Last October, students from Paris and Dar Es Salam came together for an immersive on-site design workshop on the foothills of Mount Kilimanjaro. In the Tanzanian village of Nkweshoo, where a small local healthcare facility is set to be expanded and upgraded via a dedicated maternity clinic and improved facilities, the workshop marked a pivotal moment in an ongoing project. For the students, who camped in tents erected on-site, the week offered a chance to begin the design process by experiencing landscape, culture and community, culminating in a presentation of initial building concepts to local residents, clinicians, and project partners. Almost four months later, the project – led by the Holcim Foundation’s NGX Ambassadors – celebrated another milestone, with a refined design presented to stakeholders as the culmination of a semester-long studio.

While a pair of the initial designs proposed a re-imagination of clinical design – either through a village-like cluster of small volumes, or a dramatic new building that addresses the site’s sloping grade – the community’s two most well-received concepts both adopted a more restrained, economical approach, inserting a linear building in between the two existing structures. Although the two projects adopted slightly different strategies (including variations on the notional program and materiality), their broad similarities would allow them to gradually become consolidated into a single design concept, which was rigorously refined ahead of the January presentation.

What do they know – that you don’t?

Yet, as the community cast a binding vote to advance the shortlisted designs, NGX Ambassador and École Paris-Malaquais studio instructor Meriem Chabani simultaneously organized a non-binding student vote. It yielded the inverse result. Where the community members preferred a streamlined, rational and precedent-rich design approach, the student vote strongly favored the two more architecturally adventurous concepts, which sought to re-imagine the paradigms of healthcare design. For Chabani, it presented a vital teachable moment: “Why do you think your vote was different from the community vote? Why weren’t you able to convince them? Ask yourselves; what do they know that you don’t?”

The conversation that set the stage for the studio to come, illuminating key learnings: Architectural expression must be rooted in social good and community wellbeing – and its merits must be communicated clearly and legibly. In January, the students returned with a coherent and clearly articulated vision. Amplified by an elegantly curated on-campus exhibition for attendees in Paris, January’s presentation unveiled a thoughtfully economical and culturally responsive design approach.

Drawing on local building practices and healthcare norms – informed by site visits undertaken as part of the October workshop – the design introduces a 200-square-meter linear volume that bridges the space between the two existing structures. A broad porch frames both sides of the building, creating pleasantly shaded walkways alongside the clinical spaces. Outfitted with benches, the walkways create intuitive circulation through the complex, while also allowing for spatially efficient interiors free of internal corridors.

Inside, the circulation follows the chronology of childbirth. A reception area fronts the new volume, followed by prenatal spaces, and culminating with the delivery room. Meanwhile, a new roof structure connects the building to the existing dispensary, maintaining structural separation between the two while facilitating easy circulation. This allows the current dispensary to be converted into a restful and quiet postnatal space, where mothers and newborns can recuperate and bond. The spatial logic is clearly arranged to follow and facilitate every step of the birthing process, making for a coherent and legible space. Meanwhile, the new clinical complex allows the undersized existing maternity building – which will remain separate from the new volume – to be converted into a dispensary, reflecting its distinct program.

An important milestone in the project’s implementation

For the Clinic of Care project, January’s presentation and exhibition represented a meaningful step forward. As the design continues to be refined and the start of construction approaches, on-site progress also continues in Tanzania. Working in partnership with the NGX Ambassadors, local NGO Tumbili Foundation, which has long supported the Nkweshoo community through financial and healthcare aid, has collected a wealth of local architectural samples to inform the construction strategy and final material palette, which will include locally produced bricks and glass as well as ceramics and roof tiles.

Students from both Paris-Malaquais and Dar Es Salam’s Ardhi University are set to return to the site for a construction workshop, where they will be joined by peers from South Africa’s University of the Witwatersrand (Wits). For the students and NGX Ambassadors alike, it will offer another invaluable learning opportunity. This time, expert building (known locally as fundis) will join the Nkweshoo clinicians and community members in sharing their knowledge.

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 also 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.