Research Publications/Outputs

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Building condition assessment: a performance evaluation tool towards sustainable asset management
(2007-05) Abbott, GR; McDuling, JJ; Parsons, SA; Schoeman, JC
This paper proposes a condition assessment system and process with examples of value addition towards sustainable construction. Most condition assessments are mere snapshots in time that end up gathering dust on a shelf because the value of consistent condition assessments is generally underrated and seldom fully utilised. Condition assessments should be the basis for management and maintenance decisions in the built environment towards sustainable construction. Subsequent to the 1995 National Health Facilities Audit of hospitals in South Africa, condition assessments have evolved into a technology that adds a new dimension to strategic management and maintenance of buildings and related infrastructure. A five-point colour-coded rating system has been developed and refined through experience gained during the initial and follow-up assessments and sustained research and development. Value addition include converting condition assessments into condition-based maintenance budgets, eradication of backlog maintenance, performance assessment of effectiveness of maintenance / preservation interventions, and service life prediction
Health: looking after the Nation's health
(Development Bank South Africa (DBSA), 2008-11) Abbott, GR; De Jager, Peta; Gasa, N
Health infrastructure is essential to the successful delivery of health services. With a normal planned lifespan of over 50 years, such capital investment endures for extended periods and major changes in the estate take a long time to achieve. The existing health estate in South Africa - made up of over 4000 facilities with a current replacement value of over R180 billion - is a complex mixture of facilities and is challenged, in many cases, by a combination of inherited imbalanced from the apartheid era and new investments made since the transition in 1994. A range of initiatives has been introduced to address the backlogs initially identified by the 1995 - 1996 National health Facilities Audit. These include the strengthening of strategic and project planning to ensure that the estate meets current and changing health service needs; a drive towards an equitable and inclusive health service; strategies to address affordability concerns, and initiatives to strengthen capital procurement processes. Capital investment levels have increased significantly and are projected to increase further over the current Medium Term Expenditure Framework (MTEF). However, investment levels - for new capital and especially for the operation and maintenance of the estate - remain suboptimal; that is, below the levels required to address the required changes and maintain the estate at an acceptable level. Progress has been further constrained by the erosion of staff over time and by challenges in attracting and retaining professional and key functional staff in both the health and public works departments. These features make it difficult to deliver quality health care that meets community needs. More broadly, if the potential for improved health outcomes is not realised, the Accelerated and Shared Growth Initiative (AsgiSA) objectives of systematically reducing poverty and unemployment may not be met. Since infrastructure is essential to healthcare delivery good public health, strengthened capacity to plan for infrastructure delivery and maintenance, accelerated investment and coordination are imperative
Hospital design to accommodate multi- and extensively drug-resistant TB patients
(International Federation of Hospital Engineering, 2008-10) Parsons, SA; Hussey, R; Abbott, GR; De Jager, Peta
This paper provides an overview of hospital design solutions to accommodate M(X)DR-TB patients and methodologies adopted to fast track the provision of much needed beds in the various high burden provinces in South Africa
Integration of IAM and GIS technologies to support decision making in the planning and procurement of physical infrastructure for the treatment of drug-resistant tuberculosis in South Africa
(International Federation of Hospital Engineering, 2008-10) Abbott, GR; Parsons, SA; Maritz, Johan; Badenhorst, W; De Jager, Peta
While positive progress was being made in the latter half of last century in the treatment of the Mycobacterium tuberculosis (TB) epidemic across the world, the emergence of new drug resistant forms – multi drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) threatens gains made and has raised the spectre of a resurgent and more virulent TB epidemic. Co-infection with HIV/Aids, a common phenomenon in South Africa, adds substantially to the risk of infection and numbers of patients, making control more complex and demanding. With both a high TB burden and incidence, South Africa is one of the most negatively impacted countries in the world. The real additional burden of hospitalising M(X)DR-TB patients, the urgency of the need for such accommodation, disease specific requirements for long-term acute and post-acute M(X)DR-TB care, the need to plan within an existing service strategy and limitations on available resources (budget, staff and infrastructure), requires that a new, more integrated approach to strategic planning and the provision of accommodation be developed. This paper provides an overview of new processes and a toolkit being developed in South Africa to support decision making in the planning, procurement, management and operation of physical infrastructure for the treatment of patients with M(X)DR-TB. Use is made of a new Immovable Asset Management (IAM) framework and tools being developed as well as of GIS technologies. Links are also made to facility and risk assessment tools developed for facilities benchmarking and post-occupancy evaluation. While the toolkit is being specifically developed to address the M(X)DR-TB epidemic in South Africa it is envisaged that it will have a wider application in health infrastructure planning and management. Where this paper focuses on integrated service and facility planning for M(X)DR-TB patients, the Congress paper “Hospital design to accommodate Multi- and Extensively Drug-Resistant TB patients” will focus on the design of such facilities
