Agenda 111. The Proposed Construction of One Hundred and Eleven Hospitals in Ghana
Location: Multiple Locations, Ghana
Lead Architects: Adjaye Associates
Design Consultants: Sutherland and Sutherland Architects
Agenda 111 is the latest large-scale hospital construction project initiated by the Government of Ghana. The project is so named because it is expected to deliver one hundred and eleven (111) Hospitals upon completion.
The project is a turnkey project with “Hospital Infrastructure Group Ltd” (HIGL) as the named client. HIGL state on their website that they “seek to provide excellent healthcare infrastructure as a turnkey solution for both government and private clients”. From their website they appear to be an offshoot of the firm Sutherland & Sutherland Associates (who worked on Ashesi Univeristy), and state that their firm “was registered as a partnership in 1996 having grown out of Ralph’s Studio, an architectural practice established in 1984. Since then, Sutherland & Sutherland has evolved into one of the respected architectural and project development firms in Ghana.” (Hospital Infrastructure Group Ltd Website). Sutherland & Sutherland, in addition to being the turnkey providers are also the Design Consultants for the project. A full list of consultants is available on the Adjaye Associates website.
One hundred and one (101) of the total 111 hospitals are District Hospitals to be designed by David Adjaye’s Adjaye Associates. These 101 District Hospitals bring the number of Ghanaian state projects being designed by Adjaye to an even larger sum. Seven (7) are Regional Hospitals not yet known to be assigned to any architecture firm, and two (2) are to be Psychiatric Hospitals. The Accra Psychiatric Hospital is also to be redeveloped as part of the extensive project. Neither of these latter two have been assigned to an architect yet, so this article focuses on the 101 Hospitals to be designed by Adjaye.
Visualisation of Proposed District Hospital By Adjaye Associates. Image Credit Adjaye Associates
But first, some background information on past hospital construction projects in Ghana.
Over the past twenty years, successive governments have initiated their own large-scale hospital construction projects with often abysmal outcomes. Several of those projects, once began were never completed. Others, although completed to a large extent, have been left disused empty of the necessary equipment and staff to make them functional hospitals.
Kojo Akoto Boateng and the Citi Breakfast Show team have compiled a list of some of the “‘abandoned’ (hospital) infrastructure in Ghana”, and found that 11 of those projects if finished would “collectively would add over 5270 beds to the current national capacity of 20000 beds, approximately 25% of the total capacity of the healthcare system” (Dadzie, Citi News, 2018). It is important to note that before a project reaches the sod-cutting or start of construction phase, significant amounts of money would have already been spent. So the abandonment of a typical hospital project even at the start means a significant loss of hundreds of thousands of Ghana Cedis at a minimum. When one considers the advanced stage of construction at which the list of projects compiled by Akoto Boateng, this is cause for concern. Thus many Ghanaians, including President Akufo-Addo, have bemoaned the spate of abandoned hospital projects in the country.
Now, back to Agenda 111.
Agenda 111 was launched after sustained calls to the president to keep the promises he made in the height of the covid-19 pandemic to build 88 hospitals within a year. He promised on 26th April, 2020, that that the 88 hospitals would be completed within a year, but a year later this remained unfulfilled. The covid-19 pandemic, as others have observed, seemed to come at a somewhat greater shock to various African leaders who had suddenly encountered a disease that they could not travel to Europe, the USA and occasionally South Africa to treat on account of travel restrictions. Following this alarming discovery, some African leaders pledged to once and for all fix their failing healthcare systems. Agenda 111 is part of the attempt by the Akufo-Addo government to follow through on their promises. Whether or not it joins the list of uncompleted hospital projects remains to be seen.
Adjaye Associates announced the part they are playing in Agenda 111 with a video on Instagram. The accompanying caption stated, among other things, that “the District Hospitals present an opportunity to transform Ghana’s medical system by establishing unparalleled access to healthcare facilities throughout the country”. Their video features visualisations of the project with Ephraim Amu’s Yen Ara Asaase Ni as theme music. With the first few lines of the patriotic song, composed in 1929, which remind us of the blood that ancestors shed for the land, we see an aerial view of the proposed design rotating as the surrounding landscape changes, showing the hospital in context of some of the 101 different locations.
In some of the photorealistic renderings, we see that the proposed hospital seems to sit atop some existing buildings indicating that there may be planned demolitions to make way for some of the hospitals. In other views, it seems to be in the middle of dense vegetation with no surrounding buildings. In others the district hospitals sit in what seem to be a dense urban environments. From the nearly 2-minute video presentation, it can be seen that the proposed district hospitals - said by the architects to be derived from the Akan Adinkra symbol “Denkyem (dɛnkyɛm), which symbolizes a crocodile” - will be quite similar, if not identical in all of these locations across the nation, though “adapt(ed) to over 101 locations in different urban and rural settings”.
And finally, about Adjaye in Ghana and the current politics of construction procurement and state architecture in Ghana.
