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Healthcare Infrastructure Planning and Design in the Western Cape,

South Africa

FINDING APPROPRIATE SOLUTIONSTO INAPPROPRIATE PROBLEMS

Duncan RendallChief Architect

Infrastructure PlanningWestern Cape Government: Health

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Area: 1.2 million km2

(= UK, France, Germany, Belgium & Netherlands combined)

Population: 55 million(UK population 66.6million)

Constitutional Democracy

South Africa: Geography

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Gini co-efficient score: 0.63Unemployment rate: 27.2%

AustraliaGini co-efficient score: 0.34Unemployment rate: 5.3%

BrazilGini co-efficient score: 0.47Unemployment rate: 12.3%

Source:Gini co-efficient : The Organization for EconomicCo-operation and Development (OECD)Unemployment Rate - https://tradingeconomics.com

South Africa: Demography

80% of the population are dependant on Public health services

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Area: 129 462 km2 (England 130 279 km²)Population: 6.6 million (England ± 53 million)

Western Cape Province - Geography

Capital City: Cape TownPopulation: 3.8 million

‘Second’ city: GeorgePopulation: ± 120 000

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Population growth rate: ± 1,9% p.a. (National ave 1.2%)Unemployment Rate: 20.7% (National ave 27.2%)

Health Demographic:Male life expectancy: 66.8 yrs (National ave 61.1 yrs)Female life expectancy: 71.8 yrs (National ave 67.3 yrs)

Delivery of Health Services is a Provincial Responsibility

Quadruple Disease Burden:

– Interpersonal violence

– Non – communicable diseases

– TB & HIV

– Maternal & Child related illness

July Aug Sep over 3 months

2016 94 88 124 306

2017 140 163 176 479

% increase year on year 49% 85% 41% 56,54%

Western Cape Deaths 2015

Homicides from Firearms

Source: Western Cape Government Health 2018/19 Annual Performance Plan

‘Extreme South Africa’ Documentary

by Reggie Yates featuring Khayelitsha Hospital

Western Cape Province - Demography

Forensic Pathology Services autopsy case load has increased 25% in the last 5 years (unnatural deaths)

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Primary Healthcare:

– Home Based Services

– Clinics (253 facilities)

Level 1: District Hospital (33)

Level 2: Regional Hospital (4)

Level 3: Central / Academic Hospital (3)

Specialist Hospitals:

– Maternity (1)

– Mental Health (4)

– Rehabilitation (1)

– TB (6)Forensic Pathology Services (17)Emergency Medical Services (59)

Healthcare Service Platform

Klaarstroom Satellite Clinic, Eden District Oudtshoorn District Hospital, Eden District

Paarl Regional Hospital, Cape Winelands District Groote Schuur Central Hospital, Cape Town District

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Key Infrastructure related Service Challenges:

• Security• Project Delivery timeframes• Overcrowding

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Perimeter Security and Access Control

Security

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Burglary and Theft…

Security

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Hanover Park CHC, Cape Town

Gunshot mitigation measures…

Security

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Layered approach

• Non–institutional external perimeter fencing

• Forecourt with good line of sight

• ‘Hard’ edge with single point of entry

• Strategically located security stations

Du Noon CHC, Cape Town (2015)

Khayelitsha Hospital, Cape Town (2012)

Security: Solutions

Kwanokuthula CDC, Plettenberg Bay (2012)

Khayelitsha Hospital, Cape Town (2012)

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‘Buffer zone’

• ‘Positive’ secure spaces

• Good visibility

• Overflow waiting area

• Hard and soft landscaping

Hermanus CDC (2015) Du Noon CHC, Cape Town (2015)

Khayelitsha Hospital, Cape Town (2012) Mitchell’s Plain Hospital, Cape Town (2013)

Security: Solutions

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Internally

• ‘Antidote’ to external environment

• Clear, simple layout & wayfinding for ease of navigation

• Lots of natural light

• Views to external spaces

• Artwork and Colour

• ‘Invisible’ security e.g. CCTV

District Six CDC, Cape Town (2017)Khayelitsha Hospital, Cape Town (2012)

Mitchell’s Plain Hospital, Cape Town (2013) Du Noon CHC (2015)

Security: Solutions

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• Rapid population growth

• Ageing infrastructure

• Changing service models

• Operational needs

• Limited Budgets

Project Delivery Timeframes

Default = Prefab!

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Heideveld Emergency Centre, Cape Town (2014)

• ‘Relocatable’ structure

• Cost-effective

• Urgent

Project Delivery Timeframes

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Heideveld Emergency Centre, Cape Town (2014)

• 1 450m2 new build structure

• Design commencement to construction completion – 18 months

• Industrial steel frame

• ‘Coldroom’ type internal wall panels

Project Delivery Timeframes

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Heideveld Emergency Centre, Cape Town (2014)Walk-in patients

AmbulanceDrop-off

General Layout

Project Delivery Timeframes

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Heideveld Emergency Centre, Cape Town (2014)

Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5

Project Delivery Timeframes

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Heideveld Emergency Centre, Cape Town (2014)

Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5

Project Delivery Timeframes

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Heideveld Emergency Centre, Cape Town (2014)

Project Team: Implementing Agent – WCG: Public Works, Architect – Workshop 6, QS - Talani, M&E Eng – Element Consulting, S. Eng – Ace Consulting, Contractor – Group 5

Project Delivery Timeframes

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Du Noon Temporary Clinic & MfuleniTemporary CDC, Cape Town(2012 & 2016)

• Temporary (3–10 yrs)

• Cost effective

• Urgent

Over-crowding & Accelerated delivery

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Du Noon Temporary Clinic (2012)

Existing warehouse

Approx. 600m2

31 Containers

Inception to Completion -7 months

Fully re-deployable

Over-crowding & Accelerated delivery

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Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Tempani

Du Noon Temporary Clinic, Cape Town (2012)

Over-crowding & Accelerated delivery

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Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Tempani

Du Noon Temporary Clinic, Cape Town (2012)

Over-crowding & Accelerated delivery

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Mfuleni Temporary CDC (2015)

63 Containers

Approx. 1 275m2

Inception to Completion -15 months

Fully re-deployable components + ‘warehouse’ becomes a multi-purpose sports hall for the City of Cape Town

Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Consulting, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks

Over-crowding & Accelerated delivery

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Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks

Mfuleni Temporary CDC, Cape Town (2015)

Over-crowding & Accelerated delivery

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Project Team: Implementing Agent – WCG: Public Works, Architect – Revel Fox & Ptns, QS – Liwani Cons, M&E Eng – Element Consulting, S. Eng – Nadeson Consulting, Contractor – Stefanutti Stocks

Mfuleni Temporary CDC, Cape Town (2015)

Over-crowding & Accelerated delivery

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…IN CLOSINGAs much as we are trying to move to a more pro-active planning approach, our service environment will, in many instances, continue to change faster than we can build…….but we are making inroads

Projects in progress (Current + 2 yrs): Capital Infrastructure: 134 projects ZAR1.2billion budget (AUD 120 million)

(excl. equipment & furniture)

Maintenance: 196 projects ZAR 820 million budget (AUD 82 million)

Mosaic artwork from Mitchell’s Plain Hospital, Cape Town

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Mosaic artwork from Mitchell’s Plain Hospital, Cape Town

THANK YOUDuncan.Rendall@westerncape.gov.za