Rural Healthcare Toolkit

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Rural Healthcare Toolkit Research Prospectus

Matthew Tierney MS‐RP Fall 2013 University of Minnesota Professor Gregory Donofrio

Table of Contents

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Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Literature Review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3‐6 Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7‐10 Assumptions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11‐12 Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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Abstract This paper introduces an interactive, software‐based tool developed by the author to assist architects and engineers in making informed decisions when designing healthcare projects in rural Africa. The Rural Healthcare Design Toolkit advises culturally and environmentally sensitive design decisions based on the complex interactions among infrastructure, human behavior, and the natural environment present in rural African locations. The Toolkit uses systems thinking to identify important social and environmental relationships causing “illness”, specifies building and site design considerations, and sets performance‐based goals to encourage the use of sustainable building practices in rural contexts.

The research methodology underpinning the tool interrogates green building rating systems, community engagement guides, and human development indices, identifying both common metrics and critical gaps of current technologies, which, when aggregated, became the basis for a new tool. Building and site design considerations were gathered from existing rating systems including the Living Building Challenge (LBC), BREEAM for Healthcare, LEED for Healthcare, the Sustainable Sites Initiative (SSI), the Green Guide to Healthcare, and the Sustainable Building Assessment Tool (SBAT)Further, to inform effective strategies for creating a deep contextual analysis, conducting stakeholder interviews, holding community design sessions, and fostering collaborative partnerships with other organizations, the "Human‐Centered Design Toolkit" by IDEO, "A Guide to Partnering" by Design Impact, and the "Community Design Primer" by Randolph Hester Were sourced as best practices guides. Lastly, to align project‐scaled objectives with global goals for sustainable development, the Millennium Development Goals (UN 2013) and the Human Development Report (UNDP 2013) were included and compared in the matrix.

The Rural Healthcare Design Toolkit hopes to act as a resource for architects, engineers, and landscape architects outside of Africa. The list of considerations aims at creating appropriate, project‐specific, healthcare solutions derived from patterns in the environment linking ecological health, the built environment, economic infrastructure, and human behavior. It empowers designers to develop projects that simultaneously address ecological and human health concerns at their roots while providing community amenities throughout the design, construction, and occupancy of the project.

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Literature Review In recent years, a wealth of information pertaining to evaluating sustainability in the built environment has surfaced in multiple fields such as architecture, landscape architecture, supply chain management and many others. Tools that rate the projected and measured performance of a building, infrastructure, landscape, or a product have been developed by governmental organizations, academic institutions, and private entities with the collective goal of increasing the use of sustainable strategies in the construction industry and consequentially raising awareness around eminent global issues.1 These issues pertain specifically to the industries involved in creating, maintaining and redefining the built environment because of this industry’s profound impact on the social, natural, and technological environment which we live in today. These tools have reached their initial goal of raising performance and awareness across many different fields, but like many issues in the field of sustainable design, there are gaps that exist and opportunities to refine the information so that it can be optimized for localized conditions.2 Sustainability rating systems have a short, but intense history of development. In approximately two decades, an entire field has been created around the idea of measuring performance in the built environment. In 1988, the BRE Environmental Assessment Method, or BREEAM, started its inquiry at the Building Research Establishment in Watford, UK and soon produced one of the first examples of a comprehensive and systematic rating tool for buildings. Soon after, in 1998, the United States Green Building Council launched its Leadership in Energy & Environmental Design program, which is more commonly known by its acronym, LEED. This rating system had similar intentions of assessing building performance and increasing the use of sustainable technologies throughout the United States’ building industries.3 Both of these systems evaluate performance based on a set of metrics that measure a building’s impact on the surrounding social and ecological environments.4 Subsequent versions of multiple building performance standards have refined their lists of quantifiable metrics to critically assess specific building typologies, adjust for different modes of construction (i.e. new construction, adaptive reuse, preservation), and provide different weightings for varying geographical and climatic contexts. One focused gap that still exists in the literature is the ability of such refined rating systems to adequately assess sustainability in rural African areas. As more projects in this context are built every year, it is important to address sustainability in this burgeoning field. Further, it is important to advocate holistic project values with a familiar platform of design and evaluation. The familiarity and pervasiveness of rating systems makes a case for their inclusion in this context. These rating systems have proven to be quite successful in creating awareness among architects and the public alike and have

1 Binh K. Nguyen and Hasim Altan. "Comparative Review of Five Sustainable Rating Systems." Procedia Engineering 21: 376‐86.

