Performance Evaluation of Primary Health Care (PHC) Buildings in the Federal Capital Territory (FCT)
Chapter One
Aim and Objectives
Aim
This study aims to evaluate the perception of users on the performance of selected PHC buildings in the FCT with a view to assess how well these healthcare buildings complies with best practices and help in the healing process of patients.
Objectives
The objectives of this study are to:
- Identify the standard performance criteria of healthcare buildings that aids healing of patients and positively influence users of PHC
- Evaluate the perception of users on the performance of selected PHC
- Compare the performance of the PHC studied in ii with the standards identified in i above to determine the areas requiring
- Outline specific steps to remedy the gaps in ii above to ensure the effective performance of the PHC buildings in accordance with the global
CHAPTER TWO
LITERATURE REVIEW
Introduction
Improved health care services, especially the Primary Health Care (PHC) is an important area of concern for governments in developing countries. This is because improvement in PHC services (accessibility, availability, affordability, acceptability and adequacy) will pave the way for advancement in the quality of lives of the people (Shrestha, 2010).
This present research study seeks to conduct a post-occupancy evaluation on the performance of PHC buildings in the Federal Capital Territory, with a view to provide records about their state (functionality, build quality and impact). This is because it is an established fact that patient’s health outcome have direct relationship with the design and environment of the health facilities where they are treated (Ibrahim, 2011; Dandajeh, 2011). This literature reviews attempt to support and provide the conceptual basis, research findings and policy review on this subject of BPE, healing environment and patient’s health outcome in the PHC level.
Building Performance
The Building Services Research and Information Association (BSRIA) (2011), Dandajeh (2011) and Jiboye 2012 define Building Performance Evaluation (BPE) as a form of Post- Occupancy Evaluation (POE) which can be used at any point in a building’s life to assess energy performance, occupant comfort and make comparisons with design targets. Furthermore, BSRIA findings suggested that there is significant evidence that buildings do not perform as well as was anticipated at the design stage; and the difference between anticipated and actual performance is known as the performance gap.
Building Performance Evaluation (BPE)
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To support the continual improvement of the construction and procurement process, Post Project Evaluation (PPE) and Post Occupancy Evaluation (POE) of building programmes are mandatory (Scottish Government, 2012). BPE originated in the 1960s, and in 1964 the Royal Institute of British Architects (RIBA) plan of work was established to include this BPE aspect which enables architects to formally carry out post-project review of their design. But the drawback of this BPE then was that it did not capture the feedback from occupants of the buildings or in-use energy consumption. In 1972, a revision of the RIBA plan of work was made and it included the feedback from occupants of building, hence the term Post Occupancy Evaluation (POE) was used. Therefore, Building Performance Evaluation (BPE) is a form of Post-Occupancy Evaluation (POE) which can be used at any point in a building’s life to assess energy performance, occupant comfort and make comparisons with design targets.
Building Performance Evaluation Methodology
The Building Services Research and Information Association (BSRIA) (2011) has reported the use of various techniques for conducting POE studies by PROBE using a sequential step or methodology. The identified eight steps for conducting POE are:
Step 1: Understanding the building being evaluated. Here, the building design intent and technical performance specification for the building systems aresought be understood by the assessor. These information are contained in the brief and most time sought from the facilities team.
CHAPTER THREE
RESEARCH METHODOLOGY
To achieve the three research objectives in chapter one, research methods and methodology seeks to provide the techniques employed for data collection, analysis, the strategy of choosing the methods and linking them with the results (Alalouch, 2009).
Ibrahim (2007); De Jager (2007) and Dandajeh (2011) have all examined the use of adopting standard data collection instrument used in different places. In this case the AEDET and ASPECT evaluation toolkits for health care buildings. Their conclusions were that if a valid questionnaire exists it should not be altered significantly as this affects the validity and reliability of the tool, but minor adaptation to the language is often needed in order to make it understandable to the local culture or context. Therefore, the methods and methodology used for this study were tailored and adapted to the Nigerian context, especially the National Primary Health Care Development Agency’s Minimum Standards for Primary Health Care in Nigeria.
