< Community Health Centres

General

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Under HSRDP1 a total of 29 new community health centres (CHCs) were constructed in two phases.

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Design of Facilities

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Preliminary designs for three types of CHCs, a Type A, a Type B and a Type C were developed during the first mission after intensive discussions with the Minister of Health and the Timorese doctors in MOH.

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The CHCs were designed as single-storey buildings with single-banked rooms allowing for maximum light and ventilation to all rooms.  The climate in East Timor is often hot and humid and maximum ventilation was necessary to produce comfortable conditions for patients and nurses.  The roofs were double-pitched with large overhangs on both sides to protect windows and walls from sun and rain.

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Public access to all rooms was from a front, open, access veranda which also had seats for patients waiting to be seen by staff along the outside of the veranda.  There was also access from room to room internally for staff.  Toilets for patients and staff were provided in a separate building that was connected to the clinic by a covered way.

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There were large, covered but open waiting spaces at one end of the buildings and the accommodation for the Type A CHC consisted of an office/reception room plus small store for materials and the radio battery (all CHCs were equipped with short-wave radios for communication with hospitals); a consultation/ante-natal room; a testing/injections room plus a small store for drugs and a cold-chain fridge; a treatment/observation room; a cleaner’s room plus a small store for batteries and controls for solar lighting panels.  The accommodation of the Type B CHC was similar to that of the Type A but the waiting area was larger and there was an additional consultation room.  The Type C CHC had two consultation rooms and two treatment/observation rooms but none of these were actually constructed.

See the preliminary design attachment for the three types of CHCs.

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Implementation

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A firm of consulting engineers based in Darwin in Australia (Cardno MBK International) were contracted to prepare final designs, working drawings and bidding documents for the first phase of the CHC construction programme.  They also had to carry out surveys of the proposed sites for the CHCs.  The final designs followed closely my preliminary designs and proposals for construction.

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See the final design attachment for the final designs and working drawings prepared by Cardno MBK International for the CHCs.

The CHCs in the first phase were constructed of rendered concrete blocks, with a float-finished concrete floor, louvre windows in timber frames and a roof construction of colour-coated steel sheets on timber purlins on timber rafters with a ceiling of soft-board panels fixed to the underside of the purlins.  The rafters over the external access veranda were supported on double timber columns.

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Twenty two Type A CHCs were constructed in the first phase of HSRDP1 and an existing CHC was renovated.  Three contractors were involved in the construction and renovation of the CHCs.  Two contractors were contracted to construct the new CHCs.  Neither contractor performed very well and there were considerable delays which were mainly due to the incompetence of the contractors.  One of the contractors had eventually to sub-contract the work in order to get it finished.  A third contractor carried out the renovation of an existing CHC and this work went better than the new work.  It should be remembered that the situation with regard to the construction industry in East Timor at the time was difficult.  There were very few local skilled artisans or construction firms and most construction was being carried out by expatriate firms.  While there were problems with the construction of all of the CHCs the buildings were generally finished to an acceptable standard.

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In the second phase of the project a further two Type A CHCs were constructed together with four Type B CHCs which had more accommodation.

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Some changes were made to the construction of the CHCs built in the second phase: the walls were constructed of fair-face concrete blocks with louvre windows in timber frames; the floors were of float-finished concrete and the roofs were constructed of colour-coated steel sheets on long-span lightweight steel purlins on steel rafters.  The rafters over the external access veranda were again supported on double timber columns.

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The contract of the consulting engineers was extended to cover the documentation and supervision of the construction of the CHCs constructed under the second phase of the project.

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The construction work went much more smoothly in the second phase as the contractor was a better manager and had more competent artisans and the buildings were completed to a much better standard than those in the first phase.

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There were no CHCs constructed under HSRDP2 but a further two Type B CHCs and four health posts (HPs) were constructed under the EU-funded Timor Leste Health Sector Support Programme.

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Two designs for HPs were developed, a Type A and a Type B and the designs and construction were similar to that of the CHCs.  The accommodation of the Type A consisted of a small waiting area at the end of the building; an office/reception/testing room plus a small store for materials and the radio battery and a consultation/treatment room.   The accommodation of the Type B consisted of a small waiting area at the end of the building; an office/reception/testing room plus a small store for materials and the radio battery, a consultation room and an observation/treatment room.  Toilets were also provided in a separate building and these were VIP latrines where there was no piped water supply.  Only the Type B HPs were constructed together with a number of nurses’ quarters.

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See the preliminary design attachment for the preliminary designs for the health posts and the final design attachment for the final designs and working drawings prepared by Cardno MBK International for the health posts and nurses’ houses.

The documentation for the facilities constructed under the EU-funded programme was carried out in-house by engineers working in MOH and they also supervised the construction of these facilities.

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Conclusions

Although there were problems in the first phase with some of the contractors, the CHCs were to a large part well-built and finished and provided fairly basic but desperately needed health facilities in remote, rural areas of the country.

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All CHCs were provided with radios so that the nurses could contact, and get advice from, doctors stationed in the referral hospitals.  All of the CHCs were also provided with dependable water supplies something that had been missing previously.

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The buildings with their high ceilings, insulated roofs and single-banked rooms with extensive areas of louvres on either side, proved to be very comfortable in use for both staff and patients.