MDR and XDR-TB: Revolutionising our approach to facility design for long-term care facilities improved infrastructure and services for South Africa
(2008-11) Parsons, SA; Abbott, GR; De Jager, Peta
South Africa has a high and increasing burden of tuberculosis, both drug-susceptible and drug resistant strains. In 2005 at the WHO-AFRO Regional Committee meeting held in Maputo, 46 Ministers of Health unanimously declared TB an emergency in Africa. A resolution at this meeting declared that unless “urgent extraordinary actions” are in place, the situation will worsen and the 2015 Millennium Development Goals will not be met. South Africa has committed itself to addressing this national crisis. The emergence of drug resistant strains of the disease has exacerbated the situation through posing a serious risk to public health. Drug resistant strains, multi drug resistant (MDR) and extensively drug resistant (XDR) TB strains can be acquired directly: MDR and XDR-TB are not necessarily acquired through defaulting on medication prescribed for drugs-susceptible strains of the disease. Experience has shown that drug resistant strains remain infectious for longer, are more time-consuming and costly to diagnose and result in significantly higher death rates. Some drugs can have severe side effects, increasing risk of defaulting and making it less feasible to treat in community settings. In addition, drug resistant strains of TB are far more expensive to treat than drug-susceptible strains. To effectively address this public health crisis, the National Department of Health has determined that all confirmed XDR and MDR-TB patients are to be hospitalised at specialised MDR-TB units for a period of some months. However, existing longterm care facilities for the treatment of TB patients are frequently poorly designed to address needs of MDR and XDR-TB sufferers and the healthcare workers who take care of them. The aim of this paper is to outline research aimed at determination of best-practice guidance for provision of appropriate building infrastructure for MDR and XDR-TB sufferers
A new generation of healthcare buildings in South Africa: complexities and opportunities for greening
(2012-07) De Jager, Peta; Abbott, GR
The hospital building type is widely recognised to have complex design and engineering requirements. It might be argued that the unique functional constraints and operational demands placed upon the hospital building may trump greening imperatives. Yet it stands to reason that, even with this complex building type, there must be some opportunity to reduce embodied and operational energy consumption, manage water and waste, promote social cohesion, etc without compromising the safe, effective, efficient, healing environment desirable for healthcare delivery. In South Africa there has been a commitment to transform the healthcare sector through the introduction of the national health insurance system which is to be unfolded over a 14 year period commencing in 2011. Whilst ostensibly and primarily conceived as a funding mechanism, it seems (to these authors) likely that over time the principles of universal coverage, eradication of inequity, and accessibility will be reflected in the architecture provided to support service delivery. In preparation for the national health insurance system the South African government has ramped up spending on healthcare infrastructure and the National Department of Health has initiated several support projects to strengthen quality and accelerate delivery of capital projects. This includes the development of a comprehensive set of new national norms, standards and benchmarks for healthcare building. The probable emergence of a new generation of healthcare buildings in South Africa seems an opportune moment to embed forward-thinking principles of environmental consciousness and sustainability into the policies and practices of built environment professionals in the healthcare sector.
Service life and sustainable design methods: a case study
(2008-05) Mc Duling, J; Abbott, GR
The design life of hospitals normally varies between 50 to 60 years. This paper presents a case study of a major academic hospital that reached the end of its service life only 30 years after commissioning due to a combination of unsustainable design methods and inappropriate maintenance levels. Unsustainable design methods, such as long narrow multi-floor structures resulting in excessive walking distances and ineffective flow of patients and visitors, and insufficient structural depth and height, impaired the ability of the existing structure to accommodate changing demands of a modern health care environment, and the maintainability of services, such as sanitation, steam, ventilation and air-conditioning
Towards appropriate design solutions for drug-resistant TB facilities in SA
(CSIR, 2010-07) Parsons, SA; Abbott, GR; Conradie, Dirk CU; De Jager, Peta; Bole, Sheldon; Motsatsi, L
South Africa has a high and increasing burden of both drugs-susceptible and drug-resistant tuberculosis. This disease has been declared an emergency in Africa. South Africa has committed itself to addressing this national crises by designing appropriate drug-resistant TB facilities.

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