Healthcare Design: A Global Perspective

Tim Clem joined PKA full time in the fall of 2015.  Prior to that, Tim had worked with PKA in a contract capacity over the past five years.  Throughout this period of service, we were always impressed with the work Tim was doing overseas.  When the opportunity arose to hire Tim full time this year it was a simple and exciting decision to make.  The following insight is from Tim and chronicles his work overseas these past seven years.

From 2008-2014 Tim worked from a desk in a small rural town in Costa Rica.  While coordinating design teams from around the world, Tim managed a variety of design projects throughout Latin America and the Caribbean.  These were Tim’s duties as a project leader for Engineering Ministries International.

Engineering Ministries International (EMI) is a non-profit organization made up of design professionals who donate their skills to help the underprivileged around the world.  EMI provides full design services for facilities which serve the poor in developing countries around the world.

Based in Atenas, Costa Rica, EMI’s América Latina office focuses on the Spanish speaking Americas and the Caribbean.  Projects range from churches and orphanages to schools and hospitals.  During his tenure as EMI staff, Tim participated in projects in Ecuador, Nicaragua, Guatemala, El Salvador, Honduras, Costa Rica, Panama, Mexico, the Dominican Republic, and Haiti.


In a recent presentation to the American Institute of Architects, Architecture for Health Panel, Tim presented some of the differences between designing healthcare facilities in developing countries versus North America.  These differences ranged from construction methods to design influences.

The most obvious difference is the economics of electricity.  For most of these clients, the operating budget is miniscule compared to corporations in North America.  Concurrently, the cost of electricity in these developing countries is often multiple times higher than we enjoy in North America.  As a result, design for energy efficiency is critical to the success of these projects.  Natural ventilation and daylighting become more than a good idea, but rather non-negotiables for these projects.

Interestingly, the low cost of labor can dramatically affect the design as well.  Unlike North America, where we may choose expensive materials or assemblies in an attempt to reduce the amount of labor at installation, in developing countries the material costs typically are the deciding factor in selecting building systems.  The labor to form up ten 12 inch wide by 12 inch deep grade beams at three feet on center and backfilling between the cured beams is less than the cost of the additional concrete required to pour a continuous 10 inch deep slab.

The effect of culture on design can be dramatic in some developing countries.  Gender segregation drove the configuration of a hospital in Bangladesh.  From the point of entry to the facility, men and women are taken opposite directions to facilitate this separation.  While one med/surg wing would have been sufficient for the patient load, two were required to respond to the cultural requirements.

Similarly, the culture of family ties influenced the configuration of patient wards at this same hospital.  In many developing countries, the family accompanies a patient to the hospital in order to care for his or her needs.  Space must be provided for these family members to “camp”, including sanitary facilities, a place to cook meals for themselves and the patient, and a market where the family can purchase foodstuffs.

These are only a few of the differences that must be considered when designing in developing countries.  After six years working in developing countries, Tim learned that in spite of the differences from working in North America, one thing remained the same:  the buildings we create are for people and need to be designed to meet their specific needs, whether they be cultural, economic, convenience or aesthetic.