Print.

2 Cesar A. Poveda and Michael G. Lipsett. "A Review of Sustainability Assessment and Sustainability/Environmental Rating Systems and Credit Weighting Tools." Journal of Sustainable Development 4.6: 36. Print.

3 Jennie Richards. Sustainable Industry Sector Retrospectives. Tech. Institute for Environmental Entrepreneurship The David Brower Center, n.d. Web. Sept. 2013. (http://enviroinstitute.org/wp‐content/uploads/2012/09/GREEN‐BUILDING‐A‐Retrospective‐History‐ of‐LEED‐Certification‐November‐2012.pdf)

4 Pacific Northwest National Laboratory, and U.S. Department of Energy. Sustainable Building Rating Systems Summary.

Publication no. PNNL‐15858. U.S. Department of Energy, July 2006. Web. Sept. 2013. (http://www.usgbc.org/Docs/Archive/General/Docs1915.pdf)

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advocated heightened performance in the built environment. This research attempts to combine applicable considerations from several different standards into a guide for designers operating outside of Africa. With this guide, designers unfamiliar with this type of project site will be able to address this particular context with a grounded understanding of the constraints, opportunities, challenges and strengths inherent in this type of project.

In a rural context, the surrounding landscape can be equally, if not more, important than the building to the performance of a project. In the wake of LEED, BREEAM and a host of other building metrics that have sought to create heightened levels of sustainability in the construction industry, many organizations that deal with landscapes have created similar standards that evaluate the performance of the landscape5.

Many considerations that are not included in standards focused on buildings are brought to the table with these additional site‐centric standards. Although the Living Building Challenge, developed by the Living Futures Institute, provides a useful chassis to evaluate the dialogue between the site and the building in any given project6, the Sustainable Sites Initiative is an exemplary precedent to consider in this realm.

With its focus on creating resilient landscapes made up of native plantings, efficient siting, protection of local ecologies and a host of other considerations, this standard creates a good companion reference to use in conjunction with building rating systems like LEED and BREEAM. Following the same level of prescriptiveness as many of the building standards in the market, the Sustainable Sites Initiative is often too prescriptive and complex to apply to rural contexts. It is oriented toward highly developed markets with very specialized knowledge of the scientific properties of plants, ecosystems, and construction, all of which are hard to come by in rural African sites. 7 Although scientific knowledge of the landscape is not common, an in‐depth knowledge of local ecological flows, vegetation, and wildlife can be a huge asset to a project if recognized early and used as a driver for the project design development.

As stated above, most of the ratings systems present in the field were considered overly complex and too specific in their approach to evaluating performance in the built environment with the prospect of applying such tools to rural African settings. Thus, existing rating systems present certain restrictions when applied to a context that often has little means of verification and very different building cultures.

Examples of these stark differences include methods of material procurement and delivery, construction administration, code compliance, and construction documentation conventions. The diversity of different parties presently vying for a place in the crowded market caused the United Kingdom‐based consultancy, SustainAbility, to perform an assessment titled, “Rate the Raters”, to figure out what was working and what was failing in the sustainability rating field. This study also produced a list of best practices for the myriad organizations that are creating tools to measure sustainability. Below is a succinct list of best practice considerations developed from the assessment’s third phase.8 These factors were taken into account as the author developed an aggregate tool for use in rural African contexts.

5 Building Research Establishment. BREEAM 2011: Healthcare ‐ Technical Guidance. Tech. Building Research Establishment, 2011. Web. Sept.

2013. (http://www.eastriding.gov.uk/padocs/JUNE2012/5EA47BA5EC2C11E19A249947D1069F4A.pdf)

6 International Living Future Institute. LIVING BUILDING CHALLENGES 2.1 A Visionary Path to a Restorative Future. Publication Ver 2.1.

