I have just returned from short visit to eSwatini where I have been supervising the construction component of a health project. The country’s population has one of the highest incidence of HIV/AIDs in the world and the project was aimed at improving health outcomes particularly of women and children.

The construction component of the project comprised: the renovation and extension of the maternity unit of the country’s major referral hospital in the capital, Mbabane; the construction of new maternity and operating theatre units and 12-bed maternity waiting homes at four health centres (which would probably be called district hospitals in other countries); the construction of new 24-bed maternity waiting homes at two other hospitals; the renovation and extension of a large TB Clinic in the country’s second city, Manzini; the construction of a new college of nursing; the renovation of a hospital’s maintenance workshop; the construction of a new ambulance base station for the country’s emergency response organisation and the construction of four new rural clinics.

I started working on the project in 2011 and while I prepared sketch designs for most of the facilities (with a lot of assistance provided by a health facilities planner who was working on other aspects of the project), the final designs and bidding documents were prepared by local consultants recruited for this purpose. It was not an easy project to manage as the local consultants had little experience of the design of health facilities and they required a great deal of assistance during the design process. The local pool of contractors able to carry out the construction work was also not very large and one of the contractors selected to construct one of the largest contracts had serious internal management problems that greatly delayed the completion of the buildings.

All of the buildings (apart from those that were renovated at the referral hospital) were designed to have large roof overhangs (to keep the sun off windows and walls), high ceilings and lots of cross-ventilation including high-level ventilation to central corridors where these were required and these design strategies seem to have worked as all of the buildings visited were relatively cool and comfortable without the use of air-conditioning (even those on the low veldt where temperatures during the visits were in the upper 30°s C). Most buildings are constructed of bricks made locally which were more expensive than rendered blockwork would have been but will greatly reduce the need for maintenance.

Brief descriptions and photographs of the various facilities constructed by the project are given below. A more comprehensive review will be provided on the web-site at a later date. This was my last visit to the country working on the project and I will be very sad not to go back as the people are very welcoming and easy to work with (I made many friends) and the country itself is very beautiful.

Mbabane General Hospital Maternity Unit Renovations

This is the country’s major referral hospital and the maternity unit deals with referrals of complicated cases from other hospitals and health centres in the country as well as walk-in cases from the local area. The existing maternity facilities were very run down with major areas such as delivery rooms and operating theatres not functioning. There was however very little room for expansion of the unit and it was not possible to keep the unit functioning while the renovation work was in progress. However, by utilising parts of existing courtyards and by some clever re-planning, the maternity unit has been completely renovated and extended and now provides the following facilities, many of which did not previously exist: a reception and waiting area; male and female staff changing facilities; staff rooms, meeting rooms and offices; a waiting ward for expectant mothers; two ante-natal wards plus an ante-natal isolation room; a labour ward and a high-care ward; two delivery rooms and an operating theatre suite; a sterilisation unit; four post-natal wards; two post caesarean wards; a post-natal isolation ward; a neo-natal ward and intensive care unit; clean and dirty utility rooms, nurses’ stations, public and staff toilets, etc. All rooms are fully equipped and furnished and the new maternity unit now provides first-class facilities for the women who will be using it.

New Maternity and Operating Theatre Units at four Health Centres

There are five existing health centres (which would be called district hospitals in other African countries) in the country most of them dating from the 1970s and 80s and all of them requiring significant updating and renovation. At four of these health centres at Emkuzweni, Matsanjeni, Nhlangano and Dvokolwako, new maternity and operating theatre units were constructed together with 12-bed maternity waiting homes. The maternity and operating theatre units are housed in one building with a common entrance, reception and waiting area. The operating theatre unit consists of male and female staff changing rooms and a staff room; a waiting and recovery area; a nurses’ station; a scrubs/robing area; and operating theatre; a sterilisation unit with its own staff changing rooms; plus clean and dirty utility rooms, offices, cleaners room, stores, etc. The maternity unit consists of male and female staff changing rooms; a family room; a neo-natal room; a consultant’s room; an ante-natal ward; a recovery ward; two delivery rooms; two small isolation wards; and a staff room, administrator’s room, clean and dirty utilities, stores, public toilets, plant rooms, etc. The maternity waiting homes are for expectant mothers from the surrounding rural areas and have three 4-bed rooms, toilets, showers, a dining/kitchen and a cleaner’s room. The buildings have high ceilings following the slope of the roof, large roof overhangs, ventilated lantern-roofs over central corridors and are cool and comfortable even in high ambient temperatures. The operating theatres are however air-conditioned.

