Lessons In Green Building From Africa’s First LEED-Certified Hospital

“We’re able to prove that sustainability doesn’t take high-tech solutions,” says architect Pat Bosch.


When Ghana commissioned a new hospital for its capital city Accra, the West African nation hoped to earn LEED certification, a prestigious rating of environmentally minded buildings. But “they believed there was very little hope for us to achieve it,” says Pat Bosch, design director of Perkins + Will’s Miami office and the project’s lead architect. Much of the infrastructure that supports green building in the U.S. and Canada, where LEED is most common, doesn’t exist in Ghana. But by rethinking the parameters of what a building should be, the architects were able to complete Africa’s first LEED for Health Care–certified hospital.


“You can achieve so much more in terms of energy-efficient, smart buildings by simply doing the right things,” Bosch says. “You don’t have to over-cool, you don’t have to over-light–there are ways of being more responsive to the environment. In the West, we’re obsessed with creating these closed boxes.”

Accra is a fast-growing, rapidly modernizing city. “Ghana and its Ministry of Health are a very visionary entity, and they have been progressing quickly in infrastructure,” Bosch says. “They believe they need to build smart, resilient infrastructure and are addressing a lot of their challenges using the framework of sustainability as a platform–they want to be on the forefront of the continent in terms of sustainable building . . . LEED is a certification and it is a validation.”

Still, Accra is a developing city with significant infrastructural and resource challenges. Electricity is unreliable. In 2014, when the project began, the city experienced blackouts 159 days of the year. The country is experiencing a drought and water is in short supply. Service interruptions are also routine. Moreover, the construction industry isn’t as well versed in the building and maintenance practices that are common the the West. These conditions didn’t support the installation of technically advanced mechanisms and materials. And even if the builders imported the materials commonly specified in LEED-certified buildings in the West, such a move wouldn’t be wise long-term. “It’s difficult to do LEED for Health Care, Usually, it’s achieved when you use technology like smart shading,” Bosch says. “Here we were working with brick-and-mortar construction and infrastructure that was unreliable . . . It would’ve been irresponsible to bring a lot of tech they couldn’t maintain or operate successfully.”

[Rendering: via Perkins + Will]

So instead of imposing Western building practices and techniques to achieve LEED for Health Care Silver, Perkins + Will looked for ways to design and build that were rooted in Accra.

That included natural ventilation. “This attitude of natural ventilation is not something that hospitals in the West look into because of infection control and temperature control, so you rarely have the operators or the facilities managers willing and able to go there,” Bosch says. But it was a necessity since Perkins + Will couldn’t rely on a technologically complex HVAC system. The hospital even includes outdoor rooms for large groups (culturally, most of the waiting at hospitals happens outdoors).


A solar hot water heater–made possible by the hot climate–helps curb reliance on electricity. In the event of service interruptions, an emergency generator can power the entire hospital.

Another by-product of limited power is the layout of the building itself. Elevators weren’t possible because of their power draw so the architects designed a long, but stout, building. A fully walkable ramp connects the four stories and is prominently featured in the design. “The building was fully driven by the fact that we could not rely on an elevator in vertical,” Bosch says. “Hospital ‘streets’ weave through the building, and since we had to think about it this way, we celebrated it.”

The building isn’t connected to a municipal water supply, and all of the water used is either trucked in or harvested on-site. Ghana is experiencing a drought, but when it does rain, water is collected and stored in cisterns buried underneath the building.

[Video: Bouygues Construction]

The $1 million question remains: Was it worth pursuing LEED, a system designed for buildings in Western settings, in a non-Western setting? Bosch says yes–but with conditions that ought to be thought of in the West, too.

“I think LEED is a great platform to start with and frame projects, but it should not be the only qualifier,” she says. “Do what is smart, what is efficient, and do not do certification the way some other people do, which is ‘buying’ points [through unnecessary design details].”


To Bosch, the real lesson in applying LEED to the hospital in Accra is more about what the West can learn. “What is wonderful in working on these projects is the benefit of bringing ideas to projects in the West,” she says. “We’re able to prove that sustainability is doable and it doesn’t take high-tech solutions. Simplification yields a lot more results.”

Update: This post has been updated to reflect the hospital earning a LEED for Health Care Silver rating

[Photos: Cyril Abad]

About the author

Diana Budds is a New York–based writer covering design and the built environment.