International Living Future Institute, May 2012. Web. Sept. 2013. (https://ilbi.org/lbc/LBC%20Documents/lbc‐2.1) 7 Sustainable Sites Initiative. 2009. The Case for Sustainable Landscapes. (http://www.sustainablesites.org/report) 8 Michael Sadowski, and SustainAbility. "Rate the Raters Phase Three Uncovering Best Practices." Rate the Raters 3 (2011): n. pag. 22 Feb. 2011.

Web. 28 Sept. 2013.( http://www.sustainability.com/library/rate‐the‐raters‐phase‐three#.UrCSAfRDu5K)

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Transparency = Trust = Value. Ratings that users perceive to be of highest value tend to be the ones that are most transparent. Raters who seek to keep their methodologies secret must realize that people are more likely to trust their rating ‐‐ and thus adopt it ‐‐ if they understand it.

Simple is Beautiful. In the race to stand out from the crowd, many ratings are becoming highly complex, but the analysis found some of the best ratings to be the simplest: again, understandability is critical to fostering trust.

Focus on the Future. Too many ratings focus on companies' current or past performance rather than on how they are positioned to deliver sustainable value going forward. The ratings that survive and prosper will be those that favor the winners of the future.

Double Down on Quality. As an increasing number of investors, consumers, employees and other stakeholders follow and make greater use of sustainability ratings, it is imperative that raters improve their efforts on quality assurance and control.

Get Cozier with [Context] Lastly, raters won't be able to "Focus on the Future" unless they invest considerably more time directly engaging with the companies they rate. The majority of ratings today are based on arms‐length assessments of performance. This is possible due to the nature of today's ratings and often necessary given organizational limits and ratings' scope. Going forward, we believe that every rater can and should spend more time with the companies they assess, and that there are myriad benefits to doing so (e.g. gain stronger understanding of their businesses, verify publicly reported information, help companies understand ratings and improve sustainability performance).

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Quoted directly from “Rate the Raters” Phase III

The evaluation of existing rating systems conducted by SustainAbility shows how the saturated market of sustainability standards has seeded the development of tools utilizing over‐complicated metrics. This type of development has, in its pursuit of exactness, caused designers to overlook simple solutions to imminent environmental problems of the future. When using a tool developed for the United States or European building industries, pragmatic considerations are often clouded by measurements of BTU’s, Candelas, or KWhrs in pursuit of “points” and marketing potential. Simple design considerations are particularly at home in rural African locations where electricity, delivery, and highly skilled labor are not often readily available. Like so many other areas of design, the field of project performance rating is observing a return to simpler, more straightforward approaches to achieving success. Less is more, especially when adjusting this type of assessment to be useful and practical in a rural, African development context.

A review of the existing list of standards (The Living Building Challenge (LBC)6, BREEAM for Healthcare, 5 LEED for Healthcare, 9 the Sustainable Sites Initiative (SSI), 7 and the Sustainable Building Assessment Tool (SBAT).10) used a simplification process advised by the “Rate the Raters” 8 report and an understanding derived from the author’s experience in the cultural and building contexts of rural Kenya. Overly prescriptive metrics defined in the surveyed standards were simplified to be understandable and actionable in this context. In rural locations, the lack of construction regulations, knowledge of sustainable building practices, and a standardized methodology of project delivery has caused failure in unsuspecting

9 U.S. Green Building Council, Inc. 2009 LEED for Healthcare New Construction & Major Renovations. Tech. U.S. Green Building Council, Inc., 2010. Web. Sept. 2013.

(http://www.usgbc.org/Docs/Archive/General/Docs8878.pdf)

10 Jeremy Gibberd. Sustainable Building Assessment Tool (SBAT‐P) V1. Rep. University of Pretoria, 2003. Web. Sept. 2013.

(http://upetd.up.ac.za/thesis/available/etd‐06142004‐144252/unrestricted/22SBAT‐PercentagesA.pdf)

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projects. This can be the result of oversight caused by a familiarity with a very efficient and well documented paradigm of construction and project delivery observed in the United States. That is to say, there are considerations that designers in the United States take for granted and therefor don’t include as part of the design proposal. To use the words of Cameron Sinclair previously of Architecture for Humanity (AFH), “getting it built” is often the design challenge—not the design itself. With those words in mind, this tool hopes to align design intentions with localized environmental, cultural, and infrastructural conditions.

