Governments across the region are driving the $10bn hospital build programme in the Middle East. The trend for creating new hospitals rather than expanding existing facilities means the region will end up with some of the world’s most modern healthcare buildings, offering the latest technologies.

The buildings were used as housing during the Asian games and now it is being built into a hospital

David Mullins, Hill International

Saudi Arabia’s Ministry of Health (MoH) plans to build 100 new hospitals by 2015. Speaking to MEED in August, Deputy Health Minister Mohammed Khoshim explained that primary healthcare was the kingdom’s cornerstone. A further 2000 primary health clinics will be constructed by 2015. It is understood these health centres will be built in three phases. Construction of 180 clinics is under way in Mecca and Jizan. Gunal Construction Trading & Industry Corporation with Mapa Construction & Trading Company is building 152 of the new centres and Haif Trading & Construction Company is responsible for the remaining 28.

Saudi Arabia’s ambitious health programme

Five new maternity units worth $100m each are planned for Tabuk, Hail, Dammam, Jeddah and Sakah, with an award for Dammam expected by the end of March 2011. The local East Consulting Engineering Centre has produced the design, which is awaiting approval from the MoH.

Cost efficiency and best practice are not mutually exclusive and the region’s best new facilities will be those that combine the two

Smaller 100- and 50-bed hospitals are also under construction in Al Baha, Jeddah, Qurrayat, Al Haditha, Al Ahsa and Taif. A larger medical city is planned for the northern province of Najran that will include a 200-bed hospital, dentistry centre, ophthalmology facilities and a psychiatric unit. The $61m project is part of the Najran University complex, started in 2006.

With such a vast construction programme under way, Saudi Arabia is seeking the best possible value for money. Consultants and contractors report that innovation and leading-edge design is not so much the order of the day, rather a drive for efficient buildings. “It is more about value for money. They want impressive structures but for less cost,” says a healthcare design leader working in the kingdom.

Traditionally hospitals in Saudi Arabia and the rest of the Middle East have followed US designs. “The US tends to favour the deep plan approach,” says Andy Parker, global director for healthcare at UK-based consultant Buro Happold. “Typically this is a podium with a monolithic tower and is usually square in plan. High-rise buildings are quicker to construct, but the floors are getting physically higher to incorporate the latest technologies. Floor to height might be four to five metres just to accommodate the greater air flow for air quality standards.”

The dominant design standards used in the US are the Guidelines for Design and Construction of Healthcare Facilities, produced by the US-based Facility Guidelines Institute. These are reviewed every four years. The latest guidelines for 2010 were published in March. “These are more demanding than ever,” says David Mullins, healthcare practice leader at US-based consultant Hill International. “There is an emphasis on uniformity and physical functionality with a need for protecting patients and maximising the technology at hand.”

Outcome-oriented hospital designs

Chairman emeritus of Guideline Committee for 2010 and director of healthcare at HKS Architects Joe Strague is working on projects such as the King Hussein Cancer Centre in Jordan, due to open next year. “The guidelines are outcome oriented and the environment for care is enhanced. We are currently working on the 2014 edition and there are 125 experts doing that.” Strague says the latest guidelines introduce some new requirements such as single bedrooms as a minimum to reduce the risk of cross-infection.

In Qatar, a hospital in the new Hamad Medica City is slightly unusual. It consists of four separate buildings for rehabilitation, orthopaedics, general and women. “With this facility Qatar is getting the most for its money. The buildings were used as housing during the Asian Games and now it is being built into a hospital. The architecture is reflective of the culture and the healthcare will be state of the art,” says Mullins. It is due for completion in the next few months.

With so many new facilities planned, governments in the region are keen to know more about what constitutes best practice and cutting-edge design. “In Europe, the trend has moved towards organic designs known as shallow plan where floor plans are long and thin – like ribbons, which give more access to light,” says Parker.

Access to daylight is understood to be a key factor in recovery. “Rooms are getting larger to accommodate different types of use. Years ago rooms were too small, maybe 10 square metres. Today they are more like 30 sq m,” explains Nick Balagurchik, health practice leader and operational specialist at Hill International.

Innovative ideas for hospital design

In hospital corridors, clever use of space is also being considered. Nurse stations are strategically placed beside a small number of rooms, giving them more time with patients and less time moving from one area to another.

Personalised electronic devices such as iPhones are being used for recording data, and governments in the region, particularly Saudi Arabia, are investing heavily in e-health systems. Leading IT firms such as IBM and GE Healthcare are implementing an e-health system that will link all MoH systems, provide a platform for information exchange and digitise the kingdom’s medical sector. Aziz Koleilat, general manager for GE Healthcare for the Middle East and Pakistan, says installing new technologies for information gathering and sharing is a key priority. “There is the trend to digitise information, and then a second part which is extending the monitoring and data exchange into people’s homes. You then have to coordinate the systems and here we see a big push towards e-health.”

GE Healthcare works in partnership with a range of public and private organisations throughout the region providing advisory services, equipment, training and information solutions. Koleilat says the relationships between healthcare providers and their suppliers are maturing. “The region is moving from a transactional approach to building partnerships. We are providing follow up through training and programme development,” he says.

A major programme that the company is currently promoting is its global “healthymagination” initiative. The $6bn plan has seen the firm invest $3bn in the research and development of new products that reduce the cost of healthcare procedures, increase access to its products and improve the quality of health outcomes. It aims to have 100 products or solutions in place by 2015.

In Kuwait, the Ministry of Finance is funding the creation of an entire campus dedicated to health science and education. The University Health Sciences Centre (KU HSC) will serve as the medical campus for Kuwait University. This will house a virtual hospital, a facility that, by 2014, will be equipped with state-of-the art medical simulation equipment in addition to a virtual learning centre containing a range of physiological images and e-health databases. The campus is scheduled to be complete by 2020.

Challenges for contractors

As medical methods evolve, a new facility should be able to accommodate the latest developments. For contractors this can present some tricky challenges. Government-financed projects are determined not only by the sustainability of healthcare services nationwide, but also the quality of the services provided. Governments have many other sectors to finance too and healthcare may only receive a small percentage of the budget. Profit-driven private firms are under pressure from clients to create cost-efficient spaces through modular construction and prefabrication of structural elements, rather than focusing on the patient experience. Cost efficiency and best practice are not mutually exclusive and the region’s best new facilities will be those that successfully combine the two. “With such a massive health spending programme it would be a missed opportunity if a vast quantity of hospitals were built the same as those produced in the 1980s,” says Parker.