Brazil – Healthcare and Architecture 27 January 2011

Sunny place, exciting views, colourful art in white interiors, well designed buildings with state of the art technology: we were transported to Sao Paulo to revisit hospitals enjoyed by members of A F H on the International study trip 2010.

The evening was hosted at the Brazilian embassy and we became aware of the contradictions of a country with both money and poverty: wonderful fresh food but no heating! Brazil is one of the fastest growing economies in the world. Sao Paulo is a huge conurbation, second only to Mexico city, with 20 million population and x hospitals.

The A F H members shared their experience by showing a selection of the hospitals they visited. First Lara Kaiser introduced us to the healthcare system: All Brazilians have the right to receive health services as enshrined in the country’s 1988 Constitution. Modelled on the NHS, Brazil’s Unified Health System (“Sistema Único de Saúde”, or SUS) was created two decades ago to decentralise the delivery of services. Under the SUS, it is primarily the job of municipal administrators – Town and City Halls – to manage public health services, while more general administrative responsibilities are the preserve of the Federal Government. Arguably, the municipal administrations have been slow to adapt to their new role, partly as a result of Brazil having more than 5,000 cities, 25% of which have less than 5,000 inhabitants, and partly because a slew of economic, political and administrative issues remain unresolved. Brazil’s public healthcare services are underfunded, chaotic and poorely organised. Queues, lack of doctors for basic care services, lower levels of comfort and amenities than those found in private hospitals are the norm. Unsurprisingly, 28% of Brazilians, according to estimates, turn to the private system for healthcare, and are covered by private health insurance. The remaining 72% use public facilities or can access private hospital services – funded by the public sector – for specific treatments or surgery that the public sector cannot provide.

Roy Carroll started our tour with a look around the University Heart and Cancer institutes. Housed in an uncompromisingly early modernist building of some stature, the overall design had strong forms and resilient material eg marble floors and window surrounds. The spaces were clean, uncluttered and fitted with impressive technology and equipment. The world renowned institutes had been designed with care and attention to detail: we were assured that blue walls and red carpets were just the right background if you are viewing scanning images. However, these spaces were in stark contrast to the rest of the hospital with its soulless OPD, scary pharmacy and near sci-fi ramps in public spaces: but then as Neimeyer said
Architecture is not important: But important is life.

Claudia Bloom showed us two private maternity units: both light and welcoming with well detailed modern interiors. The Santa Joanna Maternity Hospital was arranged in single rooms with babies kept in bassinets in a communal nursery at night connected to their mothers through CCTV cameras: women able to practice multi- tasking by watching two TV screens simultaneously from their beds- one of their baby and the other showing soaps! Most activity was planned and the rooms personalised with the baby’s name. There was an impressive system for recycling water from the laundry to conserve the environment. The ProMatre Maternity Hospital, another unit belonging to the same private provider, had hotel like bedrooms painted and furnished ij white. The delivery theatres were fitted with windows to the corridors through which family members could observe the surgical deliveries.
Mariangela Zanini focused on Beneficência Portuguesa founded in October 1859, which is now one of the most advanced private hospital complexes in South America. With an impressive 2000 beds arranged in two- bed rooms and 64 operating rooms including transplant and cardiac , this was a machine for modern medicine.

We also saw around one of the 20 Fleury diagnostic centres, each accommodating services to suit their loacality. Almost exclusively white, this crisp and efficient layout provided all the necessary accommodation for basic diagnostic tests in a high street location.
The presentations concluded with an entertaining film composed by Phil Gousak that paid homage to Oscar Neimeyer and Brasilia. Organised and introduced by Vicky Braouzou we felt transported to another world for sure.
Clearly the trip had been a lot of fun. So was this event. And the question on everyone’s lips- where shall we go this year?
Send your suggestions to

Some more information on hospitals visited:

The University Heart and Cancer Institutes
The FMUSP-HC System is the oldest Brazilian academic health system and it originates from the Faculdade de Medicina e Cirurgia de Sao Paulo (established 1913). The new school, with support of the Rockfeller Foundation, established a new model of medical education in the country, with the reorganization of teaching and research, and the implementation in 1944, of a university hospital linked to the school.
Today, the FMUSP-HC System is the largest in the country, comprising – besides the Medical School – institutes specialized in tertiary care, a secondary care hospital, auxiliary hospitals, units specialized in full time care of H1V/AIDS patients, Health Centre School (primary core), Primary Care Units, Medical Investigation Laboratories (LIMs) and Support Foundations.

Maternity Hospitals ProMatre and Santa Joanna
The Maternity Hospitals ProMatre Paulista and Santa Joana have a team of doctors and nurses specialized in gynaecology and obstetrics. In its team, there are also university professors and PhD doctors in obstetrics, gynaecology, neonatology and foetal medicine. It also has the most advanced prenatal exams, intrauterine transfusion and foetal surgery.
The Hospital and Maternity Santa Joana was founded in 1948, as a Health Centre. In 1991, it was redesigned and got a new wing, designed around the modern concept of a hospital-hotel. Together with Pro Matre Paulista (they are part of the same group), it was the first maternity hospital to receive the accreditation stamp of the National Accreditation Organization (ONA), showing the security standards in hospitals.


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