I am just back from a trip to Tajikistan where I was supervising the construction component of a health project. This involves the construction of 37 health centres in remote rural villages in order to increase the ability of the Ministry of Health to serve these, in many cases, very isolated communities.

Tajikistan is the smallest, and probably the poorest of the Central Asian republics and 50% of the country is over 3,000 metres above sea level. There are very few trees and large areas of those parts of the country that are not mountainous are covered by strangely shaped rolling hills, either covered in short grass or bare of all vegetation. It has few natural resources and the economy depends largely on remittances from Tajiks working in Russia although there is a very large aluminium smelting plant and a lot of cotton is grown. The country also produces large quantities of fruit, much of which is dried (there are 300 varieties of apricot!) and there are huge numbers of goats and chocolate-brown, woolly sheep. The people, like poor rural people everywhere, are very welcoming and generous and although 98% of the population are Muslim, this does not seem to stop a lot of them drinking (and offering) copious amounts of vodka and beer!

At the time of my visit, the sheep were being brought down from the mountains in the east of the country and walked down to the south where they would graze during the winter, with the shepherds either walking or riding small horses with their belongings carried on donkeys and we had to negotiate flocks of hundreds of animals that were being driven along many of the roads to the health centres.

I was there for 9 days and managed to see 25 of the health centres. This involved travel of over 2,500 kilometres much of it over unmade, gravel roads (where indeed roads existed). I have been to the country several times before over the last two years and have visited many of the sites but I had not before visited the south-east of the country (Gorno-Badakhstan Region), adjacent to the Afghanistan border, where we are constructing two health centres in very remote villages. Getting there involved driving for over 600 kilometres the first day (much of this on rough gravel roads along the Panj River that forms the border with Afghanistan) to the regional capital Khorog where we stayed the night, with another 400 kilometres plus the next day to reach the two health centres and return to Khorog in the evening; The following day we drove the 600 kilometres plus back to Dushanbe, the capital; 1,600 kilometres plus in three days! The scenery along the Panj River was spectacular with the mountains of the Hindu-Kush on the Afghan side and of the Pamirs on the Tajik side with the tops of the peaks on both sides covered in snow.

I was not involved in the design of the health centres which I must admit are not really to my liking but, as some of them are now in operation and treating large numbers of patients (one of the larger health centres is treating 200/250 patients a day) who am I to argue about the design! If, however there is a follow-on project, I would try and simplify and rationalise the design if possible.

Electricity is a problem in most of the rural parts of the country and the health centres therefore have either a solar-powered back-up system or generators.

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.​

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​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.