Architecture is at its best when it reflects community needs and nourishes cultural values. For the diverse, collaborative and multidisciplinary team now transforming a healthcare facility in the Tanzanian village of Nkweshoo, these values are the genesis of an ongoing design process. In October 2023, a co-design workshop brought together architecture students, community members, and multiple stakeholders to map out the expansion of Nkweshoo’s dispensary and maternity clinic.

The workshop marked a milestone for the Clinic of Care Tanzania initiative, a building project funded by the Holcim Foundation which responds to a longstanding local need for an improved healthcare clinic and a dedicated maternity ward. Led by Holcim Foundation Next Generation Ambassadors Meriem Chabani, Twaha Kyomuhendo, Vedhant Maharaj, and Stefan Novakovic and organized with the support of the Tumbili Foundation, a local NGO that supports the Nkweshoo community, the workshop brought together 26 students from Tanzania’s Ardhi University in Dar es Salaam and France’s Ecole Nationale Supérieure d’Architecture Paris‑Malaquais (Paris‑Malaquais School of Architecture) for an immersive and deeply inclusive week of learning and design exploration.

Living in tents erected on the site, students from both Paris and Dar es Salaam experienced an intimate introduction to the landscape, taking in local conditions and learning from community knowledge. The immersive experience led to greater understanding of the local context and community needs, which enriched the design process. “It’s my first time working on a project where I’ve been living on the site – and looking at the sunrise and sunset, feeling the changing wind and humidity on my body,” said Ardhi University student Wilson Masaka.

To kick off the workshop, community members led a deep listening circle, outlining needs and priorities for the project. The contingent included Nkweshoo Head Doctor Gregory Kwayu, village chief Twalib N Marya, Machame ward executive Helleneasta N Shayo, and Machame Cultural Tourism’s Edith and Stella Shoo, as well as village residents and neighbors.

“Many mothers that are giving birth are not coming to our dispensary to give birth because of our lack of dedicated facilities,” said Dr Kwayu. “At the same time, there’s an issue of transport, so it can be very hard and expensive to travel to a larger health center.” Comprising two compact, dated buildings, the existing health center constructed in 1995 lacks adequate daylighting, ventilation, and sanitation, as also has no laboratory facilities. While 85 women gave birth in the facility in 2022, 150 had to be redirected elsewhere.

The students also visited two larger clinics in the Kilimanjaro region, accompanied by Dr Kwayu. Here, the students were able to observe healthcare in action, while learning established practices for clinical design that suit the local climate, make best use of available building materials, and respect cultural norms. The field trip culminated in a Q&A session with doctors and nurses, before students returned to Nkweshoo to kick off an intensive, two-day design charette exploring solutions for the site. Ahead of the workshop, a series of preliminary site visits conducted by the Next Generation Ambassadors established the scope for a 200-square-meter extension, as well as improvements to the existing facilities.

The students split into four teams, each of which integrated designers from both Ardhi University and Paris‑Malaquais. Mentored by the Next Generation Ambassadors and Ardhi University professor Fortunatus Bahendwa, each of the design teams developed a preliminary site concept, culminating in the creation of scale models and drawings, which were presented to community members, including Dr Kwayu and his team of clinicians. For the students, the charrette presented an opportunity to collaborate with international counterparts, as well as the local community. “It’s great to be able to work with students from other parts of the world, share our different knowledge and learn from each other,” said Ardhi University student Emmanuel Kiyenze. Paris‑Malaquais student Lana Rabia echoed a similar sentiment, reflecting on the cross-pollination of perspectives and expertise. “It’s very enriching to develop new perspectives, and learn from students with different cultural backgrounds,” said Rabia.

Moreover, the collaborative, grassroots project facilitated an innovative pedagogical approach, integrating students with a community-led design process, requiring on-site problem-solving and communication. In contrast to a purely conceptual design studio, the process also necessitated a deep understanding of cost considerations, site conditions, and material constraints, as well as the responsibility to translate a design vision into accessible language. To make their presentations legible and convincing, the students were challenged to present architectural thinking to a diverse audience of healthcare professionals, community leaders, and local stakeholders.

Following the presentations, community members voted to select two preferred design schemes. With the workshop concluded, the Paris‑Malaquais students returned home to further refine the two shortlisted concepts in a studio led by Meriem Chabani and Frank Minnaert. Back in Nkweshoo, construction is scheduled to begin in early 2024, with the students set to return to the site for a building workshop, this time joined by a contingent from South Africa’s University of the Witwatersrand. In the meantime, the design workshop set the stage for a modest yet transformative community project. “We are very happy you have come here,” village chief Twalib N Marya told the departing students. “The hospital will be a very important step — not only for Nkweshoo, but for all the villages nearby.”

The Clinic of Care: Tanzania project will be presented at ENSAPM - Paris-Malaquais School of Architecture by Meriem Chabani on January 22, 2024 from 18:00hrs.

Funded by the Holcim Foundation and carried out in partnership with local universities and NGOs, the Clinic of Care projects in Tanzania and Indonesia are guided by the Foundation’s goals and principles. The program develops transformative approaches that combine low-carbon design with social and economic resilience, and encompass a commitment to both a healthier planet and healthier communities.