Design of an Effective Primary Health Care Centre.

Design of an Effective Primary Health Care Centre

Chapter One

Aim and Objectives

The aim of this research is to prepare a program for the design of an effective Primary Health Care Centre dedicated to improving the health status of the people in Obokun local government area of Osun state. To achieve this aim, specific objectives put forward to be pursued are, to:

Carry out case studies on primary health care centre.
Assess the brief and requirements of the client
Assess the reaction of users (the patients and the health workers) to the existing facilities.
Assess/analyze the site and the environmental factors.
Propose a scheme that enunciate and encompass the client’s and users’ requirements.

CHAPTER TWO

STATE-OF-THE-ART

Historical Review of Primary Health Care Centre

The term ‘Primary Health Care’ was used to mean the care given to the patient by the health worker who saw him/her first. It was also called ‘first contact care’; but if the patient was referred to the hospital it was called ‘secondary care’. Following this in May 1978, an international conference was headed by World Health Organization (WHO) member states in town in former USSR (now Russia) called Alma-Ata, where 134 nations including Nigeria declared that Primary Health Care (PHC) is the key to attaining health for all. At the conference, it was agreed and concluded that Primary Health Care (PHC) is essential health care made universally accessible to individuals and acceptable to them, through their full participation and at a cost the community can afford (WHO/UNICEF 1978).

In the global context, governments are searching for methods to improve the outcomes of their health care systems. Since the Declaration of Alma-Ata in 1978, there has been a greater acceptance of the fact that a strong primary care system is the foundation of an integrated health care system since it is the first level of contact for patients with the health care system. Primary care has been called the linchpin of effective health care delivery and can assist in greater continuity and responsiveness of health care (Saltman, R.B. and Figueras, J., 1997; World Health Organization, 2002, as cited in Boerma, 2006).

Primary care and primary health care are concepts that are defined differently by various people both internationally and nationally (Vuori, 1984). Barnes and colleagues (2005) compared definitions of primary care and primary health care in the broader context and found that both definitions share the philosophies of equity and justice and acknowledge prevention and health promotion as important aspects of health and well-being. However, the definitions differ in their goals and emphasis. Primary care focuses on treatment, the restoration of physical health and function, and referrals to secondary and tertiary sectors. Primary health care is driven by a population-based approach in which services are defined by the community, and it has a greater emphasis on preventive health care, intersectoral collaboration, access and consumer empowerment.

According to Rifkin (as cited in Barnes et al., 2005), there are three approaches to community participation in health care. The first is the ‘medical approach’, in which the goal is to cure disease, and control lies with the medical professional. The second is the ‘health services approach’, in which individuals are mobilized to take a more active part in the delivery of services. The third is a ‘community development approach’, in which the community is actively involved as a partner in making decisions to improve health.

Primary care encompasses the first two – “top-down” approaches. Primary health care embraces the third approach, which is “bottom-up.” Primary care focuses on intra-sectoral collaboration (collaboration within the health care sector and between health care providers). In Primary care, individuals are empowered to make decisions about their health with the assistance of the provider. In contrast, Primary health care involves integration and collaboration within community sectors to address social and economic development. By this process, communities become more involved in health issues. Primary health care also addresses matters related to the determinants of health, emphasizes collective decision making and collective action and results in a redistribution of power.

Muldoon, Hogg and Levitt (2006) compared definitions of primary care and primary health care and found that features common to both definitions included first-contact care, accessibility, comprehensiveness and coordination of care. The elements they found in definitions of primary care included person-focused care (not disease-oriented), care over time and sustained relationships with patients. These elements also define primary health care. The elements they found in definitions of primary health care but not in most definitions of primary care are as follows: Primary health care includes essential/universal accessibility; it is the nucleus of a country’s health care system; it is an integral part of the overall social and economic development of the country; it is provided at a cost the community and country can afford; it brings health care closer to where people live and work; its services are organized and adapted to the needs of a population; it provides high-quality services; it involves teamwork and interdisciplinary collaboration; its services are decentralized to community-based organizations; and it is provided by health care professionals with the right skills to meet the needs of individuals and communities.

