Capital Project Delivery Models for High Risk Healthcare Infrastructure in Developing National Health Systems

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@article{1713588,
      author = {AbuYusuf Aminu-Ibrahim, John Chinemerem Ogbete, Kazeem Babatunde Ambali},
      title = {Capital Project Delivery Models for High Risk Healthcare Infrastructure in Developing National Health Systems},
      journal = {Iconic Research And Engineering Journals},
      year = {2019},
      volume = {2},
      number = {10},
      pages = {626-649},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1713588.pdf},
      abstract = {High-risk healthcare infrastructure projects such as tertiary hospitals, diagnostic laboratories, trauma centers, and infectious disease facilities are critical to health system resilience in developing national health systems, yet they frequently experience cost overruns, delays, safety incidents, and performance shortfalls. Capital project delivery models strongly influence risk allocation, governance, accountability, and lifecycle outcomes, but evidence on their suitability for resource-constrained contexts remains fragmented. This paper examines capital project delivery models for high-risk healthcare infrastructure, evaluating traditional Design?Bid?Build, Design?Build, Construction Management at Risk, Public?Private Partnerships, and Integrated Project Delivery through a systems and risk-informed lens. Drawing on comparative literature, policy analysis, and documented project outcomes, the study analyzes how contractual structures, procurement timing, stakeholder integration, and financing mechanisms shape safety assurance, clinical functionality, and value for money. Particular attention is given to regulatory capacity, supply-chain fragility, skills shortages, and political economy factors that amplify risk in developing systems. The analysis demonstrates that while Design?Bid?Build offers familiarity and transparency, it often fragments responsibility and weakens early clinical integration. Design?Build and Construction Management at Risk improve schedule certainty but require robust client capability and oversight to prevent quality erosion. Public?Private Partnerships can mobilize capital and operational expertise, yet demand strong governance, realistic demand forecasting, and long-term fiscal discipline. Integrated Project Delivery, though rare in developing contexts, shows promise for complex healthcare facilities by aligning incentives, enabling early clinician engagement, and embedding safety-by-design, provided enabling legal and institutional reforms exist. The paper proposes a context-sensitive selection framework that aligns project risk profiles with delivery models, emphasizing early stakeholder integration, performance-based specifications, staged financing, and whole-life cost accountability. By synthesizing delivery-model trade-offs and contextual constraints, the study provides actionable guidance for policymakers, health planners, and development partners seeking to deliver safe, functional, and sustainable high-risk healthcare infrastructure under uncertainty. Implications include improved procurement governance, clearer risk-sharing matrices, enhanced clinical-user participation, digital project controls, and adaptive capacity-building strategies that strengthen institutional readiness, safeguard patient safety, and improve long-term operational performance across diverse epidemiological, fiscal, and sociopolitical environments while supporting transparency, accountability, resilience, scalability, and equitable access to essential health services within fragile and rapidly evolving development contexts globally.},
      keywords = {Capital project delivery models; Healthcare infrastructure; High-risk projects; Developing health systems; Public?private partnerships; Integrated project delivery; Risk management; Governance},
      month = {April},
      doi = {https://doi.org/10.64388/IREV2I10-1713588}
  }