Challenges of designing healthcare facilities in rural areas

The urban-rural divide in India’s healthcare ecosystem

India’s rural communities face a significant shortage of healthcare facilities. Less than 25 per cent of the country’s healthcare facilities are concentrated in rural areas where 64 per cent of the population resides. This gap has led to significant disparities in important health indicators in rural vs urban areas. For instance, on average, people living in India’s rural regions can die up to 5 years earlier than urbanites.

Despite the rise of urbanisation, more than half of India’s population is projected to be rural by 2050. The rural economy constitutes 46 per cent of national income, a huge contributor to India’s economy. It is of utmost importance to bridge the healthcare gap through sensitive design that respects the climate and culture of the region; allows qualitative, affordable and inclusive access for the most vulnerable and impoverished populations; encourages sustenance through equitable development and human resource augmentation; and allows scalability of holistically comprehensive and compassionate Community Healthcare Centres (CHCs). 

The rural-urban divide is considerable when it comes to healthcare access. Attempts to correct these systemic deficiencies through the National Rural Health Mission and the National Health Policy have largely resulted in improving overall mortality rates over the past few years, especially with the maternal mortality rates reduced by 77 per cent as compared to the global 44 per cent ensuring target goals of the United Nations’ 2030 SDG 3: Good Health & Well Being for All. According to Rural Health Statistics (2020), there is an average shortfall of 38 per cent in CHCs. This number highlights the opportunity and need to create a healthcare blueprint that is an antithesis to the typical fear-inducing, white, sterile spaces that hospitals are infamous for.

Responding to systemic building challenges in rural areas through an architecture that can heal 

Hospitals are complex, multifaceted entities where various stakeholders closely work together to create an integrated, service-infused facility. The availability of human resources, infrastructure, water, and power in the region, accessibility of the location, and timely allocation of funds are some of the major factors that impact the development of hospitals in rural areas. The planning model should be committed to dignifying design that creates a transformative impact and inculcates a sense of compassion, empathy, inclusion, and acceptance for all users. Additionally, in rural areas, hospitals should also facilitate the region’s economic and infrastructural growth. Prioritising local capacity building and sustainable practices in healthcare infrastructure can help us achieve this goal, shaping elegant, innovative, and cost-effective solutions. 

The design must focus on creating a calm healing environment that enables easy recuperation and nurtures the holistic well-being of all users, both physical and emotional. Enhancing the connection with nature, integrating art into the premises, and creating spaces that support healthy social interactions are some ways of doing this. Efficient planning that ensures ease of external and internal navigation at various levels, supporting the streamlined movement of varied user groups, is also critical.

Spatial programming to ensure local needs

Demographics can often define regional healthcare’s functional and programmatic needs. The clubbing of maternal and child care schemes in the National Health Policy is aimed at creating better resource synergies and hopefully better outcomes. Mother and Child Care departments with labour and waiting rooms, delivery rooms, and neonatal intensive care units fulfil a critical demand pertinent to rural healthcare. Designing the Mother and Child Care unit prototype sensitively in harmony with nature can transform the experience of “waiting” for childbirth into an empowering act.

One of the most successful model case studies is the 150- bed Butaro District Hospital in Rwanda, Africa. It is developed to provide both in- and outpatient services, with a particular emphasis on maternal health. Creating a model of high-quality infrastructure that can be easily adapted to the context and needs of the individual project can have a transformative effect on the way health infrastructure is developed globally. 

Zoning to ensure efficient circulation 

Efficient planning is important for ensuring that patients and visitors feel non-intimidated and can easily navigate through critical clinical and non-clinical spaces. In healthcare facility design, ‘Liminal Gaps,’ referring to transitional spaces like waiting areas, corridors, entryways, staircases, and balconies, play a crucial role in shaping the overall experience, influencing movement and interaction within the immediate environment. Thoughtful design of these transitional spaces enhances the sense of arrival, provides opportunities for rest and reflection, and facilitates wayfinding for patients and visitors. One way to ease wayfinding is to implement a consistent colour scheme in the flooring throughout all nonclinical circulation corridors. This can provide a clearly perceivable pathway to guide user movement across the building’s various zones.

Fostering belonging and facilitating connection for emotional well-being through climate resiliency and cultural sensitivity 

Climate and culture can be strong collaborators in defining the design ethos for a rural healthcare facility and ensuring it meets the needs of the community it serves. One can strive to design environments that harness sunlight and channel wind not only for thermal comfort but also to reduce the rate of spread of infections and nurture people’s relationship with nature for comfort and well-being. Building orientation is key to indoor comfort. Building alignment should enable maximum north-facing critical and non-critical patient areas with ample glare-free natural light. Through thoughtful design, such as planning for non-clinical and non-critical clinical spaces to be naturally ventilated, air conditioning can be limited to critical clinical spaces only—ensuring physical well-being through passive design while also saving on energy bills.

Additionally, embracing cultural influences such as verandas, balconies with deep overhangs, or stepped-back terraces can foster a healthy environment for healing and recovery by furthering the penetration of light and wind. Balconies along patient rooms and wards can also promote the smooth and calm recuperation of patients, enabling their path to recovery through safe engagements, including movements like walking and sitting. 

Integrating art and landscape for safe and inclusive healing processes 

Incorporating local art into the healthcare facility can alleviate anger, fear, and stress, while enhancing feelings of pleasantness. Similarly, integrating indigenous vegetation that attracts birds and butterflies fosters a biodiverse microclimate, contributing to natural healing and patient recovery. The challenges outlined above underscore the urgent need for significant improvements in rural healthcare infrastructure. Many healthcare experts are advocating for the sector to be granted infrastructure status, along with a substantial boost in funding in the upcoming July budget. This investment is crucial to address the infrastructure deficit currently observed in rural healthcare. By prioritising sensitive design that respects the climate, culture, and local needs, while also integrating efficient spatial programming and zoning, and fostering physical and emotional well-being, rural healthcare facilities can be transformed into inclusive, accessible, and healing spaces for all.