Sophie Crocker, Sheba Ross, Jane Ho and Ben Gonzalez of HKS explain how they provided a health design strategy for a nation.
Qatar has experienced significant change since the beginning of the 21st century. It had the highest rate of population growth in the world between 2003-2018, and made corresponding strides expanding healthcare provisions through its
first National Health Strategy launched in 2011. But like any national plan, guidelines are living documents and must respond to change.
Project How do you define guidelines and standards for a nation?
To ensure health infrastructure development continues to achieve national health targets, an analysis is conducted every five years to identify gaps in facilities, accommodation and equipment. In response to this analysis, an interdisciplinary international team crafted an action plan to inform the distribution of facility classifications across Qatar.
In 2019, HKS had the privilege of being a member of this team and contributing to the health facilities planning components of the action plan. This rare opportunity to facilitate the planning of a nation’s health system was an extraordinary experience. The team examined the cultural, geographic and demographic factors impacting the provision of Qatar’s healthcare.
The new Qatar Health Facilities Action Plan (QHFAP) illustrates the vital intersection of urban planning and healthcare with a masterplan incorporating a simple decision-making toolkit for a complex context.
People How can multiple stakeholders be engaged to formulate a common strategy?
HKS was contracted by PwC to provide healthcare facilities planning expertise for the updated QHFAP. The action plan was created for Qatar’s Ministry of Public Health (MoPH) which oversees the quality and effectiveness of services delivered by public and private healthcare providers, develops Qatar’s national and public health strategies, and monitors their progress.
The three parties: MoPH Health Planning and Assessment Department, PwC and HKS, worked closely to produce a series of reports supporting Qatar’s health facility planning, responding to its specific needs and projected development.
The action plan needed to address the macro – a country’s health facility distribution – while also considering the micro – a consultation room’s modularisation. It was crucial, therefore, that those influencing decisions not only represented the licensing department as well as public and private health providers, but also governing bodies responsible for planning, urban zoning and transportation as well as megacity development representatives from Lusail and the Pearl.
A project of this scale necessarily involves a more complex web of stakeholders and entails a wider accountability than that for a singular health facility or even for a regional health system. The reports: health facilities classifications and guidelines, urban planning guidelines and distribution toolkit, needed to consider existing urban and rural settlements, new districts planned and under development, as well as private and public sector modes of operation.
Process How can a multi-dimensional approach be crafted in a cohesive manner?
The action plan needed to address two things: healthcare planning and urban planning. For this reason, two specific approaches were developed:
Health facility classifications and guidelines approach
Existing facility guidelines were reviewed and key stakeholders from the health sector were interviewed to understand existing limitations and areas for improvement. We learned the guidelines made no allowances for several increasingly common building scenarios for health facilities in Qatar. These included refurbished buildings with change of use and different scales of mixed-use developments. Due to this scope gap in the guidelines, MoPH could not determine whether healthcare providers were proposing appropriate facilities for the buildings or context.
So, we developed four building scenarios: Stand-alone purpose-built and refurbishment, and mixed-use purpose-built and refurbishment. These categories enable authorities to identify key factors to consider when assessing whether a facility type is appropriate for a building scenario. Levels of complexity of healthcare facilities were developed to support analysis. For example, the more imaging or interventional services a facility provides, the more carefully a refurbishment proposal must be considered.
The nine classifications established in the previous action plan were kept to maintain continuity. They were, however, subdivided into inpatient and outpatient categories with indicative lists of services provided by each classification on a scale of complexity and mechanical, electrical and plumbing requirements.
Finally, existing guidelines were compared to the latest international guidelines from the US, the UK and Australia, identifying any international changes or updates since 2013. While international guidelines were valuable for understanding developments in facility operation standards, medical equipment needs and infection control protocols, it was important that they be analysed against the Qatari healthcare and cultural context.
For example, it is common for extended family to visit patients in hospital and accompany them to the emergency department, the increase in visitors impacts areas required to accommodate the number of family members. Cultural norms such as gender-segregated waiting spaces and requirements for prayer rooms also needed consideration.
Urban planning guidelines approach
The urban planning guidelines establish location scenarios that best enable healthcare facilities to promote the well-being of the population. Existing urban planning standards were assessed and the correlation between facility classifications, population catchment areas and facility capacity was studied.
The gaps in this correlation were identified. Attention was directed to concepts that speak to air and water quality, access to nourishing and affordable food, reduction of nuisance light and noise, mitigation of extreme temperatures, reduction of exposure to hazardous substances as well as access to mental healthcare and green spaces.
A location criteria tool evolved indicating key factors that influence facility locations along with their parameters and considerations. These were access, mobility, size, adjacency, adaptability, environmental features and identity as organised on a scale from high to low priority. This organisation creates a checklist that facilitates decision making, affording a holistic approach to distributing facilities while also indicating how to respond to changing conditions.
Qatar’s GeoMed system, a geographic information system (GIS) tool, provided information about each healthcare facility and was crucial for supporting planning. Other vital functions such as radius analysis and distance between facilities etc., enabled planners to make informed, strategic decisions about optimal healthcare facility locations.
Qatar is characterised by the dichotomies of urban and rural areas, vernacular and modern architectural developments, and high density versus sprawling suburbs. Hence, locations in Qatar for standalone and mixed-use facility developments were characterised as scenarios; high and medium density mixed-use; commercial street; landbank near high density residential; infill mixed-use; residential neighbourhoods; villas and residential neighbourhoods.
Each scenario was assigned location features including population density, proximity to transit links and suggested optimal programme ratios in the case of mixed-use. Health facility classifications were then assigned to their ideal location scenario to assist decision-making.
Product What is needed to inform a nation’s health facility planning?
We quickly determined that the updated Action Plan should be a dynamic tool for Qatari officials. So we created a toolkit to use in a variety of ways to help determine where to locate a facility classification, what to consider about that location, whether an existing building is suitable for a facility classification or whether a development would support or be supported by the addition of a health facility in a mixed-use setting.
We will highlight just one key topic for each of the facilities guidelines and the urban planning guidelines.
1 Urban planning: mixed-use
Mixed-use developments were not addressed in the previous action plan, resulting in a lack of clarity regarding how to effectively integrate healthcare into a commercial or residential development, for example. The urban planning guidelines were therefore crafted to align sites and existing buildings with ideal healthcare facility types according to the characteristics of those locations. For example, community spaces already identified in high and medium density mixed-use developments were recommended to host outpatient facilities because of their walkability traits and proximity to parks. Commercial streets, which offer a range of retail experiences, were determined to be fitting for standalone and mixed-use refurbishment scenarios that suited clinics and pharmacies.
2 Facilities Guidelines: Mobile and flexible
It became clear that the facilities guidelines needed to provide for both flexibility (where facilities can expand or contract in response to demand) and mobility (relatively isolated, rural populations desire local health facilities but do not always have the demand to support a permanent facility). These requirements were addressed through two measures: modular diagrams were developed for outpatient facility classifications indicating size while aligning the classifications to modules of six consult/exam rooms and a new classification was added to the original nine: mobile medical unit (MMU). The previous action plan only indicated overall facility areas for permanent, standalone facilities. We wanted to provide a modular spatial diagram that could be considered in multiple building settings including mixed-use and refurbishment, and classes of MMUs that could serve a range of temporary and semi-permanent conditions. Both steps increase the tools the Ministry of Public Health has to ensure every Qatari has access to convenient, appropriate and high-quality healthcare.
The Qatar Health Facilities Action Plan is an exciting and pivotal piece of strategic health planning which, if implemented as intended, will continue Qatar’s upward trajectory towards excellent healthcare provision for all its citizens.