Bayalpata Hospital delivers free, high-quality healthcare to more than 100,000 patients a year in Achham, Nepal, and its six surrounding districts—one of the country’s poorest and most remote regions. It’s managed by nonprofit healthcare organization Possible Health, which is based in New York and Nepal and collaborates with the Ministry of Health & Population of Nepal in a public-private partnership.

Dr. Bikash Gauchan, Bayalpata Hospital’s healthcare director, says when he joined Possible Health a decade ago, the hospital comprised many dated buildings with no insulation or climate control, allowing indoor temperatures to range between approximately 40 and 100 degrees Fahrenheit. Additionally, the aged site had no formal sanitation system, electricity was unreliable, and access to clean water was limited, further impacting the organization’s ability to provide healthcare services to patients.

To improve care, Possible Health reached out to Sharon Davis Design (SDD; New York), a firm that works primarily with nonprofit and nongovernmental organizations, to upgrade and expand the campus. During SDD’s first trip to Nepal, the design team witnessed doctors running between the emergency room and surgery, through crowds of waiting patients and families, many of whom often arrive without appointments after traveling many hours on foot. “Clear circulation and sufficient waiting areas for patients became drivers of our design,” says Sharon Davis, principal at SDD. “This goal influenced our approach of breaking down the scale of the complex with multiple, smaller buildings, grouped around private courtyards, with plenty of access to outdoor spaces, including balconies, as well as protection from the elements through courtyards and shading canopies.”

Construction began in late 2014, with the new 45,500-square-foot facility opening this past spring. The rural 7.5-acre campus includes five medical buildings with 70 beds for outpatient, inpatient, surgery, prenatal, dental, and emergency services, plus clinical functions, such as pharmacy, radiology, and laboratory spaces. There’s also an administrative block with staff offices and a 60-seat cafeteria.

The site’s natural topography was used to locate the buildings, with the administrative building at the highest point, overlooking the medical campus. Due to the remoteness of the hospital, many of the hospital’s staff and their families live on-site, so the project also included 10 single-family houses and an eight-bedroom dormitory in a secluded area downhill from the hospital, says Tyler Survant, project director of SDD and project manager for Bayalpata Hospital.

Inspired by the region’s building traditions (including two- and three-story houses in Achham constructed of mortared stone and finished with paint and an earthen stucco), the medical spaces are finished on the interior with stucco. Rammed earth, a local building technique, was used to construct the housing.

The project is a unique model to Nepal and has been recognized by local health policymakers, according to Dr. Bikash. “Many of the ministers from the Nepal government come to our hospital to learn our systems, to learn our physical space and infrastructure, including this rammed earth technique,” he says. “Recently it has gained interest, not only inside Nepal but internationally, because of the physical infrastructure but also the healthcare services that our organization is delivering.”

Project details:

Facility name: Bayalpata Hospital

Location: Achham, Nepal

Completion date: Spring 2020

Owner: Ministry of Health & Population of Nepal

Total building area: 4,225 sq. m (45,500 sq. ft.) built area; 3 hectares (7.5 acres) campus area

Total construction cost: 390 million NPR ($3.4 million USD)

Cost/sq. ft.: Approximately $60 USD/sq. ft.

Design lead: Sharon Davis Design

Local architect: Ethicons-EWES J/V

Structural engineer: Office of Structural Design (OSD)

Sustainability consultant: Transsolar Climate Engineering

Waste/Water engineer: eDesign Dynamics (EDD)

Landscape design: XS Space

General contractor: Subedi-Associate J/V

PV design & energy installer: SunFarmer

Medical gas: Kas Nepal

HVAC: Kalika Bhawani Construction & Engineering Solution
Sanitary and electrical works: Ranjitkar Construction

Tracey Walker is managing editor of Healthcare Design. She can be reached at