doctors without borders (msf), much more than field hospitals · #ifhecongress2018 introduction -...
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#IFHEcongress2018
Elvina Motard, Strategy & Programme Manager, [email protected]
Maria Ten Palomares, Energy Project Developer, [email protected]
Céline Van Lamsweerde, Construction Referent, [email protected]
LOG Department, MSF Brussels Operational Center
Doctors without Borders (MSF),Much more than field hospitals
#IFHEcongress2018
Introduction - Humanitarian Action
Medical Humanitarian action
1970s and 1980sgeneral coverage of
basic lifesaving medical actions
2018Level of considerable
expertise and specialism
Power structures
Socio-political
dynamics
Environmental factors
The impartial life-saving assistance provided to people suffering from severe crisis
Humanitarianaction
#IFHEcongress2018
MSF in Humanitarian Action▪ An international humanitarian medical organization
▪ Medical action & bearing witness around 3 principles
▪ Working in 73 countries and in 460 projects around the world
▪ More than 40.000 staff worldwide; 40% are non medical
▪ Funded by >90% private funds
CONFLICT EXCLUSION FROM HEALTHCAREEPIDEMICS DISASTERS
#IFHEcongress2018
MSF’s volumes of activities (2017 data)
110,000major surgical interventions involving the incision, excision, manipulation or
suturing of tissue, requiring anaesthesia
10,648,300outpatient consultations
749,700patients admitted
288,900births assisted, including
caesarean sections
6,539 surgeries – Haiti, Trauma center (121 beds)
4,100 surgeries – Burundi, Bujumbura, Trauma center (75 beds)
23,000 births – Afghanistan, Khost, Mother & Child care hospital (91 beds)
#IFHEcongress2018
MSF and Health Facilities
▪ Increasing complexity since the mid-2000s
▪ Wide range of infrastructures for health facilities
▪ Self-contained & Running autonomously
#IFHEcongress2018
Phased Approach Example – Philippines 2013
Nov 8th, 2013 – Typhoon Haiyan Mid-Nov 2013 - Emergency tent hospital operational
June 23rd, 2014 – First patient in prefabricated hospital Jan 2014 – Construction starts
Oct 2014 Prefab hospital handover
#IFHEcongress2018
Portfolio sample
▪ OCB (Brussels Operational Center)
• 26% of MSF’s total field operations
▪ 25/113 projects with oversight and management of a health facility
▪ Rapid growth of activities
• 2017: 9 construction projects; 12,900m²
• 2018: 8 ongoing construction projects; 30,000m²
#IFHEcongress2018
Objective: To provide free of charge seconday healthcare to vulnerable populations (Lebanon hosts the biggestrefugee population compared to size and number of inhabitants)
▪ 54-bed general hospital, 5200m²
▪ Full rehabilitation of a 3-floors existing building
▪ Consultancy with a local medical planner
▪ Outsourced construction work
▪ 4,3M€ (725€/m²)
Ongoing construction projects – Bar Elias, Lebanon
#IFHEcongress2018
Mar 2014First Assessment
Begining 2016Medical Strategy ready
April 2016Final layout
start of technical drawingsNov 2017
TenderAugust 2018
End of constructionNov 2018
(Planned) opening
Ongoing construction projects – Bar Elias, Lebanon
#IFHEcongress2018
Ongoing construction projects – Kenema, Sierra LeoneObjective: Reduce mother & child mortality in the Kenema district; provide safe quality health care in Lassa endemicarea / post Ebola 2014-2016
▪ 161-bed Paediatric and obstetric hospital, 12,930m²
▪ New construction: masonry (40%), prefab (60%)
▪ Up to 350 staff on construction site
▪ 16,5 M€ (1,279€/m²)
#IFHEcongress2018
2017Design
Phase 12018-2019
8,430 m² - 47 beds
Phase 22019-2020
+2.900 m² - 87 beds
Phase 32019-2020
+2.300 m² - 117 beds
Phase 42020-2021
+350 m² - 136 beds
Phase 52021-2022
+950 m² - 161 beds
#IFHEcongress2018
Ongoing construction projects – Kunduz, AfghanistanObjective: Trauma patients make use of the free quality trauma services provided by MSF health facilities in Kunduz province
▪ 48-bed, Trauma hospital, 12,743m²
▪ (Re)construction: masonry (20%), prefab mix (80%)
▪ 3 phases, from temporary to permanent structures
▪ 22,5 M€ (1,700€/m²)
#IFHEcongress2018
▪ Within an emergency medical organization
▪ Specialization of medical activities
