CHAPTER ONE
INTRODUCTION
1.1 Background
A completed building with its facilities and services must be fit for the purpose. Meaning that it should be able to perform its functions in the manner that will ensure satisfaction to its occupants (Ilesanmi, 2010; Hinde, 2012). Although buildings are constructed for different purposes (housing, school, health, etc.), their performance either excellent or poor can be seen from the eyes of its users (Ilesanmi, 2010; Jiboye, 2012). The design quality of a building have been found to influence its functions (Haciric, 2008; Ibrahim, 2011; Jiboye, 2012). For example, a well-designed school has shown to improve the teaching and learning process of teachers and students thereby improved educational achievements (Khan and Kotharkar, 2012; Khalila, Kamaruzzamanb, Baharumb, and Husina, 2015). Also, a well-designed hospital has shown to help in quick patients’ recovery, have positive impact on medical staff and visitors (Abbas and Ghazali, 2010; Ibrahim, 2011; Dandajeh, 2011).
A number of reasons have been provided on why buildings perform poorly in meeting users’ needs and expectations. The major reason was lack of adequate knowledge of users’ changing needs and preferences by architects and other professionals who design, construct and maintain these buildings. And the panacea to improve the overall performance of buildings is to explore and understand users’ needs, expectations and aspirations through regular performance evaluation by means of Building Performance Evaluation (BPE) or Post Occupancy Evaluation (POE) (Natasha & Abdul Hadi, 2008; Ibema, Opoko, Adeboye, and Amole, 2013).
Building Performance Evaluation or POE can be defined as the process of obtaining knowledge about building performance from users, and using the feedbacks to inform what needs to be improved or fine-tuned in the existing building and also used to enhance the design qualities of future building projects (Ilesanmi, 2010; Jiboye, 2012; Said, 2012). The objectives of BPE or POE are the same for all buildings including those where healthcare services takes place either for primary, secondary or tertiary purposes.
The ability of a hospital building to facilitate healing process is termed ‘therapeutic’, which can be described as the overall environment both physical and non-physical created to aid the recovery process (Abbas and Ghazali, 2010; Dandajeh, 2011). Physical environments are considered therapeutic with healing qualities when there is direct evidence that a design intervention contributes to improve patient’s outcomes (Department of Health, 2014). Evidence- based studies have confirmed and shown that better designed healthcare facilities help to improve the ease, efficiency of care, healing process and promote faster recoveries of patients. As such, an enhanced therapeutic environment will improve patients’ experiences, help them to recover their health quickly resulting in better outcomes, shorter bed-stays and reduce the running costs of healthcare facilities (Department of Health Estates and Facilities, 2008; Dandajeh, 2011; Ibrahim, 2011). It is worthy to stress therefore, that how a health care facility is designed, looks and feels to work in can have significant impacts on the patients, staff and visitors alike.
Successful projects are those that are delivered on scope, time, cost, quality, risk and achieved the desired benefits (Hinde, 2012; Siegelaub, 2010). The specific benefit targets required from Primary Health Care system (PHC) in Nigeria are tailored to address the Millennium Development Goals (MDG) 4 and 5. The recent MDG report (2013) revealed that Africa is on-track on achieving three of the eight goals. But off-track in attaining goal 4 which was to reduce Infant Mortality Ratio (IMR) from 146 deaths per 1,000 live births to 98 deaths by the end of 2015. And also on goal 5; which was to also reduce Maternal Mortality Ratio (MMR). This MMR instead has increased from 545 deaths per 100,000 live births in 2008 to 576 in 2013. Statutorily, reducing child and maternal mortality in Nigeria falls under the aims and objectives for the establishment of the Primary Health Care system (PHC) that are run in buildings across the 37 states including the Federal Capital Territory (FCT). Available records from the Directory of Health Facilities in Nigeria (2011), confirmed that there are 30,098 registered PHC buildings. Yet with these large numbers of PHCs, Nigeria still has high rate of IMR, MMR and the low average life expectancy of 52 years against 58 years for Africa? Are the PHC buildings in Nigeria designed to aid healing of patients and encourage patronage from users? How functional and impactful are they (Asuzu, 2004; Ibrahim and Price, 2006; Dandajeh, 2011; African Development Bank, 2013)?
