Malawi suffers from one of the highest rates of maternal and infant mortality in the world: in 2010, one in thirty-six Malawian women had a lifetime risk of dying during pregnancy or delivery. Over 85% of the country’s population lives in rural settings, with little access to professional medical care. As part of an effort to address this, the Presidential Initiative on Maternal Health and Safe Motherhood has committed to building 130 maternity waiting homes throughout the country. These facilities invite expectant mothers to travel to receive care, giving them a place to stay within easy reach of a hospital or health center after their 36th week.
Yet the Ministry of Health had few resources to invest in designing the prototype maternity waiting home. The result – one large room housing 36 mothers, with little daylight, ventilation or privacy - has had limited success in encouraging women to seek care. In collaboration with the University of North Carolina Project - Malawi and with support from the Bill and Melinda Gates Foundation, MASS Design Group worked with the Ministry of Health architect to design a new prototype maternity waiting home that would address these challenges and propose a high-performing, replicable solution for the country.
To create a more inviting maternity waiting home, MASS Design Group took design cues from the vernacular layout of Malawian villages, where family compounds are composed of several small buildings housing branches of an immediate family. MASS broke the large dormitory-style waiting home into similarly intimate four-bed units, a comfortable size defined in collaboration with mothers. These buildings are arranged around courtyards into ‘clusters’ of three rooms (twelve mothers). Rather than a sleeping hall’s impersonal scale, the clusters create small communities that encourage knowledge sharing between experienced and first-time mothers. Any number of these twelve-bed clusters can be assembled together, and aggregated over time as additional construction capital becomes available. In Kasungu, MASS assembled three clusters for a 36-bed Maternity Waiting Village.
This twelve-bed cluster model served as the starting point from which to develop a performance-based design adapted to the needs and habits of expectant mothers. Because of their smaller size, sleeping rooms have improved lighting and ventilation and are more comfortable. Rather than a single water outlet, each cluster includes a fourth unit housing toilets and showers, with an elevated water tank to function during power outages, as well as laundry facilities. A communal kitchen can be used by mothers and shared with the family members travelling with them.
Each room of the Maternity Waiting Village is developed around a simple scheme of buttressed columns, connected together to form different practical elements: walls, doors, as well as benches and storage areas. Birthing is not an individual experience in Malawi but a communal activity, and these elements accommodate the family and attendants who travel with mothers to seek care; benches become sleeping spaces, and built-in storage allows them to keep their belongings.
The columns support a system of wood trusses that extend the roofline beyond the gabled ceiling of each building. The saltbox and butterfly roofs of the two modular bedroom units are aligned with complimentary geometries to better capture and redirect rainwater. Their dramatic overhangs protect walls from damage by the rain; in one direction the roof overhang creates covered circulation areas, and in the other, shaded outdoor areas that play host to daily activities. The double-layered roof design encourages air circulation to keep rooms comfortable in the summer; in the winter, the butterfly design allows daytime sun to warm the CSEB walls, which emit heat at night to maintain pleasant sleeping temperatures.
Everyday life in rural Malawi takes place largely outdoors. In the Maternity Waiting Village, mothers and their family members and attendants spend their days in the courtyards and covered outdoor spaces. Dedicated education areas are used for a variety of programming, including workshops around pre- and post-natal care, and handicraft trainings to help mothers earn income while away from home, making up for the wage loss that is a significant impediment to use of maternity waiting facilities.
MASS and the Malawi Ministry of Health worked through a collaborative learning process to develop new, cost-effective building techniques that demonstrate the value of innovative design.
Due to the lack of sustainable building materials in Malawi and the issue of deforestation, the project’s walls are constructed of Compressed Stabilized Earth Blocks (CSEBs) as an alternative to traditional fired brick, which uses large quantities of wood in the firing process. Local CSEB held the stigma of being expensive, as a plaster coating was usually applied for rain protection. MASS’s team worked onsite with masons to detail joints, and experimented with soil mixes to obtain optimal water resistance; as a result, the plaster layer was eliminated. Roof overhangs further protects walls from degradation by the rain. The CSEB press remains available for use in Kasungu, where masons have expressed interest in using these new skills to continue to build with this affordable, local material. The building’s dramatic roofline marks a departure from previous construction practices in Malawi; in a country with a timber industry that it is only partially developed, it was possible to engineer beautiful exposed trusses for the building’s roofing system.
In these ways, the Maternity Waiting Village marks a careful departure from existing construction practices in Malawi. Developed collaboratively between MASS, the Ministry of Health architect, and the craftsmen who created each part of the building, the facility’s architecture emphasizes local capacity and skill development.
MASS Design Group is a design studio with offices in the United States and Rwanda. For the past five years we have worked to create a new practice of architecture that promotes dignity, opportunity and health. Our projects in over twelve different countries have proved the effectiveness of best-practice design to help otherwise under-resourced communities thrive.
As an architecture and design firm, MASS identifies the potential for infrastructure to improve service delivery outcomes, and scales these ideas by working with government on national policy. As a research and training lab, MASS uncovers and evaluates new best-practice methods, and trains architects and designers to grow the next generation of builders in the regions in which we work.
MASS’s work hinges on thorough community engagement at every phase of design and construction, to identify unique opportunities and to train artisans in new skills, an ethos we call the Lo-Fab (local fabrication) design practice.