▪ 60% of projects last for more than 4 years; average lifetime of 8 years
▪ Local constraints
▪ Rapidly evolving needs
Designing, implementing and running health facilities in the humanitarian field: Challenges
Rethink traditional logics of health facilities’ planning & implementation
Definition & implementationof flexible & easily adaptable solutions
#IFHEcongress2018
▪ Modul(h)o, prefabricated buildings▪ Beyond traditional energy setups▪ Running our health facilities: technical management
From challenges to solutions: Examples
#IFHEcongress2018
▪ Modular & flexible solutions with prefabricated infrastructures since mid-2000s
Modul(h)o, prefabricated buildings - History
2005 – Bagh, Pakistan84 containers (1,128m²)
50-bed secondary healthcare facility
2010 – Tabarre, Haiti268 containers (4,000m²)121-bed trauma center
2014 – Guiuan, Philippines18 prefab buildings (2,600m²)
General hospital
#IFHEcongress2018
▪ Goal: design health structures with high quality standards to be deployed in any context withina short timeframe, with a limited need for trained staff, and with a long lifespan
▪ Concept:
Modul(h)o, prefabricated buildings - Concept
#IFHEcongress2018
▪ 23 standard layouts defined for all medical services
▪ Definition of the product with an external partner
▪ Lifespan of 30 years
▪ 1 module = 1 week + 8 people
▪ Low-tech principles to ensure qualitycare and optimum comfort
Modul(h)o, prefabricated buildings - Solution
#IFHEcongress2018
▪ Supply plan: Prepositioning for fast deployment
▪ Since 2016, deployed in 3 countries; ongoing deployments in Kenema & Kunduz
Modul(h)o, prefabricated buildings - Deployments
LocationNumber of
modules
Deployment
timeFacility built
Doro
South Sudan
9
(1,300m²)13 weeks
Obstetric department,
inpatient maternity department,
neonatal intensive care unit,
emergency consultation ward
Bassikounou
Mauritania4 (580m²) 8 weeks Operating department
Tabarre
Haiti8 (1,100m²) 15 weeks Outpatient structure
#IFHEcongress2018
Beyond traditional energy setups - Vision• 350-400 stationary generators currently deployed.
• Fuel consumption: 1400 m3/year.
• Total fuel spending: 4.9 M€/year.
• CO2 emissions: 13,500 tones/year.
Power Sources: Gensets and Renewable Energies
Energy storage
Energy Consumption Energy Supply
Demand side management
EnergyEfficiency
Provide technically, socially, environmentally and economically responsible energy solutions adapted to context and needs, offering the best setup for our operations
#IFHEcongress2018
Kunduz’ Trauma Hospital
• Installed power: 1.583 kW.
• HVAC load: 44% total installed power.
Beyond traditional energy setups – Case studies
• 8* 220kVA synchronized gensets
• Energy efficiency measures: HVAC
Kenema Pediatric’s Hospital
• Installed power: 576 kW.
Centralized Semi- Decentralized
• Phase 1:
• 3*220kVA synchronized gensets
• PV Production: 750 kWp ; 2750 PV panels (270 Wp)
• Battery Storage: 1500 kWh
• Phase 5:
• 4*220kVA synchronized gensets
• Photovoltaic Production: 1.500 kWp
• Battery Storage: 3.000 kWh
Bar Elias General Hospital
• Total installed power: 875 kW.
• Energy monitoring strategy : assess and re-assess the actual service needs
From electricity to energy
#IFHEcongress2018
▪ Longer projects duration = more stakes in the technical management
▪ Changing operational needs
▪ Turnover of team members
▪ No normative aspects; development of our own tools
▪ Toolkit for technical management
▪ Risk identification & mitigation
Running our health facilities: technical management
#IFHEcongress2018
Conclusion
▪ Complexity vs Effectiveness
▪ Specialisation vs jack-of-all trades versatility
▪ Engineering vs tech trends
OPPORTUNITIES OF ENGINEERING
FIND PROFESSIONALS WITH HIGHLY
DIVERSE BACKGROUND
Expertise needed Decision-making
CHANGES IN
MEDICAL
HUMANITARIAN
RESPONSE
INCREASE
COMPLEXITY OF
OPERATIONS
FLEXIBLE
ENGINEERING
SOLUTIONS
#IFHEcongress2018
Elvina Motard, Strategy & Programme Manager, [email protected]
Maria Ten Palomares, Energy Project Developer, [email protected]
Céline Van Lamsweerde, Construction Referent, [email protected]
LOG Department, MSF Brussels Operational Center
Doctors without Borders (MSF),Much more than field hospitals