Citizen HKS Partners with Engineers for Overseas Development on Uganda Maternity Ward

December 8, 2014

Uganda has one of the highest infant mortality rates in the world, with 61 in 1,000 children dying before their first birthday. Citizen HKS and Engineers for Overseas Development (EFOD) are working to help decrease that tragic statistic.

Dan Flower, an associate in HKS’ London office, has worked with EFOD, a U.K.-based charity (founded by Dan’s father, Ian, in 2000) that aims to broaden the skills and experience of young design and construction professionals by training them to work on projects in regions of extreme poverty in sub-Saharan Africa.

For the last 12 years, Flower has worked on a number of EFOD projects in Uganda in his spare time. He has written briefs, scoped projects and managed design work for several grain mills, a medical center and a food storage center in Kachumbala, located in the Bukedea District of Uganda. Some 170,000 people live in this eastern part of the country, which is entirely rural and one of Uganda’s most impoverished regions. In addition to Uganda, EFOD has completed projects in the African nations of Ghana and Zambia.

In March, when HKS announced the launch of Citizen HKS, the firm’s public interest design initiative, Flower connected with Citizen HKS practice leader Ellen Mitchell-Kozack about partnering with EFOD on a new maternity ward in Kachumbala. “Our deep experience in healthcare design and delivery is a natural advantage,” said Mitchell Kozack. “Dan’s direct connection to EFOD and his previous work in and knowledge of Kachumbala, its people and culture, make this project a great fit for Citizen HKS. We’re excited to partner with EFOD on our first official Citizen HKS project, and first-ever project in Uganda,” she added.

The district’s current maternity unit, which is housed at the site of the proposed new facility, was originally constructed in the 1950s. It is completely outdated and inadequate to manage the region’s needs, which sees an average of six births daily. The facility has just two rooms – one used for deliveries, and one used for both pre- and postnatal care. Faced with a choice, many women choose not to go to the health center to give birth.

The health center is staffed around the clock, seven days a week, and women are encouraged to travel to the center by motorcycle taxi (piki) as soon as labor pains begin. There is no transportation system or ambulance service available in the district. Following delivery, new mothers remain under observation for 24 hours before returning home; however, if the beds are in use and the floor is also full, mothers are discharged early. While there is an attempt to provide a delivery room for each mother on any given day, it’s rarely possible.

Maternity Ward Vision

The project comprises a new maternity ward at the site, and the existing rooms will be re-purposed for other medical functions. The new building will house delivery suites and pre and postnatal wards to handle a minimum of six births per day, with the flexibility to support future expansion.

Early concept design layouts call for a 200-300-square-meter facility to establish an envelope for initial funding levels. Construction is expected to last eight months and be completed in 2015. A team from EFOD is scheduled to arrive in Kachumbala in January for a site assessment and general planning.

EFOD has secured partial funding for the maternity unit through the Welsh government and is seeking additional funding for the project, estimated at $160,000. They plan to test the design with U.K. health professionals interested in partnering on the project to provide midwife support in the maternity unit.

Key Design Considerations

  • Sustainable design features are critical in locations where the power supply isn’t reliable and natural resources are limited.
  • Natural ventilation is a major driver; design considerations include a pop-up roof for open clerestory space, strategic placement of operable windows, dog run openings and exterior corridors.
  • Preferred building material is interlocking, soil-stabilized bricks (ISSB) which can be made locally, reducing the amount of cement needed for construction.
  • Keep it simple – maximize repetitive forms and standardized modules.
  • No power tools – if it requires a bolted connection, it will have to be pre-fabricated.
  • Consider a solar-powered rainwater catchment and filtration system to collect runoff during the rainy season.

About Engineers for Overseas Development

Founded in 2000, EFOD is a U.K.-based charity that delivers projects which improve the health, hygiene, education and self-sufficiency of poverty-afflicted communities in a sustainable manner. EFOD provides training for young architects, engineers, project managers and apprentice craftsmen by linking design and construction teams to projects in in Sub Saharan Africa, broadening the skills and experience of budding industry professionals. Project teams are responsible for project fundraising, commissioning, designing, project delivery and sourcing local labor to assist with construction. For more information, visit

About Citizen HKS

Founded upon the fundamental principle that all people deserve to live in socially, economically and environmentally healthy communities, Citizen HKS is involved in public interest design projects around the world. Since its founding in 1939, HKS has completed construction projects totaling more than $77 billion in more than 1,498 cities located in 84 countries. The firm operates from 27 offices worldwide.

For more information, contact Ellen Mitchell-Kozack at

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