Primary health care is delivered in the community at the first contact point between members of the public and health workers. In the past, people would see their general practitioners either at their homes or in the doctor’s surgery. If necessary, they would be referred to specialists to receive care. However, the sustained trend towards specialization amongst doctors starting out on their careers has produced a shift towards medical and diagnostic centres offering extensive medical services. The advantages for the patient are shorter waiting times and a greater possibility of being able to receive a diagnosis and treatment without having to be referred to another doctor. For the doctor, the advantages are the introduction of more regulated working hours and ability to exchange and learn from the experiences of other doctors in the practice. This is a combination of two or more practising doctors with shared staff and premises.

Although the main core of primary care service is the general medical practice, with the emphasis on the general practitioner (GP), modern healthcare centres increasingly comprise nursing and other professional staff of primary and community healthcare teams whose roles are also important. There could be, for example, nursing and midwifery teams (practice nurse, health visitor, district nurse, midwife, community psychiatric nurse, school nurse, etc.) as well as visiting therapists and practitioners in specialist disciplines. The members of the team work interdependently, although each has his/her role clearly defined. There are also the administration staffs that run the centre (e.g. practice manager, receptionist, records clerk and secretary). Social workers and dental practitioners might also use the facilities.

The Three Levels of Care And Hierarchy of Health Care Delivery Units

Whatever their administrative organisation and in whatever way they are financed, all the systems of health care delivery comprise a range of institutions which are graded according to their degree of sophistication and specialization, and the level of care they can provide.

The health care system in Nigeria is built on the three-tier responsibility of the Federal, the State and the Local governments. These three levels of government correspond to the three levels of care viz; the primary level, the secondary level and the tertiary level.

CHAPTER THREE

CASE STUDIES

The essence of this segment of the report needs no elaborate emphasis. In the words of Charles Wolf Junior “Those who don’t study the past will repeat its error; those who do will find other ways to err”. The reasons we reflect on yesterday, is to enable us have a comprehensive knowledge of today and at the same time think about tomorrow. By doing this, we know the past work, understand and correct its short comings for a better future. In order to fully understand the principle behind designing a building typology, an initial assessment of the existing building typology would have to be done. The initial assessment will be in term of spatial, functional, equipment and operational efficiencies and standards.

Case studies are historical documents used for this purpose. Historical information is gotten by first looking at the issue as a whole before considering them in isolation. Through this process, we obtain a clear comprehensive knowledge of the subject matter we are tacking and the circumstances that lead to the concept.

An in-depth attempt is made at studying and analyzing some existing primary health care centres to enable the understanding of the basic techniques employed in the satisfactory design of successful health centres as well as to reveal problems that must be addressed.

The following case studies were selected because of the opportunity each present for the evaluation of the different typology of primary health care centres:

Comprehensive Health Centre, Ibokun
Comprehensive Health Centre, Eleyele, Ile Ife
The Waldron Health Centre
Kentish Town Health Centre
Grindon Lane Primary Care Centre
Thetford Community Healthy Living Centre
Heart Of Hounslow

CHAPTER FOUR

DESIGN CRITERIA

Introduction

The proposed primary health care building for Obokun Local Government Area, Osun state is expected to be unique one. It is also expected to be a landmark and main focal building within Iponda town, which is proposed to be located in order to emphasize the significance of the primary health care centre to the public.

Project Goals and Objectives

The aim of this study is to prepare a program for the design of a primary health care centre that will provide functional and adequate spaces for the current and future needs of Obokun Local Government Area, Osun State.

The objectives are to:

Carry out case studies on primary health care centre.
Assess the brief and requirements of the client.
Assess the reaction of users (the patients and the health workers) to the existing facilities.
Assess/analyze the site and the environmental factors.
Propose a scheme that enunciate and encompass the client’s and users’ requirements.

