PERFORMANCE EVALUATION OF PRIMARY HEALTH CARE BUILDINGS IN THE FEDERAL CAPITAL TERRITORY (FCT)

ABSTRACT

Existing studies have established that the physical characteristics of buildings have significant influence on occupants’ satisfaction. However, studies has shown that the conventional ways that public hospital buildings in Nigeria are designed have contributed to stress, depression and anxieties because of loss of privacy, control over eating and sleeping times, and noise. And in addition contributed to dangers, allergies and other acquired infections called Hospital Acquired Infections (HAI) to patients and staff. This study assessed the performance of Primary Healthcare Centre (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. The objectives of this study were to; identify those 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 PHC buildings and outline appropriate steps to remedy the identified gaps to match up with the global standards. This was a descriptive cross-sectional study conducted in six PHC buildings across the six area councils of the Federal Capital Territory (FCT), Nigeria. A purposive sampling technique was used to select a total of 334 samples (patients, medical staff and visitors’) from the target population. Data were collected with the aid of an adapted version of - Achieving Excellence Design Evaluation Toolkit (AEDET) questionnaires. Both descriptive and inferential statistics were used to present simple mean, standard deviation and test for statistical significance of the results. Ten criterion, categorized into three criteria namely; functionality, build quality and impact were identified as the required standards for healthcare building performance. They aid in the healing of patients, improve the productivity of medical staff and attract patronage from visitors. The results show that users’ perception
on the functionality and build quality of the PHC buildings which concerns the extent to which it facilitates or inhibits the activities of the medical staff who carry out the functions inside and around the building was poor. Also, the staff and patient environment which was addressed by impact was assessed to be poor. In view of these, patients in PHC buildings do not have privacy during their stay for treatment and cannot be alone with others to have private discussions because of the multiple bed system that is currently run. The toilets, bathrooms and other facilities for the use of staff, patients and visitor are not befitting and dignified enough to attract patronage. The study recommends that the National Primary Healthcare Development Agency’s (NPHCDA) Minimum Standards for Primary Healthcare and the Ward Minimum Healthcare Package upon which the design of PHC buildings in Nigeria is based should be updated and reviewed to reflect modern trends in healthcare architecture.

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).

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.

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.

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.

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:

1. Identify the standard performance criteria of healthcare buildings that aids healing of patients and positively influence users of PHC buildings.

2. Evaluate the perception of users on the performance of selected PHC buildings.

3. Compare the performance of the PHC studied in ii with the standards identified in i above to determine the areas requiring improvements.