Agenda 111 is a major initiative that incorporates 111 Hospitals including 101 District Hospitals, 2 Psychiatric Hospitals, 7 Regional Hospitals, and the Redevelopment of the Accra Psychiatric Hospital. Commissioned by the Hospital Infrastructure Group (HIG) on behalf of the Ghana Government. It is a major healthcare infrastructure initiative that broke ground two days ago at the official sod cutting ceremony in Ghana’s Ashanti Region.

President Nana Addo Dankwa Akufo-Addo of the Republic of Ghana at a sod cutting ceremony in Ghana’s Ashanti Region that marks the beginning of the construction of 101 District Hospitals designed by Adjaye Associates.

districts location map

Agenda 111 is part of a massive vision for Ghana’s healthcare sector, the realization of which will lead to Ghana becoming a Centre of Medical Excellence and a destination for medical tourism. – President Nana Akufo-Addo

aerial view multiple locations

By approaching the hospital as more than just a place for the provision of medical services, the design scheme aims to unlock the potential of this ambitious initiative by repositioning the hospital as a piece of community infrastructure that embodies sustainability, efficiency, and generously provides green spaces to facilitate wellness and healing.  – David Adjaye

dusk aerial view

The District Hospitals present an opportunity to transform Ghana’s medical system by establishing unparalleled access to healthcare facilities throughout the country. Guided by the ambition to define a next-generation hospital experience, the design concept merges 21st-century technology with a contextual and holistic approach crucial to the delivery of state-of-the-art healthcare.

Each hospital facility is planned as a single-story campus featuring Patient Reception & Processing, Administration, Pharmacy, Labs / Diagnostics, OPD, Physiotherapy, Public Health, A&E, Surgical Ward, Pediatric Ward, Maternity Ward, Isolation Ward, and Surgery. The primary care facilities are then supported by other structures such as Mortuary, Waiting Pavilions, Security Pavilions, Residences for Families and Doctors (separated), Laundry, Waste Management, Energy Centre, Kitchen, Central Store, and Maintenance Yard.

axonometric view

Unlocking the centuries-old wisdom of the Adinkra symbols, our design sought inspiration from the Denkyem, which symbolizes a crocodile—a creature able to thrive with both air and water that is celebrated for its adaptability and intelligence. Acknowledging that the building design will need to adapt to over 101 locations in different urban and rural settings across the country, the design scheme embraces smart strategies and ecologically responsive systems able to conform to each unique geographic condition. The use of prefabricated systems works conductively with materials to maintain the lowest possible carbon footprint whilst also maximizing the ability to reproduce efficiently and rapidly.

concept sketch 1

concept sketch 2

concept sketch 3

design philosophy + organisational strategy

Departing from the assumed poor industry standards of hospitals where visitors often feel lost on arrival, the form of the building becomes a tool for wayfinding with a defined canopied entrance that guides you into the heart of the building. Through a language of clustered horizontal and vertical bars, the building branches out from a central spine that is activated by a central garden and a series of nature-filled public spaces. Easily identified by the lush landscaping situated within the center of the single storey campus’, the introduction of public gardens departs from the status quo of hospital design where all spaces are entirely enclosed and sterile. Instead, the central garden and the ancillary green spaces punctuate the plan and provide an overall atmosphere of healing crucial for patients.

main canopy entrance
central courtyard
public garden and circulation

The patient ward is situated at the outermost perimeter along the rear of the building to ensure natural light and open-air flow, crucial for health and healing.  Designed for their specific functionality, the building’s are differentiated through their roof structures: gable or Butterfly. For programmes such as the patient wards, the Butterfly Roof is used to maximize the amount of natural light and cross ventilation resulting in less energy consumption for artificial lighting and excessive mechanical cooling.

building diagrams
east facing cross section
patient ward

In contrast to the patient wards where maximized light and airflow are welcomed, other spaces such as surgery require a more controlled environment. In these instances, the Gable Roof typology is deployed. This ensures minimum exposure to the natural elements using the roof’s long overhangs to protect against the sun’s rays and provide shade on the building envelope. Despite the differences in the roof structures, both types effectively harvest rainwater and provide an insulated shell to minimize heat gain on the building interiors.

Design Team:

Architect: Adjaye Associates

Design Coordinator: Sutherland & Sutherland Architects

Biomed: Titan Biomedical Engineering

Contractor: Varies

Electrical Engineer: Global Engineering & Technology

Kitchen Consultant: Smollensky’s

Hospital Consultant: Ministry of Health

Landscape: Brix Landscaping

Mechanical Engineer: Global Engineering & Technology

QS: CC&M Consult Ltd.

Signage: Mainline

Structural & Mechanical Engineer: CSEng

Drawings & Renderings: Courtesy Adjaye Associates

Project Animation:

Project Gallery:

Founder and Senior Editor of ArchPosé. An Architect, blogger and editor with unwavering interests in youth driven programs and issues concerned with the development of the built environment of Ghana/Africa. A volunteer at heart, speaker, programs coordination and anything related to progressive, positive, passionate mindset change for development. Follow me on Twitter/Instagram @danielmolesarp and email me at