Published By: BHI Communications

StrXur: Designing for Health Equity

This story was originally published on StrXur by Bluebeam. 

Saving lives through good design. It may sound like a grandiose statement, but it’s what Build Health International (BHI) does every day. The Massachusetts-based organization was founded by Jim Ansara, founder and former head of Shawmut Construction, and Dr. David Walton, a physician at Brigham and Women’s Hospital and Harvard Medical School.

The two met about a decade ago while working in Haiti with the nonprofit Partners in Health to design and build Hôpital Universitaire de Mirebalais (HUM), the country’s premier referral hospital and the largest hospital powered by solar energy in the Southern Hemisphere. While proud of HUM’s success, it was clear to both Ansara and Walton that the need for efficient, sustainable and contextually-appropriate healthcare infrastructure extended far beyond one facility in central Haiti. The two decided to combine their deep knowledge of building practices and medical care to create a nonprofit that designs and builds high-quality public health infrastructure for the world’s poorest and most vulnerable communities.

Today, Ansara and Walton still lead BHI—Ansara as director and Walton as CEO. The organization has grown rapidly over the past five years, and most staff based at the headquarters in Beverly, Massachusetts. Many of BHI’s projects are in Haiti, though they’ve also completed projects in Sierra Leone, Liberia, Niger, Peru and elsewhere.

Low cost, high impact


One of BHI’s recent projects typifies their model: building the Center for Infectious Disease and Emergency Care (CIDEC) at St. Boniface Hospital in Fonds-des-Blanc, Haiti. Completed in 2018, the project is remarkable—and typical for how BHI builds and designs.

The 10,000-square-foot facility is split between an isolation ward for patients with highly infectious diseases and an emergency department with triage areas and examination rooms. This may seem standard, but in Haiti, BHI’s work has completely changed the options available for care in many communities. St. Boniface Hospital, run by Health Equity International, is the only referral hospital in southern Haiti for at least 2 million people. It provides the quality of care that all Haitians deserve, but typically only the wealthiest can afford.

BHI is committed to strengthening the public sector and making high-quality care available to everyone, particularly the most vulnerable. To achieve this and have the greatest impact, BHI keeps quality high and costs low for both themselves and their hospital partners. They leverage regional efficiencies and building practices by employing local labor alongside a small team of highly skilled architects, engineers and construction managers. By soliciting donated materials, equipment and design software, they can build for one half or even a third the price of what other contractors charge per square foot in Haiti.

“Everything we do is focused on optimizing efficiency,” says Omar Hernandez, BHI’s director of engineering. “We know that every dollar BHI can save will be used by our NGO partners to save more lives at the facility.”

Collaborating across oceans

Still, construction requires collaboration and doing that from afar can be a challenge—especially when operating from Massachusetts in the US to Haiti. BHI tries to keep site visits from the US team to a minimum to help keep costs low.

To that end, they relied very heavily on Bluebeam Revu, the collaboration and markup solution, and especially Bluebeam Studio, the function in Revu that allows real-time collaboration and editing from anywhere, anytime—even when communication is otherwise difficult.

“We’re designing, building and maintaining healthcare infrastructure in low-resource settings where we don’t have reliable data or cell signal. But with Bluebeam Revu, all of our construction administration is done directly within Studio. We’re grabbing questions and RFIs from Studio, we’re marking them up in Studio, and we’re sending the responses back in Studio,” said Hernandez. He estimates that using Revu saves BHI about 10% on costs. And that’s not considering the unseen benefits, like aiding in project handover.

BHI likes to take a long view on cost-efficiency. By building sustainably and designing efficiently they can help ensure hospitals continue running smoothly and economically long after their work is done.

Building for change

This is particularly important in resource-constrained countries, like Haiti, where materials and funding aren’t always available for facility maintenance or equipment repairs. For instance, instead of installing mechanical fans which can be expensive to repair and require a technical knowledge that’s sometimes difficult to find locally, BHI will install ceiling fans and use passive ventilation techniques to keep the air changing constantly.

They also build in configurations that are easily adaptable because needs can shift so often, whether due to technological developments, outbreaks of disease, natural disasters, or economic instability. In the new CIDEC at St. Boniface Hospital, it’s as easy as moving a wall here and there if an extra surgery is needed or they want to cut the number of isolation wards in half.

That’s another bonus to documenting everything in Revu: at the end of the project, the team has a set of up-to-date digital as-builts to hand over. That means the incoming facilities team can benefit from and add to a live document, greatly aiding in managing and maintaining the facility. It also means that the architects don’t have to draw a set of as-builts at the end of a project, saving them time and money.

Walton has seen the direct fruits of his organization’s labor. He pointed out that as BHI builds more healthcare facilities in underserved communities the acuity of the patients decreases. Before these facilities are built, the clinics that were few and far between would see only the very sickest patients. However, once more people get regular care, the community by and large is healthier.

“Our goal is to build facilities that can be maintained by local staff and continue to serve the community for decades to come,” Walton says. “Sustainable, resilient infrastructure is key to building and strengthening the public healthcare systems in Haiti and around the world. No one should have to die because they can’t access or afford basic care.”