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Europe: Appitite for reconstruction
In a structural sense, the more advanced European healthcare economies are being pulled in opposing directions, but with flexibility key to progress, and even survival, the manifestation of architecture as the art of middle-ground compromise is as strong as ever, says Andrew Sansom...

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South America: The promise of parity
While the shadow of political corruption still exerts an inimical influence over many parts of South America, the region’s economic growth and long-standing promise of social fairness are key to the development of new healthcare infrastructure. Andrew Sansom reports...

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Africa: Age of Engagement
Partnerships – from governments pairing up with private investors, to a more participatory approach to healthcare design – are emerging as a key theme in African healthcare. Emily Brooks explores what this new sense of shared responsibility might bring.

Rapid economic growth – real and predicted – means more investment than ever before in Africa’s people, resources and infrastructure; and yet its health issues could threaten to derail the optimism and entrepreneurial spirit that defines the continent and are such a critical resource to the region.
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Africa: Supporting role
Despite its devastating health problems, Africa is making vital inroads towards self-sufficiency, with the private sector playing a key role, writes Emily Brooks.

In June 2009, the International Finance Corporation (IFC) launched a major new private equity fund specifically for African healthcare projects. Over the next 12 years, the Heath in Africa Fund will invest between US$100m and $120m in private-sector health services, from hospitals and clinics to insurance companies and medical manufacturing companies.
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Australasia: Amongst the banksia
The design of Western Australia’s Fiona Stanley Hospital reflects not only the needs of the indigenous and migrant populations of the state but also the unique natural environment in which it is set, as Morag Lee explains.

There is still a preconception of the specialist healthcare architect as a planning guru, carefully piecing together a jigsaw of rooms to achieve functionality, efficiency and perhaps very little else – a plodding, logical thinker, deprived by strict clinical requirements and restricted budgets of an environment which will allow them to express true architectural vision.

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Australasia: Southern stars

Efficiency and service delivery are under the spotlight in Australia and New Zealand as Kathleen Armstrong reports.

Australia seems to have sailed through the global recession with hardly a bump. But pressure on the health system is growing in response to the needs of a diverse, growing urban population and a disparate, ageing rural population, requiring improvements to how healthcare is delivered in the most efficient way possible.
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Australasia: Space to expand

Exciting new hospitals are being designed to meet Australia’s growing urban population, mirrored by the redesign of services and facilities in remote, rural areas, while in New Zealand the expansion of healthcare facilities continues. Kathleen Armstrong reports.

Australia’s healthcare system has many layers. A federation of six states and two mainland territories, the Northern Territory and the Australian Capital Territory, decisions about healthcare delivery are in the hands of both state and federal governments. This can lead to some disparity from state to state between healthcare services and the facilities in which they are provided.
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South America: Southern symmetry

Keen to tap into the latest research and innovation, Latin America looks north for new partnerships while retaining a distinct regional flavour, writes Emily Brooks.

Two prestigious gatherings in South America in November 2009 promoted the region’s healthcare to a world audience. But what’s the overall picture for a continent that straddles the developed and the still-developing, and experiences high levels of inequality, despite the promise of swift economic growth?
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Middle East: Culture and care

Following the economic dramas of the last year, the Middle East healthcare market is showing encouraging regional signs of maturity and vision for the future. Veronica Simpson looks at what might lie ahead.


The global economic meltdown has claimed many casualties, and few as spectacular as Dubai, a city bristling with grandiose commercial (and architectural) schemes, many of whose financial foundations have recently turned out to be, literally, built on sand.
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Australasia: Grand designs

There is energy in the air Down Under with the focus on the long-needed modernisation of healthcare facilities – and at the forefront is good design. Kathleen Armstrong reports


There is a boom in Australia – and it is not just in the export of natural resources which have enriched the island continent. Over the last few years, and especially since the election of the Labor Government in 2007, money has been flowing into the regeneration of healthcare facilities throughout the country, bringing old stock into the 21st century.
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Asia: Contrast and change

Clinical excellence for moderate cost? Or poverty and low health outcomes? Southeast Asia’s healthcare may be sharply divided, but Emily Brooks finds much to celebrate.


Southeast Asia is not easily pigeonholed when it comes to its healthcare. A proportion of its 570 million inhabitants enjoy gold-standard facilities and some of the best health outcomes to be found anywhere; on the flip side of the coin, poverty and its associated disease burden present serious challenges to development in many other areas. In between these extremes sit a number of countries with some of the fastest-growing economies in the world, their governments seeking to deliver quality healthcare for all and improve infrastructure to do so.
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Singapore: Clean sweep

Fatimah Lateef describes the changes Singapore General Hospital has made to its infrastructure to reduce infection risk following the 2003 SARS outbreak.


During the severe acute respiratory syndrome (SARS) outbreak a few years ago, it became clear that, because of their many public entrances, it can be difficult and often costly for hospitals to control the entry, and thus the infiltration, of infectious diseases.
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USA: Survival of the fittest

Good design is not a luxury. But as North America faces up to its toughest prospects for years, many healthcare infrastructure projects are either being shelved or cut back. Veronica Simpson reports on how a strong design ethos can make the difference when times get tough.


The North American healthcare sector is reeling from the current financial meltdown – hit harder than most, given the exposure of its massive private healthcare system to stock market crashes. Modern Healthcare magazine recently ran a front cover story detailing the scale of US healthcare projects that have been cancelled or put on hold with the headline: “It’s green. It’s digital. It’s patient-centered. It’s not going to open. Not for a while, anyway.”
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Africa: A sense of belonging
A World Architecture Festival award winner, the CBF Women’s Health Centre in Burkina Faso combines social and environmental responsibility with design innovation in harsh conditions to meet a local need, reports Erika Trabucco.