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Research Methodology A multi‐part research strategy was used to create an approach a complex topic from multiple angles.

Phase I of the interview involved on‐site immersion in Kenya to provide real world considerations to an otherwise academic topic. Phase II of the research used mixed‐methods (comparative analysis, grounded theory, and multiple case‐studies) to gain a wider perspective of the problems unearthed in Phase I and to create an actionable tool for use within the professional architectural environment. Phase III hopes to implement the tool developed in Phase II into real projects being developed. This three‐part strategy uses various means of gathering knowledge and synthesizing real‐world phenomena into a legible format that promotes healthy design solutions in rural locations throughout Kenya and Sub Saharan Africa.

In Phase I, immersion and cultural ethnographical studies were conducted over four visits to urban and rural parts of Kenya to attain knowledge of cultural and religious practices, building strategies, local economies, and public health with a particular interest in the spread of HIV/AIDS and applicable transects concerned with aid and development in this part of the world. One project location was a remote island in Lake Victoria, Mfangano. Two projects were designed and constructed here by the author and a team of local artisans and community members. The first project was a community center and Voluntary Counseling and Testing (VCT) facility. This project examined the link between a non‐ native, predatory Nile Perch fish populations and the transmission of HIV/AIDS through mobile fishing industries in the region. The second project on Mfangano explored an economic connection in the HIV/AIDS transmission network with a focus on food insecurity as a primary target to quell the HIV/AIDS transmission in the area. In this project, a 3,000 gallon solar‐powered aquaponics farming system was designed and constructed by the author and an interdisciplinary team of community members and graduate students over a summer. The project provides a means to generate income for the Ekialo Kiona Community Center through local markets, it provides nutritious vegetables for local consumption year round, and it produces Tilapia, a native species of Lake Victoria for both bait and consumption. Both of these projects started an inquiry into two different topics that create lasting sustainability in rural, Kenyan locations; (1) How can a project address and enhance local culture and (2) how can the infrastructural and societal constraints of remote locations present problems in the design, construction and post‐occupancy stages of a project.

A third project was developed in an urban slum outside of Nairobi, Kenya, called Kibera. The design charge was to create a schematic design for a community center for 60 at risk girls. The project would serve as a dormitory for the girls (sleeping quarters, bathing facilities, cafeteria, kitchen, recreational spaces, etc.), a meeting space for visiting and local communities, and a computer lab. While observing very lenient building codes and sub‐standard construction practices in the area, the author identified that self‐induced standards for resilient construction, community engagement, and efficient building systems (Energy, sanitation, potable water, ventilation, etc.) were necessary to achieve desired performance goals in the built project. This experience deepened the author’s understanding of community engagement processes, project delivery in challenging socio‐political contexts and sustainable design strategies in Sub Saharan Africa.

Phase II of the research was conducted by the author and other contributors largely in the United States while working in a partnership between the University of Minnesota and Perkins and Will’s Minneapolis, MN and New York City, NY offices to create strategies for the firm and university to deliver high‐caliber projects to rural areas. The design charge involved creating a deep site analysis, a tool to outline considerations for sustainable design, and a way to implement those considerations in the real world. A tool was developed using a cross‐relational matrix of various sustainable design rating systems,

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community engagement handbooks, and human development indices in Microsoft Excel. Each standard was consulted in a manner that was both comparative in its approach and reductive in its goals to create a comprehensive list. Each standard was looked at in two ways: (1) does the standard outline goals aligned with a given list item identified by the author in response to case studies and personal experiences in Kenya? And (2) are there other considerations that this standard outlines that should be included in a list that is catered to rural Kenyan development of a healthcare facility? Using these two primary questions, a list of considerations and a weighting scale were developed to create a tool that allowed designers to create informed decisions in the process of conceptual design, schematic design, and construction documentation.

The research methodology underpinning the tool interrogates green building rating systems, community engagement guides, and human development indices which identified both common metrics and critical gaps of current technologies, which, when aggregated, became the basis for a new tool. The list of criteria advised by the tool uses a list of considerations generated through a retrospective analysis of the two rural projects and the third, urban project mentioned in phase I. This initial list of considerations developed areas of focus that the next step in the analysis augmented, redefined, and synthesized into a list which validated real‐world phenomena with systems used widely throughout the design professions.

