The statistics are staggering. It is estimated that three-quarters of the world’s AIDS population lives in Sub-Saharan Africa; most have no access to lifesaving drugs, testing facilities or even basic preventative health care.One of the major factors inhibiting medical professionals in Africa from treating this disease is the inability to access vast areas of the continent with adequately equipped medical facilities. To meet this need, Architecture for Humanity challenged the world’s architects and health care professionals to submit designs for a mobile HIV/AIDS health clinic.Designers were given six months to develop schemes for a fully equipped, mobile medical unit and HIV/AIDS treatment center that could not only be used for testing, prevention and treatment of the disease but also for disseminating information regarding the virus and providing basic health care services. In submitting designs, entrants were asked to consider a number of criteria; chief among them, ease of deployment and maintenance by a small team of medical professionals, community acceptance and cost.
In addition to Architecture for Humanity’s advisory board, a number of other groups were consulted and participated in developing design criteria for the competition including: John Hopkins University School of Hygiene and Public Health, voluntary counseling and testing facilities in Zimbabwe and Ghana, the World Health Organization, UNESCO, Southern Africa AIDS Information Dissemination Service and the Population Council.
More than 530 teams from 51 countries entered the competition. In November 2002, an international jury of architects and medical professionals met to select the first, second and third place winners, as well as a Founders Award and eight notable entries.
The jury process was rigorous and thorough. All seven jury members reviewed each entry. Discussions revolved around issues of mobility, storage, security and community involvement. For example, the jury believed that semi-articulated trucks would not be able to cover the region’s difficult terrain, particularly during inclement weather. Designs dependent on a specific vehicle type would require maintenance and spare parts unavailable in many areas, a number of jurors agreed, while designs that could be deployed using a range of transportation modes offered greater mobility. Adequate and flexible storage, as well as the need to secure equipment and supplies both during transport and at night, also presented significant concerns. Creating ownership within the community, the jury felt, was another important goal. Recognizing the diversity of the region both in terms of geography and culture, the group favored designs that could be? localized? rather than? Africanized? The winning designs as well as others that inspire, inform and provoke were exhibited at the Van Alen Institute in New York City, which partnered with Architecture for Humanity to host the competition jury and curate the exhibition. The exhibition has also been shown at the Architecture + Design Museum, in Los Angeles, The American Institute of
Architects gallery in San Francisco, the Danish Design Center in Copenhagen, Denmark, and is set to travel to the Royal Institute of British Architects in London, and the Africa Center in KwaZulu-Natal, South Africa.
Need and Impact
A number of organizations have called for the development of a network of mobile and satellite clinics to provide basic health care and combat the spread of HIV/AIDS in Sub-Saharan Africa. They include Doctors without Borders, The Harvard AIDS Institute, UNAIDS, and the World Health Organization.
A comprehensive review of strategies addressing structural deficiencies commissioned by The World Health Organization’s Commission for Macroeconomics and Health (CMH) revealed that the infrastructure necessary to stem the spread of AIDS do not require the extensive facilities of modern hospitals but can be effectively administered through small clinics and dispensaries. The CMH study, issued in 2002, refers to these as close-to-client systems and suggests that increasing the capacity of these local clinics and dispensaries through stable financing is well within the ability of international efforts.
Community-based approaches to treating and preventing HIV/AIDS have been proven effective in a number of developing countries, including Ghana, Kenya, South Africa and Uganda. With funding from the World Bank, Uganda began investing in local clinics and outreach centers as part of a nationwide initiative to combat the spread of HIV/AIDS in 1994. Since then, the rate of prevalence of HIV/AIDS in Uganda has declined nationwide from 14 percent (and in some urban areas as high as 30 percent) to 5 percent in 2001, according to the Uganda AIDS Commission. However, even in Uganda, access to care is inadequate in rural areas. In its National Strategic Framework for HIV/AIDS Activities (2000/1-2005/6) the Uganda AIDS Commission
cited ‘inadequate HIV testing and counseling services particularly in rural areas’ as one of the major constraints to treating and preventing HIV/AIDS and called for the expansion of voluntary counseling and testing facilities in rural areas.
In May 2003, President George W. Bush signed into law a five-year, $15 billion Emergency Plan for AIDS Relief worldwide. A key component of the plan calls for the development of a layered network of central medical centers that support satellite clinics and mobile units in rural areas. According to the plan, these mobile and satellite clinics would be staffed by lay technicians, possibly rotating nurses, and local healers, who would be trained in standard clinical evaluations and the distribution of medication refills.
The AIDS Research and Family Care Clinic in Mombasa, Kenya estimates that a single clinic has the potential to provide testing, treatment and care for upwards of 10,000 people. Other medical and relief organizations give higher estimates. Once designed and built, these clinics could be used by relief and community health organizations to create a highly dispersed and effective network of care. In addition to providing testing, treatment and awareness education to underserved populations, a network of easily deployable mobile clinics equipped with satellite communications systems could provide critical information to central health care centers in order to track prevalence rates in outlying regions, assess the needs of specific communities and deploy limited resources accordingly. In the future, such a network could also play a vital role in distributing antiretroviral drugs and eventually a vaccine.
Implementing Architecture for Humanity’s designs for a Mobile HIV/AIDS Health Clinic for Africa would represent a significant step toward building a dispersed and efficient network of care in Sub-Saharan Africa.
We are currently developing a prototype based on the winning entry by architects from the Danish design firm KHRAS, and a workshop is planned in KwaZulu-Natal, South Africa to refine and further develop the clinic’s design. During the workshop, which will be held at the Africa Center for Health and Population Studies at the Nelson Mandela School of Medicine in December 2003, teams of architects representing the four winning designs will collaborate with relief organization representatives, local doctors, engineers and transportation experts to develop construction plans for a working prototype based on KHRAS’s winning entry.
KHRAS, whose award-winning projects include Copenhagen’s metro and airport, Greenland’s Nature Institute and the Danish Pavilion at Expo ’92 in Sevilla, Spain, brings an extensive background in building public infrastructure and health care facilities to the project. Following the workshop, KHRAS has committed time and resources to develop construction documents and oversee construction of the finalized design. Arup, an international engineering firm, has also committed a team of consultants to provide the cost, transportation and structural analysis reports necessary to develop a prototype of the clinic on a pro bono basis.
Pending funding, construction of the prototype could commence as early as January 2004. Once built, the International Medical Corps, which has 50 doctors serving seven countries in Sub-Saharan Africa, and the AIDS Research and Family Care Clinic, which has six doctors based in Mombasa, Kenya, have both committed to staff and equip a finished prototype for testing in the field. In addition, we have been approached by a number of medical groups to create clinics for Angola, Ethiopia, Liberia, Ghana, Somalia and Southern Sudan. Once the prototype has been completed, the finished design will be made available to other health care providers so that versions of the clinic may be replicated throughout Sub-Saharan Africa—and eventually, other regions of the world.
Already, Architecture for Humanity has received tremendous support for this project. Advisory board members include Pritzker Prize-winning architect Frank Gehry as well as former Congressman and U.S. Ambassador to Denmark, Richard N. Swett, FAIA. The project has also received praise and support from former President William J. Clinton; Ambassador Jack Chow, the Special Representative of the Secretary of State, Colin Powell, for Global HIV/AIDS; and a number of U.N. and U.S. ambassadors.