Healthcare Design: A Global Perspective

Tim Clem joins PKA full-time and brings with him vast experience optimizing architectural designs in accordance with fiscal, cultural, and environmental considerations.

Timothy Clem joined PKA full-time in Fall 2015. Prior to that, Tim had worked with PKA in contractual capacities for five years. Throughout this period, Tim was also doing impressive work abroad, chiefly in Central and South America.

From 2008-2014, Tim worked out of 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 (EMI).

EMI is a non-profit organization composed of design professionals who donate their skills to help the underprivileged throughout the world. EMI provides full design services for facilities that serve the poor in developing countries.

Based in Atenas, Costa Rica, EMI’s América Latina office focuses on the Spanish speaking Americas and 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 minuscule compared to those of North American corporations. Concurrently, the cost of electricity in these developing countries is often egregiously 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 the use of daylight are more than just good ideas, they’re imperative aspects of each project.

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.

Cultural values can even profoundly affect building design 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 ensure separation. While one medical-surgical 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 despite the differences from working in North America, one thing remained constant: We create buildings for people, and our architecture needs to fit their specific needs, whether they be cultural, economic, logistic, or aesthetic.