Breaking ground on Kilimanjaro

After a collaborative design process, construction documents were prepared and government approval obtained. Site clearing began in June 2024 and construction has now started, including a new plumbing well. These crucial elements including adequate site drainage have been carefully planned to form a solid basis for future building extension. This follows months of planning and design exploration, culminating in an on-site construction workshop with students from around the world in October 2023. Each team was assigned specific tasks, focusing on various aspects such as buildings (maternity ward, clinic, bathrooms), topography, existing tree placements, and waste disposal locations.

The current dispensary consists of two barrack-like structures constructed in 1974 that lack adequate daylight, ventilation, and sanitation. One of these buildings serves as a maternity unit, while the other functions as a general health dispensary. The local community has long been advocating for an expansion of the maternity facility that currently has only one bed. In 2022, 85 women gave birth in the existing maternity building, while 150 had to be redirected elsewhere. Tanzania’s maternal mortality rate is several times higher than the global average. Accessible and affordable childbirth services that are respectful and culturally acceptable are an ongoing challenge in rural settings that this project seeks to address.

The aim of the project set for completion in early 2025 was to design and build the new maternity ward while documenting and choreographing the design process, and maintaining a high degree of care. The project serves an acute local healthcare need, while also creating an opportunity to employ, learn from, and empower the local community. Initiated by the Holcim Foundation’s Next Generation Ambassador program, led by Meriem Chabani (France), Vedhant Maharaj (South Africa), Twaha Kyomuhendo (Uganda), and Stefan Novakovic (Canada).

Working with community and a holistic paradigm of sustainability

Facing a pressing climate crisis, limited financial means and a long reckoning with the legacies of colonial infrastructure, architects must apply the tools of practice in a fundamentally different way. The design team worked closely with the small community of 500 people to understand needs and consider carbon cost, community, culture - and collaboration. The principle of adaptation over demolition is at the heart of the design ethos: both as a response to the environmental impacts of new construction and as an understanding that buildings serve as vessels of history and culture.

The on-site survey of the existing buildings identified issues including fungi, cracks and thermal bridges, as well as challenging irregular and sloped topography - emphasizing the importance of addressing discomfort, deterioration and potential dangers to the users’ well-being when designing and renovating health infrastructure. Technical solutions were designed to prevent water ingress from the ground into the foundations, posts and walls, as well as from the roof. To extend life expectancy for the existing buildings and protect exposed foundations, wooden poles and roof frames were replaced or treated.

To enhance indoor comfort, an insulation system was added to the existing corrugated metal sheet roofing. Walls were insulated to improve temperature control and suspended ceilings were removed or re-done. All electrical outlets were replaced and the exterior re-painted to provide the buildings with protection.

Materials research to build understanding

Material research played a crucial role in the project. A series of material sheets were compiled that detail the characteristics, uses and suppliers of each identified material. Discussions with local community members enriched the understanding of the challenges associated with different materials, resulting in a comprehensive database that serves as a valuable reference during the design phase.

Design incorporating vernacular traditions and best practice

The final building design combines a rectilinear form with a secondary volume serving as reception and waiting areas, creating an open and welcoming entry space. The design features shaded corridors, comfortable seating, and natural ventilation, balancing clinical privacy with indoor-outdoor porosity. Placed between the two existing entities, the proposal utilizes a flat portion of terrain for efficient construction and allowing for a continuous spatial experience. Extending the galleries of each existing structure creates a new circulation system with the core functions housed in-between.

Locally sourced materials that support the local economy are used in the construction. Baked bricks for walls, various wooden elements, and custom-designed details (including banana leaf moveable partitions, eucalyptus cladding below the roof, and thatch for insulation) contribute to the shaping of an identity unique to the Nkweshoo maternity clinic.

Vedhant Maharaj and Twaha Kyomuhendo conducted a preliminary site visit in 2023 and established a partnership with the Tumbili Foundation which has been providing healthcare aid since 2017, together with local stakeholders, clinicians led by Dr Gregory Kwayu and community liaison Machame Cultural Tourism.

Design Development: Learning from the Community

The design was then developed during a week-long collaborative workshop in October 2023. Students from Dar Es Salam’s Ardhi University and the Ecole Nationale Supérieure d’Architecture Paris-Malaquais joined our Next Generation Ambassadors, Dr Kwayu, and community stakeholders, including village chief Twalib N Maria and ward executive Helleneasta N Shayo, to establish design parameters.

Split into four teams of French and Tanzanian students, the conceptual designs were presented to the Nkweshoo community, who voted on the new building’s site placement, form, and circulation. The preferred design combined formal simplicity with social elements and mountain landscape celebration. Paris-Malaquais students refined the design, incorporating feedback from a virtual session with community members, culminating in a design emphasizing intuitive circulation from reception to delivery space to a postnatal room. Paris-Malaquais students spent the next semester refining the design through a studio led by Meriem Chabani. In early 2024, the students presented their refined work to the community members in a virtual session.

Collaborative approach is context-sensitive and community-centric

The updated design incorporated formal simplicity with intuitive circulation that follows the journey of new life: with a reception space leading to a prenatal space, culminating in a tranquil postnatal room. The two new volumes are joined by a shared gable roof, spanning across the entry space. Cantilevered over both buildings, the roof frames the complex with shaded circulation corridors and comfortable outdoor seating.

The form, materiality and circulation draw on vernacular traditions and local best practice – but also incorporates a site-specific strategy that reflects community priorities. Seating, fenestration, and shared outdoor spaces are contoured to maintain open views celebrating the Kilimanjaro countryside while mitigating solar heat gain.

Generous seating and communal spaces allow partners and family members to accompany mothers during labor. Throughout the complex, natural ventilation fosters comfortable conditions, while carefully balancing clinical privacy with indoor-outdoor porosity.

Sustainable, socially inclusive – and deeply collaborative

Funded by the Holcim Foundation and carried out in partnership with local universities and NGOs, the Clinic of Care projects in Tanzania and in 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.

For a student, having the chance to design a project slated for construction is a rare opportunity - with the challenges of including multiple voices while maintaining effective task distribution and management.

Image credits

Renderings of project produced by students from École Paris-Malaquais (France): Riad Baghdadi, Karima Boulekraouet, Soren Brousse, Grégoire Chiriac, Sourya Diarra, Darius Krüger, Rachelle Louis, Carla Martinez, Mickaël Osorovitz, Miriam Obi, Lana Rabie and Océane Seba.