongress2018
Primary Healthcare:
– Home Based Services
– Clinics (253 facilities)
Level 1: District Hospital (33)
Level 2: Regional Hospital (4)
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)
Healthcare Service Platform
Klaarstroom Satellite Clinic, Eden District Oudtshoorn District Hospital, Eden District
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
Perimeter Security and Access Control
Security
#IFHEcongress2018
Burglary and Theft…
Security
#IFHEcongress2018
Hanover Park CHC, Cape Town
Gunshot mitigation measures…
Security
#IFHEcongress2018
Layered approach
• Non–institutional external perimeter fencing
• Forecourt with good line of sight
• ‘Hard’ edge with single point of entry
• Strategically located security stations
Du Noon CHC, Cape Town (2015)
Khayelitsha Hospital, Cape Town (2012)
Security: Solutions
Kwanokuthula CDC, Plettenberg Bay (2012)
Khayelitsha Hospital, Cape Town (2012)
#IFHEcongress2018
‘Buffer zone’
• ‘Positive’ secure spaces
• Good visibility
• Overflow waiting area
• Hard and soft landscaping
Hermanus CDC (2015) Du Noon CHC, Cape Town (2015)
Khayelitsha Hospital, Cape Town (2012) Mitchell’s Plain Hospital, Cape Town (2013)
Security: Solutions
#IFHEcongress2018
Internally
• ‘Antidote’ to external environment
• Clear, simple layout & wayfinding for ease of navigation
• Lots of natural light
• Views to external spaces
• Artwork and Colour
• ‘Invisible’ security e.g. CCTV
District Six CDC, Cape Town (2017)Khayelitsha Hospital, Cape Town (2012)
Mitchell’s Plain Hospital, Cape Town (2013) Du Noon CHC (2015)
Security: Solutions
#IFHEcongress2018
• Rapid population growth
• Ageing infrastructure
• Changing service models
• Operational needs
• Limited Budgets
Project Delivery Timeframes
Default = Prefab!
#IFHEcongress2018
Heideveld Emergency Centre, Cape Town (2014)
• ‘Relocatable’ structure
• Cost-effective
• Urgent
Project Delivery Timeframes
#IFHEcongress2018
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
Project Delivery Timeframes
#IFHEcongress2018
Heideveld Emergency Centre, Cape Town (2014)Walk-in patients
AmbulanceDrop-off
General Layout
Project Delivery Timeframes
#IFHEcongress2018
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
Project Delivery Timeframes
#IFHEcongress2018
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
Project Delivery Timeframes
#IFHEcongress2018
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
Project Delivery Timeframes
#IFHEcongress2018
Du Noon Temporary Clinic & MfuleniTemporary CDC, Cape Town(2012 & 2016)
• Temporary (3–10 yrs)
• Cost effective
• Urgent
Over-crowding & Accelerated delivery
#IFHEcongress2018
Du Noon Temporary Clinic (2012)
Existing warehouse
Approx. 600m2
31 Containers
Inception to Completion -7 months
Fully re-deployable
Over-crowding & Accelerated delivery
#IFHEcongress2018
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
Du Noon Temporary Clinic, Cape Town (2012)
Over-crowding & Accelerated delivery
#IFHEcongress2018
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
Du Noon Temporary Clinic, Cape Town (2012)
Over-crowding & Accelerated delivery
#IFHEcongress2018
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
Over-crowding & Accelerated delivery
#IFHEcongress2018
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
Mfuleni Temporary CDC, Cape Town (2015)
Over-crowding & Accelerated delivery
#IFHEcongress2018
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
Mfuleni Temporary CDC, Cape Town (2015)
Over-crowding & Accelerated delivery
#IFHEcongress2018
…IN CLOSINGAs 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