Functional/Spatial Criteria

Spaces, sizes and their relationship

The following facilities will be housed by the proposed primary health care building:

CHAPTER FIVE

SITE AND ENVIRONMENTAL ANALYSIS

Location and site selection for project

Fig: Map showing the 36 states in Nigeria, including Osun state.

Nigeria lies within the tropics. This region lies between latitude 23⁰27’ north to 23⁰27’ south of the earth surface. Within this area the sun is perpendicular at noon at least one day of each year. For all the points, in this region, the sun is almost vertically overhead during the entire year. The peculiar characteristics of the tropic include high amount of sunshine, high amount of rainfall, high humidity levels, almost uniform weather throughout the year and high temperatures. Architectural design in the tropics must take into consideration the peculiar climatic features of the region.

Site Location

The Primary Health Care Centre is being proposed to be located in Iponda town in Obokun local government area, Osun state, Nigeria, Africa. Its geographical coordinates are 7^o 44’ 0” North, 4^o 43’ 0” East. Obokun local government covers a total land area of 527km² (203sq mi), and a total population (according to 2006 census) of 116,511.

Fig: Map showing Obokun Local Government Area, including the neighbouring ones.

The site is located at a few distance away from the existing Iponda Health Centre. There is a major road in front of the site, the major road links Ilesa to Ibokun. The site is flanked by a fallow land to the right, and an uncompleted building to the left. Also, located at the other side of the road which is directly opposite the site, is a fallow ground and electric poles running along the front. Presently, there are no structures on the site. It is an uncultivated bushy land. Some of the trees would be retained while many would be removed from the site.

CHAPTER SIX

APPROACH TO DESIGN

Design Considerations

There are some factors that are to be considered before starting proper. These factors are discussed in this chapter.

Design Goals:

Form
Create a design that will accommodate the users and their various activities in the health centre.
To create a design that will consider the comfort of the users.
To create a simple form design
Functions
To avoid conflict in traffic flow within the building and the external environment
Provide design that provide individual’s need without difficulty
Provides design that provides undisrupted flow of activities.
Zoning

To facilitate the translation of planning principles into the design, group activities within the building are categorized into the following three zones:

REFERENCES

Architectural Press, second edition (1999). METRIC HANDBOOK Planning and Design Data.
Boerma, W.G.W. (2006). Coordination and integration in European primary care. In R.B. Saltman, A. Rico, & W. Boerma (Eds.), Primary care in the driver’s seat? Organizational Reform in European Primary Care (1st ed., pp. 3-21). Berkshire, UK: Open University Press.
Dennil, K. (1999). Aspects of Primary Health Care. Cape Town: Oxford University Press.
Department of Health (2013). Health Building Note 11-01: Facilities for primary and community care services.
Directorate General of Health Services (2002). Guidelines for Primary Health Centres. [Brochure]. India: Ministry of Health & Family Welfare.
Emeka E. O. and Masemote G. M. (2011). Functioning and Challenges of Primary Health Care (PHC) Program in Roma Valley, Lesotho. South Africa: Tshwane University of Technology & National University of Lesotho.
Muldoon, L.K., Hogg, W.E., & Levitt, M. (2006, September/October). Primary care (pc) and primary health care (phc): What is the difference? Canadian Journal of Public Health, 97(5), 409-411.
Rifkin, S.B. (1986). Lessons from community participation in health programs. Health Policy Plan, 1, 240-9.
Saltman, R.B., & Figueras, J. (1997). European health care reform: Analysis of current strategies. Copenhagen: World Health Organization.
Vuoir, H. (1984). Primary health care in Europe – problems and solutions. Community Medicine, 6(3), 221-231.
World Health Organization (1978). Primary Health Care. Report of the International Conference on Primary Health Care, Alma-Ata, USSR. 6-12 September 1978.
World Health Organization. (2002). The European health report. Copenhagen:, Denmark WHO Regional Office for Europe.

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