Findings from Khalil and Husin (2009); Forbes (2011) and Hinde (2012) has shown that design decisions when translated into physical facilities that accommodate health services and patients’ care environments should be evaluated in order to determine if they are fit for purpose. This is because the shortage of POE means that planners and architects do not have access to accurate findings regarding healthcare buildings’ performance and no evidence to show how building designs and its environment management meets the needs of its client and users. Therefore, to avoid making repeated design mistakes and to even alignment with strategic business intent, POE is required for healthcare buildings.
1.2 Statement of the Problem
Existing studies have established that the physical characteristics of buildings have significant influence on occupants’ satisfaction (Ibema et al, 2013, Jiboye, 2012). In Nigeria, studies has shown that the conventional ways that hospital are designed have contributed to stress, depression and anxieties because of loss of privacy, control over eating and sleeping times, noise, etc. And in addition contributed to dangers, allergies and other acquired infections called Hospital Acquired Infections (HAI) to patients and staff (Atata, Ibrahim, Akanbi, Olurinola, and Sani, 2006; David and Famurewa, 2010; Samuel, Kayode, Musa, Nwigwe, and Aboderin , 2010; Dandajeh, 2011).
Some of these assertions led to a research study by Dandajeh in 2011 on the appraisal of the therapeutic performance of teaching hospital buildings that accounts for less than one-third of Nigeria’s population. However, no studies have specifically assessed the therapeutic performance of PHC buildings which is identified to be the appropriate settings to tackle over 90% of the major causes of morbidity and mortality due to its proximity to about two-thirds of Nigerians (Ibrahim, Price and Dainty, 2006; Ibrahim, 2011; Abdulraheem et. al., 2011).
There is the need therefore for this study to evaluate the performance of PHC buildings with a view to assess how well these healthcare buildings complies with best practices and aid the healing process of patients, productivity of medical staff and other users.
1.3 Significance of the Study
Recent research findings by Dandajeh (2011) confirmed the suitability of the use of the adapted versions of Achieving Excellence Design Evaluation Toolkit (AEDET) and All Staff and Patient Calibration Toolkit (ASPECT) for the assessment of the performance of hospital buildings (Tertiary Healthcare facilities) in Nigeria. But no record exist for that of the PHC. It is needful therefore to extend the use of this toolkit to assess users’ satisfaction of PHC buildings. The results from this study shall serve as a baseline study on the therapeutic performance of PHC that will greatly benefit stakeholders, government authorities and designers responsible for its building in Nigeria. In addition, it shall provide a basis for improving PHC design quality and guide the decisions for future healthcare schemes.
1.4 Aim and Objectives
The aim of this study is to evaluate the perception of users on the performance of selected PHC buildings in the FCT with a view to assess how well these healthcare buildings complies with best practices and help in the healing process of patients.
1.4.2 Objectives
The objectives of this study are to:
Identify the standard performance criteria of healthcare buildings that aids healing of patients and positively influence users of PHC buildings.
Evaluate the perception of users on the performance of selected PHC buildings.
Compare the performance of the PHC studied in ii with the standards identified in i above to determine the areas requiring improvements.
Outline specific steps to remedy the gaps in ii above to ensure the effective performance of the PHC buildings in accordance with the global standards.
1.5.1 Scope and Limitations
This research covered physical related assessments of PHC buildings in the Federal Capital Territory (FCT), and not on the services rendered by medical staff. This choice of the FCT is based on convenience and the fact that the design of most PHC buildings are the same throughout the country. In addition, the Comprehensive Health Care was selected as the study sites because it is the reference type in the health system structure where other health facilities (health post and clinics) transfer patients to for admission and comprehensive treatment. The target populations are patients, medical staff and visitors of these PHC buildings and Achieving Excellence Design Evaluation Toolkit (AEDET) is the only evaluation toolkit used in this research.
1.5.2 Limitations
The evaluation of the therapeutic performance of the studied PHCs were limited to the subjective perceptions of the various categories of PHC users in the FCT only. These perceptions could be different from other users in different locations even though the designs of PHCs are the same.