This is a presentation from Day One of the SAFHE/CEASA 2011 conference. Amira Osman presents lessons learned from the construction of the INO Hospital in Bern, Switzerland using “open building” practices. Open building allows for a more agile architecture and allows for modification and change over time. Presented by Amira Osman.

This is a presentation from the SAFHE/CEASA 2011 conference “Planning” section about the Hospital Upgrade done to the Dr AG Jeetoo Hospital in Mauritius. It was created and presented by Colin du Toit.

The Publication of the Public Finance Management Act repealed the Exchequer Act and consequently, the SAHNORM and its management structure. Without a similar subsequent system or structure to manage health infrastructure planning, a haphazard methodology of managing health facility norms and standards came about. The cost of building health facilities increased dramatically and inequity of applied standards stifled the efforts of health planners to provide equitable access to health care.

This paper proposes a methodology to provide a new system of area standards, driven by clinical needs, in order to give guidance to health planners, give a baseline for cost comparisons and a method of judging value for money in a given health facility design. The proposed area standards framework provides a benchmark for sizing clinical areas according to their function and level of care, and to provide allowances for their essential support services. This will provide a new basis against which any new facility can be measured. Managing area is a proven manner of positively influencing capital cost, be thereby reducing capital requirements while retaining maximum clinical service output.

“More clarity for less costly confusion”.

- How do we get more for less? 

This is the talking point to be addressed at the upcoming biennial SAFHE/ CEASA conference which is set to take place at the OR Tambo Conference Centre in Boksburg from the 6th of April this year. The conference, which is being held for the eighteenth time, attracts wide participation from across South Africa, and beyond. The common goal of delegates is to improve hospital engineering, clinical engineering and healthcare technology – this year with our resource constrained context firmly in view. The conference, hosted at a new venue each time, has a three-track formal presentation programme covering: design, building and maintenance; management, systems and operations; and equipment. The papers – delivered by both public and private sector experts from variety of professional disciplines – never fail to spark lively debate.

The landscape of South African healthcare estate looks set to transform in the near future. With the much anticipated National Health Insurance programme yet to be fully described, the future of healthcare infrastructure and technology is shrouded in mystery. An expert panel speculates on what the impact might be. There will be case studies of contemporary hospital architecture which strives to be environmentally responsible and to provide value for money. A foreign prototypical hospital built on principles of “open” architecture will be discussed. “Open” architecture strives for less waste and ready adaptability and so also enduring relevance. Should we adopt these principles in our future hospitals? Then there will be a report on the assessment of forensic observation units which promises to provide a glimpse into the legislative future of our hospitals. Alternative contracting processes, construction techniques and delivery models will all be explored in the pursuit of the elusive goal of achieving “more for less.”

A futuristic vision of the hospital radiology room will be presented. CT scanning methods have been revolutionised over the past two years. Already available new technology can provide almost real time visualisation of cardiac images and radically reduced scan times. This promises to provide profound benefits for both patient and medical staff. The continually emerging new capabilities and techniques for clinicians owing to the sudden rapid advances in CT technology will be discussed. It is argued that shorter scan times will mean quicker through-put, greater operational efficiency. But at what cost?

With efficiency on the lips, no contemporary discussion on hospital or clinical engineering is complete without enquiring into energy efficiency and the question of how to get it right. Recently light-emitting diode (LED) technology has been introduced into operating theatre lighting which claims to have twin advantages of being a “fit and forget” (aka low maintenance) solution and providing energy efficiency. In addition to exploring these advantages and explaining how LED technology differs from conventional theatre light solutions, we will be shown how inherent problems of monochromatic colour composition of LED’s are solved to bring the lights into service in hospital operating rooms.

Another intriguing operating room technology that will be presented is blood salvage. Blood salvage - that is retrieving and restoring one’s own blood for re-infusion (instead of transfusion of donor’s blood) – is currently an uncommon practice. Yet, this technique may offer a safer, more economical and culturally acceptable alternative to access the scarce and critical resource of blood.

Cultural acceptance, stigmatisation and the challenge of making acceptable healthcare environments safe from airborne contagion will be the topic of two papers on TB infection control. The first, a set of case studies describes a set of engineering and architectural design principles specifically developed for the South African context, though rooted in international best practice method. The second paper is a rapid inventory of the science and research behind technologies which have been demonstrated effective against airborne pathogens as well as a quick look into some promising technologies which might be used in the future in our quest to conquer one of Africa’s most challenging public health threats.

