CHALLENGES AND BEST PRACTICES DURING SITE SELECTION FOR HEALTH CENTRES IN ETHIOPIA BY DAMENAW YOHANNES INSERT GRAPHIC TO ADD MAP MAP IS 6.

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1 CHALLENGES AND BEST PRACTICES INSERT GRAPHIC TO ADD MAP DURING SITE SELECTION FOR HEALTH CENTRES IN ETHIOPIA MAP IS 6.17 TALL BY DAMENAW YOHANNES 1

2 BACKGROUND Ethiopia has an Estimated Population of 80 million The country uses four-tier health service system - Health Post - Health center - Primary Hospital - Referral Hospital 2

3 Contd Up to 2007, the no of Health Centers in the country were about 800 The government embarked on ambitious plan of increasing this to 3500 by 2010 The design used is standard depending on the soil condition(expansive and non-expansive) This presentation is focused on the problems observed during the site selection of the health centers 3

4 Objectives of the Presentation To create awareness of the importance of following the basic principles involved in selecting sites for health centers To present known site specific issues and problems To discuss options for dealing with these issues and problems 4

5 Basic considerations for Site Selection Size of the Site Set back Transportation Availability of utilities and infrastructure Natural features of the site, resource, opportunities and limitations Pollution prevention Topography, drainage Soil type and condition 5

6 Site Selection Size of the plot The site should be able to accommodate all the planned functional requirements as well as future expansion. The minimum site requirement for a health center is 6000m 2 with possible area for future expansion in to a district Hospital 6

7 Site Selection Set Back The HC blocks should be placed at reasonable location from neighboring facilities, A minimum of 6 meters set back is required from the street as well as from the neighboring site on all sides. 7

8 Site Selection Availability of utilities Infrastructure Health centers should be accessible during construction, provision of drug, furniture and equipment. Access should be free of obstructions such as plantation. In the absence of clean grid water supply; bore hole, deep wells, water pumps and proper treatment to unclean water source should be available. In the absence of electric grid supply, alternative power supply such as; generator or solar panel should be provided. 8

9 Problems observed in relation to site selection Orientation and site adaptation Topography, Drainage and Foundation location of the site Access to Health Centre 9

10 Orientation and site adaptation Climatic conditions The standard design for hot, humid and cold climate should be specified. Wind direction: Arrangement of facilities should consider prevailing wind direction. Buildings should be parallel to the wind direction, Incinerator or combustion box should be placed in such a way that the buildings could not be affected with the smoke. 10

11 Orientation and site adaptation Orientation, sun glare and heat: Buildings should be located with their openings and windows facing the direction with less solar glare and heat North South direction is applicable to most parts of Ethiopia. If there is no convenient site terrain in the surrounding, proper site adaptation has to be done and the standard design has to be modified for that particular site. 11

12 Orientation and site adaptation Orientation and site adaptation 12

13 Failure to adapt HC site 13

14 Failure to Adapt the Site 14

15 Failure to Adapt the Site 15

16 Failure to Adapt the Site 16

17 Failure to Adapt the Site 17

18 Failure to Adapt the Site 18

19 Failure to Adapt the Site 19

20 Failure to maintain gap between blocks 20

21 Topography, Drainage, and Soil Consideration Steep sloped terrain is difficult during construction and expensive. Flat terrain with gentle slope for easy drainage of storm water is ideal for a health center. Complete and accurate data including soil type should be collected for planning and adaptation. 21

22 Drainage Problem, Blocks too close 22

23 Drainage Problem, Block below NGL 23

24 Drainage Problem, Block below NGL 24

25 Wall crack-possible foundation problem 25

26 Drainage Problem, Block below NGL 26

27 Drainage Problem, Block below NGL 27

28 Drainage Problem, Block below NGL 28

29 Improper location of health centers Some of the Factors that should be considered are : Obstruction: high tension power grid, Telephone poles etc Should be at a reasonable distance from noise, Chemical hazards and any sort of pollution. (Grinding mill, High way traffic, chemical factories, slaughter house ) Patients or clients should be able to locate and identify the health center easily. View obstructions to the health center have to be avoided. 29

30 Existing Structures 30

31 Obstruction 31

32 Obstruction 32

33 Blocks scattered-road crossing the HC site Toilet Block OPD, IPD, Delivery 33

34 Access to Health Centre Should have direct access to the town or village and to the majority of the population and Public facilities Should be at a safe distance from flood prone areas, dams, rivers or other water bodies and land slide 34

35 Access to HC site 35

36 Access to HC site 36

37 Access to HC site (seasonal) 37

38 Access to HC site (seasonal 38

39 Conclusions Proper selection of the HC site is a major factor that determines economical construction to enable proper function of staff Serious consideration should be given to the selection of the HC site in order to ensure the new HC Will last several decades Be able to deliver quality health services to the local population 39

40 Thank You! 40