A Cautionary Tale

Form follows function is a maxim associated with late 19^th and early 20^th century architecture, coined by Louis Sullivan and taken up by his one-time assistant Frank Lloyd Wright.  The principle proposes that a building’s purpose or function should be the starting point for its design rather than any aesthetic concept.

This maxim, together with the notion that the simplest idea is probably the best, modified in tropical countries by the necessity of taking into account the effects of the local climate and nowadays of reducing carbon emissions, has been one of the guiding principles in my architectural career.

Admittedly, I have had the good fortune of not having had to work in the commercial sector where the client’s wishes with regard to the architectural image of a building have had to be taken into account but have worked mainly on educational and health buildings in the Global South where more mundane constraints such as extremes of climate, limited budgets, the scarcity of any but basic materials and the low capacity of local builders have outweighed any purely ‘architectural’ considerations.

The following cautionary tale concerns the design of a new hospital which illustrates, I believe, what happens when you ignore the basic principles outlined above.

The Ministry of Health (MOH) in a West African country had contracted an international firm of consultants to design a new paediatric ward adjacent to an existing health centre in the country’s capital but had not been able to find the funds to construct it.  MOH therefore asked the project manager of a donor agency already active in the country if it would fund its construction. 

I was already working on a school building project in the country when I was asked by the project manager if I would join a team of advisors, including a hospital design specialist to assist him with this project. 

The consultants were fairly newly established firm that had been working in the Global South on the design of health buildings and other facilities and which had built up a practice with offices in Africa and elsewhere with an enthusiastic staff of mainly young architects. 

The paediatric ward as designed was circular in shape and the site was extremely restricted with no room for expansion.  It was not possible to proceed with this design or to use the site because of the advisors’ concerns about both the design and the restricted site. 

After discussions with MOH, the donor agency agreed to fund the design and construction of Phase 1 of a new hospital, which would include paediatric facilities, if MOH could find a suitable site.  A large site was found outside the city with space for Phase 1 and a possible Phase 2 of the hospital together with other facilities.  It was agreed that the original consultants, as they had a contract in place with MOH, would prepare designs and bidding documents for Phase 1 and a Masterplan for the remaining development.

The consultants assembled a large team (some in-country and some overseas) to design the new facilities, including architects, structural and M & E engineers, landscape architects and quantity surveyors.  Although some of the architects had experience of the design of health facilities the team did not include a hospital designer and none of the team had significant experience of designing buildings for hot, humid tropics.  These factors, together with the fact that the consultants were employed by MOH and not by the donor agency paying for the construction, led to many of the subsequent problems. 

The initial Phase 1 design took the form of three circular units on three levels linked by large circulation areas.  The advisors felt that an inappropriate design concept was being imposed that would lead to difficulties in the arrangement of furniture in the circular spaces, inefficiencies in the use of space, excessive areas of circulation and the need for solar control measures all around the building.  They also felt that the building would be difficult for local contractors to build and there was concern that the square metre cost assumed by the consultants was too low.   

The consultants agreed to revisit the design according to some general principles that would reduce costs:

• the buildings should be simple to construct,

• the main facades should face north-south in order to reduce the amount of solar protection required,

• the majority of the buildings should be naturally ventilated,

• the design should allow for future expansion of both individual departments and the hospital overall.  

There followed an extended period of re-design and negotiation between the consultants, the MOH and the advisors which became increasingly frustrating for all parties.  The consultants were reluctant to take advice from the advisors on the design of facilities such as the imaging department, the operating theatres and the in-patient wards (the consultants had very unorthodox ideas about these) or on the orientation and ventilation of the buildings but because they had a contract with MOH and not the donor agency, the advisors could not insist that they take their advice.

The design of the in-patient wards was particularly contentious as the advisors considered that the bed arrangements did not provide sufficient patient privacy or enough space for medical staff to work around the beds.  The consultants’ refusal to take advice on these and other matters eventually led to the hospital design specialist resigning.