If all the talk is too much, then delegates can take a little time out to enjoy the extensive trade exhibition to see the technologies being discussed: the scanners, the salvage equipment, air disinfection technologies. Here industry professional will have a chance to see what’s new along with the usual dependable industry staples, meet colleagues and share experiences.

Hospital floors so shiny and clean that you can see your reflection; five new flagship tertiary
hospitals for our increasing numbers of doctors-in training and the establishment of a Infrastructure
Unit at the National Department of Health. This is the new face of the public sector healthcare
presented by the Minister of Health, the Honourable Dr Aaron Motsoaledi, MP in his address to
SAFHE & CEASA delegates. Speaking at the opening of the 2011 Conference on the 6th of April at
the OR Tambo Convention Centre in Boksburg, the esteemed visitor outlined the ANC five point
strategic plan which, amongst other objectives aims to see health systems strengthened and jobs
created. Lack of jobs, noted the Minister, is dangerous. Infrastructure projects from design, through
to construction and maintenance have the potential to generate many employment opportunities.
Within the objective of delivering healthcare services, he noted, infrastructure and medical
equipment have a critical role to play.

The Minister was encouraged by the presence of a large number of skilled hospital and clinical
engineering professionals at the conference, given the current purported lack of skills in public
service. South African consultants built an inspirational underwater restaurant in Dubai. Through
the 2010 World Cup project many large infrastructure projects were successfully completed. Several
key health infrastructure programmes have been successful. For example 41% of today’s clinics have
been built since 1994. Nine new multi-drug resistant TB wards have been built and are currently
being opened across the country.

However, despite these successes there has also been growing underspending in public health
infrastructure projects. Coordination challenges have seen examples where completed facilities
remain uncommissioned and disused due to lack of equipment or water connection. Furthermore,
the engineering of health facilities are not always conducive to best practice medical care.
Healthcare buildings must allow for cleanliness, to be brought to shiny, reflectively clean surfaces.
Ventilation (and other architectural and engineering means) should be brought to bear in order to
address infection prevention and control.

Recently progressive efforts have been made to address chronic government underspending.
The National Treasury Infrastructure Delivery Improvement Project (IDIP) initiative which aims to
augment skills in provincial health, and education has been established. Through this technical
advisors have been deployed to provinces. National Department of Health has established the
Infrastructure Unit and its systems support Infrastructure Unit Systems Support (IUSS) in which the
National Department of Health partners with Council for Scientific and Industrial Research (CSIR) and
Development Bank of South Africa (DBSA) are to provide support to provincial departments (where
needed) and to provide national norms and standards for buildings and equipment. An Office of
Standards Compliance is currently being established which will have an inspectorate and will oversee
accreditation. These will provide enabling framework for the much anticipated National Health
Insurance (NHI) through which healthcare services will be extended to all.

The question was posed as to how industry could assist.

Subsequent speakers commented on the considerable opportunity that will be made available
through the procurement of five prestigious new tertiary hospitals at George Mukhari, Chris Hani
Baragwaneth (South Africa’s – possibly Africa’s – largest hospital), King Edward VIII, Nelson Mandela

Medical Hospital and a brand new facility in Polokwane that were announced. These facilities will be
needed to support a drive to increase training for doctors and health care workers, which despite
population growth have remained unchanged in recent times.

Dr Motsoaledi joined dignitaries from the National Department of Health and special advisors to the
Minister Mr Massoud Shaker, Ms Nonkonzo Molai, and WHO representative from the Department
for Health System Governance and Service Delivery, Mr Roger Schmitt in wishing delegates well on
their deliberations over the three day biennial conference.

SAFHE/CEASA 2011 is the biennial conference held in order to bring the healthcare community together and discuss and explore new problems and solutions. Each event thus far has been a success and this year is proving to be no exception. Thus far the speakers and presentations have been of an excellent quality and the opportunity for meeting new people and networking has been better than ever.

This years theme has been “More with less”  which in the current economic climate is a timely frame for discussions.  The programme will be structured along the lines of parallel tracks following an opening plenary addressing strategic issues;

1. Design, Building and Maintenance
2. Management, Systems and Operations
3. Equipment

We will soon be releasing a feature that allows members to submit their resources and content directly through this website, but until then, if you are interested in providing content for the website,  please contact the SAFHE web team here.

Welcome to the new SAFHE  holding page. We are busy building the new site at present, so please be patient and subscribe to our RSS feed to keep in touch so that you can be informed of the official website launch.

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All the best

The Safhe Web Team