This step used a breadth analysis to first create a resource that placed all of the standards in one list compiled in Microsoft Excel, and secondly to identify where each had their topical strengths and weaknesses. The analysis consulted: 

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The Living Building Challenge (LBC)11‐ This resource was used because of its approach to holistic building design. It considers site metrics that some of the other systems do not include and sets ambitious goals for performance based not only on design but also on actual performance validated by post occupancy reports and energy bills instead of modeled projections. Further, this resource provides a methodology for some topics (i.e. net zero water and net zero energy) that are not prescriptive but rather take the approach that the method is less important than the outcome. This strategy has potential in the context of diverse rural locations where methods of attaining “sustainability” will almost undoubtedly be site‐specific.

BREEAM for Healthcare12‐ Similar in some ways to the Living Building Challenge, this primarily European rating system evaluates project performance on a list of considerations which are weighted differently. It is one of the oldest systems that has been in use and has therefore gone through many iterations and refinements throughout the years. This system also involves stringent reporting and evaluation both during the design process and post‐occupancy to evaluate project success on a number of different levels by a representative from BREEAM. For all of these reasons, this system was used as a primary template for creating an interactive design checklist for a new typology driven by program and location.

LEED for Healthcare13‐ Arguably the most widely used rating system, LEED has the ability to attain points in a number of areas based on indicators and benchmarks associated with each of the different areas of interest. LEED has adapted its considerations for a number of different typologies (Residential, Neighborhoods, Existing Buildings, etc.) but an applicable rating system for rural locations seems to be a

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International Living Future Institute. LIVING BUILDING CHALLENGES 2.1 A Visionary Path to a Restorative Future.

Building Research Establishment. BREEAM 2011: Healthcare ‐ Technical Guidance.

13 U.S. Green Building Council, Inc. 2009 LEED for Healthcare New Construction & Major Renovations. Tech. U.S. Green Building Council, Inc.,

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missing thread of inquiry which this research hopes to fill. LEED relies mainly on building performance metrics and some site considerations to attain project sustainability.

Sustainable Sites Initiative (SSI)14‐ To reinforce the importance that an effective landscape design has on project performance in rural contexts, this initiative was included to bring site‐scale considerations into the conversation. This initiative developed specific considerations for the design of the landscape (i.e. plant types, stormwater management, material sourcing, etc.) and uses case studies to iterate and refine the considerations from inception to second edition. Further, this initiative requires documentation of site‐scale analysis which this tool asserts is an important step in the process of creating sustainable design solutions.

Sustainable Building Assessment Tool (SBAT)15‐ This tool was developed in South Africa to begin an inquiry surrounding the way that rating systems which are generally associated with urban, developed world contexts can be used similarly to assess rural developing world contexts. It uses similar metrics as many of the other rating systems for both site and building related indicators but also includes some of the factors that become context specific to rural locations with lenient building regulations, informal construction industries and generally less control for the designer in project delivery.

All of the guides above were sourced to provide building and site design considerations. Further, the breadth analysis uses survey and partnering guides to inform effective strategies for creating a deep contextual analysis, conducting stakeholder interviews, holding community design sessions, and fostering collaborative partnerships with other organizations: 

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The "Human‐Centered Design Toolkit" by IDEO16 was used to identify effective means of getting design knowledge from direct and indirect interactions. The toolkit effectively outlines strategies for conceptualizing project needs, identifying community goals, and creating context‐specific solutions that are holistic in their reasoning and viable in their delivery. In addition to a written guide which outlines specific strategies to get the most out of immersive experiences and brainstorming exercises, the toolkit provides templates for site surveys, interviews, and prototyping.

"A Guide to Partnering" by Design Impact17 was used to address a common weak point in humanitarian and pro‐bono projects, the interface between the organization on the ground and the entity creating the design documentation often from remote locations.

This guide brings salient issues of project feasibility to the forefront of the conversation.