Research Design
A descriptive cross-sectional survey research design method is suitable and used for this study. Asika (2010) and Osuala (2005) had advocated that a cross-sectional descriptive survey method is used for research studies where the behavior of one or more of the variables are to be observed all at once in one shot study without interference, manipulation or control.
Study Population
The population of study is a census of all items or subjects that possess the characteristics or that have knowledge of the phenomenon being studied (Asika, 2010). The quality of healthcare design and its environment imparts on the medical staff, patients and visitors of PHCs. Therefore, the medical staff, patients and visitors are the target population across the six PHC buildings used as the study site for this research study. The medical staff comprise of doctors, nurses, pharmacists, community health extension workers (CHEW) and laboratory scientists. While the patients considered are both the out patients and those on admission. The visitors are the people visiting the PHC either to see the patients on admission, or as carers to the patients at the time of conducting this research.
Sample Size and Sampling Procedure
Sampling Frame
The available records of the target population from each of the selected PHCs was used to draw a sample frame for this study. This is shown in tables 3.1 – 3.4.
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION
This chapter contains the detailed presentation of the data collected from the questionnaires. These data were further analyzed and discussed in an attempt to achieve the aim and objectives of this study.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Summary of Findings
The aim of this study as identified in section 1.4 was to evaluate the perception of the users on the performance of PHC buildings in the FCT with a view to assess how well these healthcare buildings complies with best practices and aid the healing process of patients. To achieve this aim, four specific objectives were identified also in section 1.4. And to achieve the aim and objectives, this study utilized adapted version of AEDET Evolution toolkit to assess the performance of six PHC buildings in the FCT. A summary of the findings are provided as follows:
Tencriterion which were summarized into three criteria of Functionality, Build quality and Impact were identified from literature as standard healthcare performance parameters that aids patients outcome and positively influence other users towards PHC services. These criterion are: Use, Access, Space, Performance, Engineering, Construction, Character and Innovation, Form and Materials, Urban and Social Integration, and Staff and Patient The first objective which is to identify those standard building performance criteria that aids healing of patients and positively influence users of PHC buildings is achieved by these findings.
The second and third objectives of this study which is to evaluate users perception of the performance of selected PHC buildings and compare them with identified standards was achieved by the followingfindings:
The functionality of the assessed PHC buildings which was addressed by the criteriaof use, access, and space was generally perceived to be poor. It means that the way the PHC buildings are designed do not provide enough space for the medical staff to perform their duties and operate the healthcare systems and facilities housed in them. Users of the PHC buildings have difficulties in moving around the premises and its surroundings do not provide variety of means of transport. The rooms and space sizes provided in the building are not enough to handle the projected workloads (beds, waiting spaces, storage, etc). Parking areas for visitors are not adequate and well sign-posted, and the routes are not well lit at night. The consequences are that medical staff are hindered from performing their duties of effective and efficient services to patients and will be stressed with workloads among other problems. Also, this will cause difficulties for patients, especially those with disabilities to have access to the premises which in turn causes stress and affects their satisfaction of the building. Visitors will be stressed and there are tendencies for accidents around the PHC
The build quality of the assessed PHC buildings which was addressed by the criteria of performance and engineering, was generally perceived to be poor. It means that the PHC buildings are not easy to move around by staff and carry out activitiesin their departments, it is difficult to clean because of the way it i
designed and they do not have durable finishes. The medical staff respondents specifically do not agree that the PHC are fit for their purpose and that the components of the building are of high quality. Also, there are no emergency backup systems to minimize disruptions during work operations. The consequences are that patients will not receive the appropriate attention, services and treatments required from the medical staff. This is because the morale of these medical staff are low due to limited spaces to carry out their activities and lack of enough equipment to work with.