TB Clinic at Manzini

This clinic was housed in existing buildings on a very restricted site in the centre of Manzini. The buildings had been extended over the years with the result that the clinic was very badly planned as well as being in very poor condition. It has been completely renovated and re-planned with parts of the existing building being demolished and replaced with new extensions. The clinic now has a new entrance/reception area leading to an open courtyard with wide access/waiting verandas to three sides. There are consultation rooms, counselling rooms, a new X-ray unit, a new, much enlarged laboratory, staff changing rooms and toilets, public toilets, offices, stores, a staff room, a meeting room and a separate cough booth. The new clinic should make a significant contribution to the treatment of TB in the town.

College of Nursing at Good Shepherd Hospital

There was a small existing school of nursing at Good Shepherd Hospital housed mainly in temporary buildings. A completely new college campus has been constructed on a sloping site adjacent to the hospital and the campus consists of the following facilities: an administration building; three 2-classroom buildings, a science laboratory, a computer/IT room; a demonstration ward; male and female student toilets; a staff room with staff toilets and stores. The campus has a large parking area at the top of the site and a central, covered access route that steps down the slope of the site. All of the buildings (which face north-south) are accessed off this central route via open access verandas and all buildings have windows to both sides giving plenty of cross-ventilation. The latter, together with the orientation, high ceilings following the slopes of the roofs and large roof overhangs (although these are not as large as I would have wished) make the rooms cool and comfortable.

Maternity Waiting Homes at Good Shepherd Hospital and Raleigh Fitkin Memorial Hospital

Both hospitals had existing maternity waiting homes which were too small, lacked facilities and were in very poor condition. The waiting homes provide accommodation for women from the surrounding rural areas who are not sick but who require somewhere to stay before they come to term. The new waiting homes provide accommodation for 24 women in six, 4-bed rooms together with toilets and showers, a kitchen/dining room and stores. Both buildings have a high, well-ventilated central corridor and the rooms have high ceilings following the slope of the roof, lots of opening windows on the outside walls and high level louvres tot the corridor rooms. These, together with large roof overhangs make the rooms cool and comfortable.

Ambulance Base Station at Nftonjeni and maintenance workshop at Pigg’s Peak Hospital

An ambulance base station for the country’s emergency response services has been constructed on a new, sloping site in Northern Hhohho Region. The base station consists of a large parking and maintenance building for the ambulances and an administration building that accommodates the response team and administration staff. The parking building is open at the front with a lockable maintenance bay, an office, stores and changing facilities. The administration building has a large communications room for the response team, a meeting room, a kitchen/staff room and changing rooms and toilets. Ceilings are high, roof overhangs are large and all rooms have plenty of cross-ventilation. The maintenance workshop at Pigg’s Peak Hospital has toilets, showers and changing facilities for male and female staff; a staff room/kitchen; an office; workshop bays for electrical work, plumbing work and carpentry work and a store for materials.

Rural Clinics

Standard designs for three types of clinics (Type 1 the smallest; Type 2 and Type 3 the largest) were prepared by the consultants and one Type 1, one Type 3 and two Type 2 clinics have been constructed. These three types of clinics were accepted by MOH as the standard clinics to be constructed by all agencies in future (although this does not appear to be happening at present).

The Type 1 clinic (the smallest clinic) consists of one building with the following accommodation: an entrance/reception area; a TB consulting room with an external waiting space and an external cough booth; an HIV counselling room; a pharmacy and a store; a nurses’ room; a treatment room; a midwife’s room; a laboratory; an environmental officer’s room and a store; a staff room; a laundry; male and female public toilets; male and female staff toilets; stores and a cleaner’s room.

The Type 2 clinic is similar to the Type 1 but with the addition of a dental room and a child-wellness room. The pharmacy, laboratory and some stores are also larger.

The Type 3 clinic (the largest clinic) consists of two buildings, Building A and Building B. Building A is similar to a Type 1 clinic but with the addition of a dental room; a child-wellness room; an immunisation room and a small delivery room for emergency deliveries. The pharmacy, laboratory and some stores are also larger. Building B has an environmental officer’s room and a store; a secretary’s room; a laundry; a staff room and male and female staff toilets and stores.

Architecture in Developing Countries: A Resource

The design and construction of appropriate, low-cost buildings for education and health in rural areas of the developing world.

Nigel Wakeham is an architect who lived for 23 years in Southern and West Africa and the SW Pacific working on education, health and other projects. He has since worked for over 20 years as a consultant for national governments and agencies such as the World Bank, DFID, ADB and AfDB on the implementation of the construction components of education and health projects in many countries in the developing world.​​​

The objective of this website will be to provide the benefit of more than 45 years of experience of working in developing countries to architects and other construction professionals involved in the design and construction of appropriate, low-cost buildings for education and health. It will provide reference material from the projects that Nigel has worked on and technical information on the design, construction and maintenance of educational and health facilities and other relevant topics and these will be added to from time to time.

I am happy to be contacted by anyone requiring further information on any of the projects or resources referred to in this website or by anyone wishing to discuss work possibilities.