Like the Human‐Centered Design Toolkit, this guide provides templates which allow the designer to outline their project goals, methods, and projected outcomes in a concise manner. the "Community Design Primer" by Randolph Hester18‐Developed by one of the pioneers of community based design processes, this book defines methods of holding stakeholder inclusive design sessions aimed at creating context specific solutions to complex problems.

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Sustainable Sites Initiative. 2009. The Case for Sustainable Landscapes. (http://www.sustainablesites.org/report)

16 IDEO. Human Centered Design Toolkit. Publication. IDEO / BMGF, n.d. Web. Sept. 2013. (http://www.hcdconnect.org/toolkit/en)

17 Design Impact, and Tarsadia Foundation. Design and the Social Sector: A Guide to Partnering. Publication. Tarsadia Foundation, n.d. Web. Sept. 2013.

(http://www.d‐impact.org/design‐and‐the‐social‐sector‐a‐guide‐to‐partnering/)

18 Randolph T. Hester. Community Design Primer. Mendocino, CA: Ridge Times, 1990. Print.

15 Jeremy Gibberd. Sustainable Building Assessment Tool (SBAT‐P) V1

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Human development indices were also consulted to align project‐scaled objectives with global goals for sustainable development:  

The Millennium Development Goals (UN 2013)19 and The Human Development Report (UNDP 2013)20 was used to identify goals that the UN and UNDP have classified as primary indicators of positive human development. These indicators include human health issues like access to water and food, sanitation, and healthcare services. The indicators also include aspects of ecological “health” measured by species diversity, habitat loss, etc.

When used together, all of these different guides, systems, and goals can inform positive development in areas that have little or no regulation in building/construction and even less basis for methods to guide sustainable building and site design.

In Phase III, this tool was used to retrospectively evaluate the three projects designed by the author in Kenya and was used to examine other projects of similar typologies in order to inform the algorithms which governed the rating system, the scope of design considerations, and the outcomes which were projected when applied to a real project in the context being studied. Case Studies #1 (Ekialo Kiona Community Center), and #2 (Solar Powered Aquaponics), were evaluated from conception and planning stage through construction and post‐occupancy. Project #3 (KGSA Safehouse), is still in its fundraising stage and thus, provides a different type of case to evaluate the applicability of the tool. This project allowed the author to predict the impact of certain design/engagement decisions on the project in its un‐built state. This setting was not available in the other cases. The multiple case study approach identified gaps in the list, over‐prescriptiveness demanded by some of the indicators within the rating system, and served to combine and simplify various considerations across lists and within categories so that the tool could be applied to many different contexts around the world, not just to those within the Kenyan context.

Although the methodology employed by this research project used a wide range of precedents in its aggregation and comparison and used a rigorous method of evaluating their strengths and shortcomings, there are many other rating systems available (Green Globes, Well Building Standard, etc.) which, if included, would have undoubtedly produced a slightly different outcome. Further, some indicators within the proposed rating system were incorporated solely based on a set of case studies administered by the author within the country. These areas were not directly translated from existing standards and are therefore subject to some level of scrutiny based on a small sample size and author bias. This type of inferred inclusion was necessary to address the context of Rural Kenya which was well outside the scope of most rating systems and therefore was not considered to be part of achieving project sustainability. It is the hope of the author that others will add to this list of project considerations, test it extensively, and reevaluate its worth, use, and outcome.

19 Millennium Development Goals 2013. Publication. The United Nations, 2013. Web. Sept. 2013. (http://www.un.org/millenniumgoals/pdf/report‐2013/mdg‐

report‐2013‐english.pdf)

20 Human Development Report 2013. Rep. United Nations Development Program, 2013. Web. Sept. 2013.

(http://hdr.undp.org/sites/default/files/reports/14/hdr2013_en_complete.pdf)

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Assumptions and Next Steps In developing a tool to evaluate complex interdependencies among multiple factors, there are various inherent biases, assumptions, and compromises that are made to create a cohesive paradigm of assessment. Often, the process of reducing complexity in a given situation in the built environment involves creating a reductive list of “categories”. This study was no exception to that rule but thought about the reductive list as a way to understand and design for the complexity that is present in many rural African contexts. To use the words of John Muir, "When we try to pick out anything by itself, we find it hitched to everything else in the Universe."21 In the context of rural Kenya, complex interdependencies are embedded in the relationships that exist among people, the natural environment, built infrastructure, and economic/political infrastructures. To take this range of influences into account within a single tool reductive lists were generated for each lobe of influence that were looked at as separate but dependent factors that ultimately influence the lasting sustainability of an environment.

