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Market Report: Eastern EuropeIt has been 17 years since the collapse of the Soviet Union, but it is only now that the rebuilding of the healthcare sector in thecountries of the former USSR and Eastern Europe is really beginning to get under way. Years of neglect have left buildings in a poorcondition, impacting on patient care. And as they look for ways to modernise, architects and construction specialists from around theworld are looking at how they can get involved.During the Soviet era, health was not a priority and investment was low. At the same time, there were large numbers of smallhospitals. The primary care sector was relatively undeveloped, hospitals were often disease-focused and there were parallel healthsystems for specifi c sectors, such as the army, the police or transport, each with their own set of hospitals and medical care.In the USSR, funding was focused on bed numbers rather than the care provided. This, says Bernd Rechel from the LondonSchool of Health and Tropical Medicine, led to unnecessary hospitalisation and an ineffi cient use of resources. In its 2004 report onhealthcare in the Ukraine 1 , the EuropeanObservatory on Health Systems andEasternPolicies said: “Despite the limited resourcesavailable for the healthcare system, planningcontinued to be oriented towards the goalof ever-increasing capacity, measured bythe number of hospital beds and of healthpromiseThe modernisation of healthcare facilities and reform ofthe healthcare sector is gaining pace in Russia and EasternEurope. Kathleen Armstrong looks at recent developmentsand the challenges and opportunities they providepersonnel. As a result, Ukraine, as manyother former Soviet republics, had one ofthe world’s highest numbers of hospitalbeds and physicians per capita. Inevitably,increased quantity was at the expenseof quality, and in many cases encouragedharmful practices such as lengthyhospitalisations for minor disorders.”Under-investment in facilities meant thatsome hospitals in rural areas didn’t evenhave basic amenities, such as running wateror sewerage 2 .After the fall of the Soviet Union, mostof the countries in the former USSR andin Eastern Europe fell into a period ofeconomic decline and, as a result, healthcaresuffered further. In Russia, the “worseningeconomic situation in the 1980s and 1990sled to a slow deterioration in services, asequipment became antiquated or needed to be replaced, drug stocksdwindled and the fabric of buildings decayed” 2 .A mixed storyCountries in the region are now stepping up investment in the sector.Funding is most secure in Russia and Kazakhstan who are reaping thebenefi ts of the oil boom and, therefore, have more funding availableMedicover Hospital, WarsawCost: approx £13million (at 2006 prices)Client: MedicoverLead Consultant: ArupArchitect: Nightingale Associates and Atelier 7Health Planners: TribalStructural Engineer: ArupServices and Environmental Engineer: ArupQuantity Surveyor and Planning Supervisor: ArupLandscape Architect: Atelier 728 October 2008 | WORLD HEALTH DESIGN
to invest in new facilities. However, for other countries in the region budgets aremore insecure and progress has been slower.Funding to support infrastructure development has come from a range ofsources, including the European Union, the World Bank, the Islamic DevelopmentBank and the World Health Organization. However there are many other areas ofinfrastructure in each of the countries that desperately need attention and are alsolaying claim to the funds, so resources are limited. So, many countries in EasternEurope and the former Soviet Union are now looking to the private sector as away to fi ll the gap.In Romania, the government announced plans in May 2007 for the constructionof 20 country emergency hospitals and eight regional hospitals 3 . Procurementprocedures for the facilities were originally planned to be fi nished a year ago butSwissmed Hospital, GdanskCost: 70.000.000,00PLNClient: Swissmed Centrum ZdrowiaLead consultant: ARCHstyl Maria PodwojewskaGeneral Contractor: POLNORDArchitect: Watkins Gray International LLPConstruction Management: Jacek SwigostLandscape Architect:ESTA Jolanta Bogucka-Delezuchthey have only recently been completed. Once construction begins, the government says they will be completed in 18 months.In Bulgaria, there were only 18 hospitals in the country in 2000. By 2007, there were 71 new hospitals and another 80 are expected tohave opened by the end of 2008 4 . The government has a policy of public-private partnerships and at the beginning of this year approvedthe full privatisation of hospitals.Georgia has also privatised its healthcare sector and all butfour of the 254 state-owned hospitals have now been taken overmainly by healthcare and real estate companies, on the provisothat they will be refurbished and will not be converted to anyother use for a period of seven years. According to a report inPharma & Healthcare Europe 5 , fewer than 30% of the country’s16,455 hospital beds are currently in use and the governmentis aiming to eventually reduce the number of hospitals in thecountry to 100, restructuring healthcare to a system with lessspecialised and more general hospital care.The WGI-designed Swissmed hospital in Warsaw, currently under constructionPrivate inroads into PolandIn Poland the switch to private healthcare is also well under way.Construction of the fi rst private hospital since EU accessionbegan in June 2007 with €30m investment from medical servicescompany Medicover. Colin Hockley, managing director ofNightingale Associates which designed the facility, said the hospitalWORLD HEALTH DESIGN | October 2008 29
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Page 4 and 5: ContentsEditorial DirectorMarc Sans
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Page 14 and 15: Uniting the disciplines of architec
Page 16 and 17: DialogueCultural challengesPhil Ned
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Page 21 and 22: The debate about single hospital ro
Page 23 and 24: Dongtan City: An eco-exemplarClient
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