Created by AIDOS, an Italian NGO fighting for women’s rights in developing countries, the CBF [Centre pour le Bien-e^tre des Femmes] project, financed by the Democratici di Sinistra Political Party and with a contribution from the European Commission, is a health centre and training and counsellling facility with a particular focus on addressing the widespread health issue of Female Genital Mutilation [FGM].
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Africa: Pride of Ghana
Peta de Jager visits Sunyani Hospital in rural Ghana, which, despite struggling with overcapacity, is still impeccably run and maintained six years after its completion.

Surrounded by the forests of the Southern Ashanti Uplands of Ghana, Sunyani Hospital is grandly laid out in a beautifully manicured landscape garden, in a neatly walled precinct separating it from the surrounding city. Some 400km north-west of Accra, Sunyani is both a district and regional capital: originally founded in the 19th century as an outpost camp for elephant hunters (it takes its name from the Asante word for elephant), it was declared a district headquarters for the British Colonial Government in 1924.
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Africa: Beautiful Africa
Mike Nightingale calls for the effective use of international expertise in developing local solutions to address Africa’s health issues.

In many ways, 2009 is set to present a frightening and extremely challenging time for the world. Comfortable economic assumptions in the developed world have been turned on their head, making vital investment in the emerging economies even more challenging than before the current economic crisis.
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Africa: Time to heal
An injection of design could be the stimulus Africa needs to improve its health condition, reports Emily Brooks.

Statistics concerning Africa’s healthcare problems are breathtaking: eight million lives are lost a year through preventable disease; 18.8% of South Africans are HIV-positive; in order to beat TB, the funding gap is some $11bn. In 2001, African heads of state pledged to spend 15% of their national budget on healthcare, as a prerequisite to meeting the United Nations’ Millennium Development Goals by 2015. At this halfway point, just three countries out of 53 (Botswana, The Gambia and Seychelles) are at or near this figure.
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Eastern Europe: Eastern Promise
The modernisation of healthcare facilities and reform of the healthcare sector is gaining pace in Russia and Eastern Europe. Kathleen Armstrong looks at recent developments and the challenges and opportunities they provide.

It has been 17 years since the collapse of the Soviet Union, but it is only now that the rebuilding of the healthcare sector in the countries of the former USSR and Eastern Europe is really beginning to get under way. Years of neglect have left buildings in a poor condition, impacting on patient care. And as they look for ways to modernise, architects and construction specialists from around the world are looking at how they can get involved.
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China: China rising
There are more than 320,000 hospitals and clinics in China, most of them either undergoing – or needing – refurbishment. What opportunities are being created for enlightened and progressive new healthcare buildings? Veronica Simpson reports.

It would be impossible to calculate the billions that have been spent transforming China’s cities in the last five years, as that great, once communist nation embraces consumerism, capitalism and modernity. But while western eyes widen in amazement as shiny steel and glass skyscrapers and 12-lane highways are constructed in a matter of months by the vast Chinese workforce, there has been growing concern that, in the rush to dazzle the world’s TV cameras assembled for this year’s Olympics, little or no attention has been paid to infrastructure.
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Middle East: Gaining ground

The Middle East continues to be a hotbed of construction activity – with medical facilities high up the list of priorities. Veronica Simpson reports on the potential risks and rewards for Western architectural firms involved in the building boom.

As Western economies topple towards recession, the Middle East shows no sign of a slowdown. The building boom that has come to typify this region continues unabated, and state-of-the-art medical facilities for both the growing ex-patriot populations and the wealthy residents of the United Arab Emirates are top of the wish-list.
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Ireland: A tale of two countries

Kathleen Armstrong explains how Northern Ireland and the Republic of Ireland – both surfing a wave of new economic opportunity – are approaching their ambitious healthcare building programmes.

He is a man with a vision. As head of Northern Ireland’s Health Estates Agency, John Cole is in charge of developing a healthcare estate that radiates design quality and provides healing spaces for a population of more than 1,700,000 people. His strategy is ambitious and challenging, but for those who want to be part of the creation of innovative health facilities, it is an exciting place to be.
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Singapore: A class apart

Singapore’s healthcare facilities are world-class, reflecting its reputation for clinical excellence, reports Ruby Lai-Chuah.

Singapore is ranked by the World Health Organization as having the best healthcare system in Asia, with a multitude of specialised, expert treatments in oncology, gynaecology, cardiology, ophthalmology and many other specialities. In fact, according to consultants, Watson Wyatt Worldwide, Singapore is acknowledged as having one of the most successful systems in the world both in respect of financial efficiency and community health outcomes. Evidence of this achievement are the nation's 11 Joint Commission International (JCI) accredited hospitals and treatment centres, which is one-third of all the JCI-accredited facilities in Asia.
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Canada: Making places, healing spaces

Sean Stanwick describes how Canada’s regional responses to healthcare design are rooted in the life-affirming connection between humanity and nature.

The Canadian healthcare system has enjoyed a longstanding reputation for being one of the best in the world. Part of this recognition is based on the fact that pre-eminent Canadian hospitals intentionally draw on regional or natural themes to create meaningful and relevant designs. As a result, several examples have risen to international attention by addressing both the innate human desire to connect with natural surroundings and the necessity to deliver technologically advanced medical infrastructure.
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