In the process of reducing the complexity of the situation into a legible tool, the author used immersive experiential research conducted over several visits to Kenya from 2009‐2013 and extensive academic research into human/infrastructure/environmental relationships present in this particular geographic context to guide the development of considerations that are “hitched” together in the web of any geographic location. In another location, these relationships may change considerably. Given different climatic, cultural, political, economic and environmental factors, the next iteration of this tool should take into account localized factors in many different locations and possibly alter the scope of some of the metrics to be applicable to many different rural contexts. This study has catered its agenda to a rural Kenyan, and more specifically, a Maasai/Kipsigis cultural context. In this sense, the tool is not directly applicable to different locations without modification. In an effort to create a prototype it was important to direct the metrics toward a particular location that had a few important qualities: 1. The author had personal experience in the building industry of that context.

2. There were past and current projects which could be evaluated either retrospectively or prospectively using the rating tool.

3. Other professionals in the building/development industry could both help cater the tool to a wide range of uses, and use the tool once it was developed to advance sustainable building practices in rural areas.

This tool used country‐wide UN data that is publically available for almost every country in the world to “weigh” factors dynamically given a particular location. In future iterations of this type of tool, the idea of “localized weighting” should be explored further to adjust the priorities of a project to “treat” the inherent site risks and harness the potential present in any location. Possible means of creating this type of weighting system could use GIS buffers either in ArcMap or GIS Online for a particular location to attain localized information which would alter the importance of certain metrics within the tool. Web crawlers and queries using SQL databases to find cultural data, weather data (.WEA files)22 and other

21 John Muir. My First Summer in the Sierra Boston: Houghton Mifflin, 1911, pp. 110 22 http://www.ncdc.noaa.gov/climate‐information

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information could be used to generate climatic stocks and risks models much like a SWOT analysis.

Lastly, more descriptive UN data sets, when considered as part of a larger inquiry, could create a “snapshot” of a particular location on the globe with information more closely catered to sustainable architectural development. This type of analysis would be more useful in comparison to current “country snapshots”23 developed by the UN to assess human development indices around the world.

While useful as a weighting system for a pilot project such as this, a more rigorous and localized system than the UN developed country snapshots should be employed to create a tool that can truly be applied to a number of different cultural, ecological, economic, infrastructural and political contexts.

23 http://unstats.un.org/unsd/environment/Questionnaires/country_snapshots.htm

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Timeline Nov 5th – Nov 12th – GGHC and loose ends incorporated into the tool.

Nov 12th – Nov 21st – Prep for Research Slam and Mid Term Presentations Nov 21st – Dec 5th –Inclusion of case studies to examine the tool and cost/energy estimating widgets.

Dec 5th‐Dec 12th – Writing bibliography, literature review, methods, findings, assumptions etc.

Dec 12th – Dec 20th – Finalization of paper, presentation, in design file, excel tool, and loose ends Dec 20th – Jan 19th – Fundraising Package, Prep for final presentation and creating all deliverables in final format.

Important Dates Nov 14th – Graduate Research Slam (UMN) Nov 21st – Mid Term Presentation at UMN Dec 26th – Jan 6th Matt in NY (Try to set up meeting with NY office) January 19th – Final Presentation of Research at UMN and delivery of fundraising material to NY office.

Deliverables Word Document – Abstract, Introduction, Methods, Literature Review, Bibliography, Assumptions/Findings, Next Steps, and Conclusion In Design File‐ Interactive PDF with complete Baraka Site analysis. Library of resources (Articles, Books, Websites, Maps, Graphs, Images, Movies, Case Studies) ‐Also included is a blank indesign template with interactive features embedded for use in later projects.

Excel Tool – Rating system tool integrating multiple rating systems, guides for immersion, and human development indexes.

PDF Presentation—A presentation outlining the history, methodology, use of the tool, and case study outcomes as validation for the excel tool.

Fundraising Package—3D renderings and plans showing schematic level design for the Baraka Clinic.