2. INTRODUCTION Health care facilities are comprised of wide range of services and functional units. Some of the functional units include: DIAGNOSTIC AND TREATMENT FUNCTIONS SUCH AS  IMAGING FACILITIES  LABORATORIES  CASUALTY  OPERATING THEATRES DISPENSING FUNCTIONS SUCH AS  PHARMACIES  STERILIZATION HOSPITALITY FUNCTIONS SUCH AS  FOOD SERVICE  HOUSE KEEPING ADMINISTRATIVE FUNCTIONS SUCH AS  STRATEGY FORMULATION AND IMPLEMENTATION  ACCOUNTING AND FINANCE TRAINING FUNCTIONS SUCH AS  RESEARCH AND TEACHING  ETC

3. NEED FOR PLANNING  Each of these wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized planning knowledge and expertise.  This is so because these functional units can have competing needs and priorities and aesthetic tastes must be balanced against mandatory requirements, functional needs and financial setbacks.

4.  Physical relationships between these functions determine the configuration of the hospital and certain relationships between the various functions are required.  Planning should facilitate flow of human traffic, services, movement of materials and waste since the physical configuration of a hospital and its transportation and logistic systems are inextricably intertwined.  Hospital planning is also influenced by site restraints and opportunities, climate, surrounding facilities, budget, and available technology.

5. Some of the salient design attributes include: Efficiency and cost effectiveness  Promote staff movement efficiency.  Allow easy visual supervision of patients by limited staff  Include all needed spaces without redundancy.  Provide an efficient logistics system.  Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas. E.g. Positioning sterilization room to cover outside requisition and within.  Consolidate outpatient functions for more efficiency  Group or combine functional areas with similar system requirements  Provide optimal functional adjacencies., such as locating the surgical intensive care unit adjacent to the operating theatre.

6. Flexibility and expandability. Since medical needs will continue to change, hospitals should:  Follow modular concepts of space planning and layout  Use generic room sizes and plans as much as possible.  Be served by modular, easily accessed, and easily modified mechanical and electrical systems  Be open-ended, with well planned directions for future expansion.

7. Therapeutic Environment  The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness

8.  Using cheerful and varied colors and textures,  Admitting ample natural light wherever feasible.  Providing views of the outdoors from every patient bed.  Designing a "way-finding" process into every project. Patients, visitors, and staff all need to know where they are, what their destination is, and how to get there and return.

9. Cleanliness And Sanitation Hospitals must be easy to clean and maintain. This is facilitated by:  Appropriate, durable finishes for each functional space  Careful detailing of construction features.  Adequate and appropriately located housekeeping spaces  Special materials, finishes, and details for spaces which are to be kept sterile.  Incorporating operational and maintenance practices that stress indoor environmental quality.

10. Accessibility All areas, both inside and out, should:  Comply with the minimum requirements for invalids circulation.  Be designed so as to be easy to use by the many patients with temporary or permanent handicaps. E.g. use of ramps lifts and hoists  Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for wheelchairs to pass easily. A minimum corridor width of 2400mm is recommended.  Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious

11. Controlled Circulation  Outpatients should not travel through inpatient functional units.  Typical outpatient routes should be simple and clearly defined.  Visitors should have a simple and direct route to each patient nursing unit.  Separate patients and visitors from industrial/logistical areas or floors  Outflow of trash, recyclables, and soiled materials should be separated from movement of food and clean supplies, and both should be separated from routes of patients and visitors  Transfer of bodies to and from the morgue should be out of the sight of patients and visitors

12. Aesthetics  Aesthetics is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include:  Increased use of natural light, natural materials, and textures  Use of artwork  Attention to proportions, color, scale, and detail  Bright, open, generously-scaled public spaces  Homelike and intimate scale in patient rooms.  Compatibility of exterior design with its physical surroundings

13. SECURITY AND SAFETY In addition to the general safety concerns of all buildings, hospitals have several particular security concerns:  Protection of hospital property and assets, including drugs  Protection of patients, staff and visitors.  Safe control of violent or unstable patients

14. Sustainability  Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design. Design emphasis should be towards the use of sustainable innovations such as:  Use of solar power to boil water  Rain water harvesting using roof catchment  Use of environment friendly medical incinerators

15. DEVELOPMENT OF HEALTH CARE FACILITIES IN KENYA. Identification of need.  The Ministries in charge of health identify the need for expansion or setting up of a health care facility based on demographic disposition of an area. Feasibility studies  Studies are conducted to establish the appropriate size of health care facility to be set up and appropriate facility brief drawn. Design proposals and cost estimates  The Ministry of Health communicates the intentions for setting up or for upgrading existing health care facility to the Ministry of Public Works and preliminary designs proposals are done and cost estimate prepared.

16. Confirmation of funds  The ministry of Health liaises with the Ministry of Finance for confirmation of funds or for liaison with donors Detailed design and Bill of quantities  Detailed designs and Bills of Quantities are prepared by the Ministry of Public Works in liaison with the Ministry of Health. Tender action and award.  Competitive bids are invited and the tenders awarded to the most responsive bidder.  Construction Phase  The actual construction process is undertaken with joint supervision of works by both Ministry of Health and Ministry of Public Works to ensure quality works.

17. Completion and Handing over.  Once the works are properly carried out, the facility is handed over to the Ministry of Health. Operation and Maintenance  Operations of the facility and general maintance is carried by the ministry of Health in liaison with the Ministry of Public works.

18. CHALLENGES ENCOUNTERED POLITICAL INTERFERENCE  This occurs when politicians want to avoid the established project identification process that is carried out by the clients. LACK OF ADEQUATE PERSONNEL  Our Ministry has not engaged adequate number of specialized consultants who obviously play an important role in hospital planning and design such as Biomedical Engineers. INADEQUATE/IRREGULAR FUNDING  Allocation of development funding is more often inadequate. SCARCITY OF EXPANSION SPACE  Poor planning of existing facilities make facility expansion sometimes impossible.

19. " A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels."... Hardy and Lammers ….. END …...