The final design for Phase 1 dropped the initial circular design and consisted of a ‘closed’ design with two large, interconnected rectangular buildings each with an internal courtyard with accommodation on all four sides and with the main axis of the buildings running from northwest to southeast.  See second sketch below.

Although many aspects of the design were considered by the advisors to be well thought out such as the large waiting areas, protected courtyards for expectant mothers, play spaces for children and the landscaping which included planting, paths around the site and a lake to drain the very wet, lower part of the site, concerns were again raised about some of the detailed design, orientation of the buildings, construction and the cost per square metre used to estimate the construction budget.

Design: the concerns set out above about the design of some of the facilities had not been addressed and the ‘closed’ design of the buildings meant that it would be very difficult to extend individual departments or the building as a whole.

Orientation: the preferred orientation for buildings in the tropics is for long elevations to face north-south in order to reduce the exposure of walls and windows to the sun. Buildings with long elevations facing north-south require minimal protection to windows and walls from the sun on these elevations but any deviation from this orientation leads to exposure to the sun of other walls and windows. 

See sketch below.

The orientation of the buildings with the main axis running from northeast to southwest therefore meant that all elevations of the buildings would be exposed to the sun at some point during the day and extensive and expensive solar protection devices would be required on all elevations. 

See second sketch below.

Construction

The construction of the buildings was more complicated and expensive than necessary:

• The main structure consisted of large numbers of reinforced concrete columns, beams and slabs.  

• The buildings had undulating roofs consisting of panels of profiled steel roof sheets supported on steel purlins on a complicated arrangement of reinforced concrete rafters and stub columns on top of the concrete roof slabs. 

• Protection from the sun was provided by large numbers of 2-storeys high, reinforced concrete fins to external walls. 

• A large number of reinforced concrete ‘solar chimneys’, approximately 5-storeys high, were located around the buildings to provide natural ventilation to the buildings.  Whether they would function as designed was uncertain.

The photos give some idea of the amount of reinforced concrete used on the project.

Construction Cost

The cost estimate prepared by the consultants was considered to be unrealistic given that the cost per square metre on which it was based was over a year old (and was considered to be low in the first instance) and because of the complexity of the final design and the large amounts of reinforced concrete and site works. These concerns about the design, orientation, construction and cost of the Phase 1 buildings were raised with the consultants but they were ignored.

While the construction drawings for Phase 1 and the Masterplan were being completed, a contract was let to a local company (who had a foreign partner) to carry out advanced site works in order to shorten the final construction period.  The work was completed to a good standard, but the contract overran by nearly 50% of the contract period.

The Phase 1 contract was put out for bids and the lowest bid (very close to the consultants’ estimate) was submitted by the contractor carrying out the advanced site works.  Two bids from overseas-based contractors were very much higher than the lowest bid.  Concerns were raised by the advisors about both the level of the winning bid and the length of the contract period, which, at 2 years, was considered to be at least a year too short given the complexity of the work and the performance of the contractor on the advanced works contract.  Once again, these concerns were ignored by the consultants.

After work started on site, it soon became clear that the contractor had badly under-estimated the construction time needed and the cost.  From the start, work on site was slow due to the contractor’s cash flow problems, staffing issues, problems with materials procurement, insufficient support from the contractor’s foreign partner and the extensive rainy season, the effect of which had not been fully factored into the contract period.  

At the end of the two-year contract period approximately 50% of the work was complete and a one-year extension was granted. It was considered unlikely however that the contractor would complete the work in this period given his progress to that point and it appears that the work came to a halt before the end of the extended contract period, possibly due to the effects of the COVID epidemic.  

Of all of the projects that I have worked on, this was my only direct experience of a project going badly wrong, largely because the consultants ignored the basic principles set out at the beginning of this piece and also the advice of the advisors on the detailed design, orientation, construction, contract length and cost.   An inappropriate and expensive ‘architectural’ solution was imposed on what should have been a simple, appropriately designed and functional hospital which could have been an exemplar design for hospitals in West Africa. 

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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.

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