The reception of the news that Adjaye is to design even more buildings for the state has been met with consternation by some in the architecture community. Architect Tony Asare, Principal Architect at Tekton Consult, in an article published by Citi News quotes comments and questions he received from other architects concerning the news:
”so now Local Ghanaians cannot even design District Hospitals and that has to be given to Adjaye and Associates?” I retorted that of course he is Ghanaian. “But it was handed over to him on a silver platter?” was a response. “In addition to all other large projects; the Cathedral, and a long list of projects”.
The last sentence references the last time architects in Ghana were up in arms about a similar announcement that Adjaye had been appointed to design yet another massive state project. In his article, Asare declared:
“I join my colleague architects to say we are seriously concerned with the consistent abuse of Section 40 Procurement Act, without conscience and no attempt to equitably and legally go through the process for local architects who also make a living. There are about 1,200 architects in Ghana and we are not incompetent.”
The Honorary Secretary of the Ghana Institute of Architects, Augustus Richardson has called out the sidestepping of fair architectural competition and the lack of openness and transparency around the selection of David Adjaye to design 101 hospitals under the Agenda 111 project. He also criticised the government for not following it’s own procurement laws, or it’s own public statements committing to fair, transparent and legal procurement practices - such as the ones made by Vice President Bawumia and Ken Ofori-Atta, Minister of Finance at the incidentally titled “Value for Money Conference on the Construction of Roads, Schools and Hospitals”. As Richardson plainly put it in an interview on the “Kapito Show” on Metro TV,
“This is wrong… I would be shocked if someone says it is right. It is not the right way to go. You need to open it up, for ideas…”
Richardson also pointed out that in other jurisdictions with better “best practices”, Adjaye has entered and won architecture design competitions against other global heavyweights in fair and open competitions, stressing that “it is important” for the government “to grant those…in the country the opportunity to express their thoughts”.
Both Richardson and Asare were emphatic about the fact that they, like many other architects in Ghana, welcomed the entry into Ghana by David Adjaye - both when he opened his first office which closed after a few years, and when he reentered and reopened his office as the architect of choice of the NPP Government with the National Cathedral Project - but were disappointed by the current turn of events.
The theme of “local architects” versus “foreign” or foreign-trained architects, is a recurrent one in the debates and concerns over the apparent monopoly of Adjaye’s firm. In July 2019, the president of the Ghana Institute of Architects, Architect Richard Nii Dadey and Architect Ekow Sam petitioned the government over a list of several major public projects that had ostensibly been awarded to David Adjaye by the government (including the “National Cathedral, New Parliamentary Chamber, Marine Drive Master Planning, International Cancer Centre for Children, Trade Fair Centre Redesign, GNPC Accra Head Office, GNPC Takoradi Office Complex, New Office Complex for the Bank of Ghana (Cedi House 2), Airport City 2 Design, New Railway Terminal Design, Okyehene Palace Design, Redevelopment and Expansion of Ghana Embassy in US”). Among other things, their petition stated that:
“Due to the monopolisation of awarding projects to Foreign Architects and Engineers, the negative impression and image is being created in the public that, locally trained architects and engineers are incompetent and not qualified to undertake such projects in the country, which is totally untrue,”
In responding to the petitioners regarding one of the named projects, the Parliamentary Service Board insisted that “it followed the required process leading to the choice of the eventual winner, which is owned by renowned British architect of Ghanaian descent, Sir David Adjaye” (Modern Ghana, 2019). In any case, the Parliamentary Chamber project has apparently been put on hold after many Ghanaians threatened a protest and used the #DropThatChamber hashtag on social media to resoundingly reject what they saw as an unnecessary expense. Adjaye Associates also responded to the petition, stating that they were “doing legitimate business in the country and (had) not infringed any laws”(Melvin Tarlue, Daily Guide, 2018).
The artist, political cartoonist and satirist Bright Tetteh Ackwerh has also weighed in on Adjaye in Ghana with two cartoons referencing key issues. As is his typical approach, his cartoons channel popular culture and political commentary to drive his message as in the examples below. The image on the right depicts Akufo-Addo holding on rather strongly to a model of Adjaye’s Cathedral, while Ackwerh’s caption states his disappointment with the president for channelling resources into “another church in the capital” and with some visual artists who are involved with the project. The image on the left depicts Adjaye urging on Akufo-Addo as he does the #CrateChallenge, a viral, as of August 2021, video challenge which has been criticised as foolhardy and dangerous.
Ghanaian Political Cartoons featuring Adjaye and his projects in Ghana. Cartoons by Bright Ackwerh
It cannot be ascertained if this Agenda 111 Hospital project will break from the norm of failed hospital projects and succeed. A thing however that is clear and easy to predict is that this is not going to be the end of complaints about government flouting of procurement laws. Neither as another election season fast approaches, is this likely to be the end of Adjaye looming large as a figure in the politics of construction procurement and state architecture in Ghana.