The Impact of the assessed PHC buildings to users was addressed by the criteria of Character and Innovation, Form and Materials, and Urban and Social Integration.It was generally perceived that the locations of the PHC buildings was good and are sensitive to neighbors and passers-by. But the PHC buildings are not interesting to look at and without artworks; they do not raise patient’s hope to be cared for and reassuring atmosphere. The consequences are that these buildings are not serene and conducive for the healing process of
The staff and patient environment of the assessed PHC buildings was generally perceived to be poor. Patients in PHC buildings cannot choose to have visual privacy,do not have private place to be with others, cannot be alone and the toilet / bathrooms are not located logically and convenient to use. The spaces where patients spend time do not have enough windows for clear views and the premises are not calming and interesting to them. Patients and staff do not have access to usable landscaped areas to easily see plants, vegetation and other features. There are no provisions for varieties of artificial lighting patterns that are appropriate for day and night in the PHC buildings and users cannot easily control the artificial lighting and temperature even though they can easily open the windows / doors.
Conclusions
Healthcare buildings are said to aid healing and improve the outcomes of patients when they provide facilities that supports healing process such as provision of privacy, well positioned adequate windows, plants, landscape, sound insulation between rooms, durable finishes, art work, well defined and attractive lobbies, reception and sub waiting areas. These will create serene and conducive environment for the hospital building users.
Findings from this study reveals that the design of PHC buildings in the FCT is such that the provided spaces, use and access are inadequate. These deficiencies constrains and restrict the activities of the medical staff who carry out healthcare functions inside and around the building. In turn, health services to patients are hindered and visitors are dissatisfied with PHC services and its environment. Discoveries from this study concludes that the PHC building components are not of high quality, do not have durable finishing and the engineering systems do not have back-ups to accommodate workloads during power outages. These in turn lowers the morale of medical staff due to limited spaces to carry out their activities and lack of enough equipment to work with.
Evidences from the findings in this study confirms that although the locations of the PHC buildings are sensitive to neighbors and passers-by, they are not interesting to look at and without artworks. They do not raise patient’s hope to be cared for, multiple occupancy rooms, poor bathroom, toilets facilities and lack of access to usable landscaped areas to easily see plants, vegetation and other features are among the common problems associated with these PHC studied. The consequences are that these healthcare buildings are not serene and conducive for the healing process of patients.
This research study has contributed to knowledge by providing a record of the performance of PHC buildings towards the healing of patients. In addition, it has also provided a toolkit for PHC building performance evaluation in Nigeria and shown that the provisions for PHC facilities by the National Primary Healthcare Development Agency’s (NPHCDA) Minimum Standards for Primary Healthcare is not sufficient to attract patronage from users.
Recommendations
Based on the findings and conclusions from this study, the following recommendations are made:
Themain recommendation is that the National Primary Healthcare Development Agency’s (NPHCDA) Minimum Standards for Primary Healthcare and the Ward Minimum Healthcare Package upon which the design of PHC in Nigeria is based should be updated and reviewed to reflect modern trends in healthcare architecture.
The Minimum Standards for Primary Healthcare document should integrate the following specific recommendations in future designs of PHC buildings in the FCT:
Separate parking for disabled people should be provided close to the entrances of the building. This will assist them in having full access to thehospital
Pedestrian access routes in the PHC buildings should be constructed to be attractive and suitable for wheelchair users and people with other
The number of PHC users have increased and as such, adequate numberof equipment storage spaces should be provided for the use of the medical
Toilets/bathrooms should be located logically, conveniently and discretely in the building to avoid bad odour from human
Adequate sized windows for clear views should be provided in the staff and patient’s areas because it is established fact that people prefer places with proper
Lobbies, sub reception areas and sub waiting areas should be designed to be attractive and well defined particularly in staff and patients
Provision for art, plants and flowers in the building should be encouraged and this will make the building serene and conducive for healing
The engineering equipment provided in the PHC buildings should haveback-up systems and provision of alternative sources of power to enhance the services rendered to patient by the medical
As a recommendation for further studies, an energy measurement performance evaluation of PHC buildings using NHS Environmental Assessment toolkit (NEAT) should be
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