{"presentation":{"slides":[{"elements":[{"x":18.51851851851852,"y":4.319654427645788,"width":79.520697167756,"height":88.55291576673866,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

Ventilation is defined as the supply\/ distribution\/ exchange or removal of air from spaces by mechanical or natural means.<\/strong><\/span><\/span><\/p>\n\n

\n\t
Airflow is a natural process whenever there is change in temperature or pressure. Air keeps moving displacing the room air, and the time to replace the entire in-room air depends on the size of the room, the openings, and the presence of additional\/mechanical force. <\/span><\/li>\n\t
This air-flow, also called ventilation, will allow the entry of outside air or clean recirculated air to remove extra heat, humidity and infectious aerosols from occupied spaces to meet health and comfort requirements. <\/span><\/li>\n\t
When fresh air enters a room, it dilutes the concentration of particles in room air including aerosols responsible for the transmission of TB that can otherwise remain suspended in the air for significant periods of time.<\/span><\/li>\n\t
Thus, ventilation is recognized as an important factor influencing the transmission of airborne diseases.<\/span><\/li>\n<\/ul>\n\n
<\/p>\n"},"subContentId":"b56bad04-2422-42e5-ae22-0294b7710040","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":2.178649237472767,"y":32.4622030237581,"width":15.359477124183007,"height":30.23758099352052,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64192a9cc829a.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"63a706b0-71cc-410b-a308-a02562ef96a3","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":7.625272331154684,"y":0,"width":79.520697167756,"height":100,"action":{"library":"H5P.Table 1.1","params":{"text":"
\n\t\n\t\t\n\t\t\t
\n\t\t\t\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t<\/colgroup>\n\t\t\t\t\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\n\t\t\t\n\t\t\t
\n\t\t\t\t\t\tType of Health care setting <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\tMinimum ACH<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t\t
\n\t\t\t\t\t\tRegistration\/Waiting<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\t><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span> 6 ACH<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t\t
\n\t\t\t\t\t\tOutpatient departments<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\t><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span> 6 ACH<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t\t
\n\t\t\t\t\t\tInpatient departments<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\t><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span> 6 ACH<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t\t
\n\t\t\t\t\t\tHigh-risk settings<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\n\t\t\t\t\t\t ART centres, TB \/ Chest departments (outpatient and inpatient) , <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>Bronchoscopy procedure rooms, <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>MDR-TB wards and clinics, Airborne isolation rooms<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span> <\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t\t \n\t\t\t\t\t\t><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span> 12 ACH<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/td>\n\t\t\t\t\t<\/tr>\n\t\t\t\t<\/tbody>\n\t\t\t<\/table>\n\t\t\t<\/th>\n\t\t\t <\/th>\n\t\t<\/tr>\n\t<\/thead>\n\t
<\/td>\n\t\t\t <\/td>\n\t\t<\/tr>\n\t\t
<\/td>\n\t\t\t <\/td>\n\t\t<\/tr>\n\t<\/tbody>\n<\/table>\n\n
<\/div>\n"},"subContentId":"0fe69957-4f20-49f9-a9df-6be6c11b8e8b","metadata":{"contentType":"Table","license":"U","title":"Untitled Table"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":2.178649237472767,"y":67.02203023758099,"width":91.50326797385621,"height":33.04535637149028,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Air changes per hour or ACH is the number of times that the total air volume in a room or space is completely removed and replaced in an hour. <\/span><\/span><\/strong><\/p>\n"},"subContentId":"6922ac3a-3422-4c56-9f38-4f4e1f0d6917","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":20.697167755991288,"y":6.479481641468682,"width":66.44880174291939,"height":6.479481641468682,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Types of Ventilations<\/strong><\/span><\/span><\/p>\n\n
\n<\/ul>\n"},"subContentId":"88b152fe-58b6-4506-be30-42c34a98dd58","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":53.37690631808278,"y":19.478941684665227,"width":44.66230936819172,"height":77.7537796976242,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Natural ventilation is the preferred method for ensuring adequate air exchange<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\n
\n\t
\n\t
Natural ventilation is achieved by designing a layout that supports the unrestricted flow of natural air<\/strong>.<\/span><\/p>\n\t<\/li>\n\t
\n\t
For effective cross-ventilation, openings (windows and doors) should be at least 10% of the floor area on each side (total 20%)<\/strong><\/span><\/span><\/span><\/span><\/span><\/p>\n\t<\/li>\n\t
\n\t
Doors and windows should be kept open<\/strong> to bring in fresh air from outside.<\/span><\/p>\n\t<\/li>\n\t
\n\t
The placement of furniture, equipment, supplies etc. should not block<\/strong> or restrict the opening of doors and windows.<\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"57bf8a6c-b349-4a83-b5c9-dde17cf06521","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":25.91792656587473,"width":22.875816993464053,"height":5.183585313174946,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
1. Natural Ventilation<\/strong><\/span><\/p>\n\n
<\/p>\n"},"subContentId":"66ccef0d-dc89-4ae0-99e1-465a4a6db4af","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":1.0893246187363834,"y":38.99827213822895,"width":50.10893246187364,"height":49.0280777537797,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-65ae1444e8760.png","mime":"image\/png","copyright":{"license":"U"},"width":1573,"height":622},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"1472eea2-3fd6-40d5-8425-ce3460a21842","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":17.429193899782135,"y":4.326393088552916,"width":61.00217864923747,"height":77.96976241900649,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-65ae14b5b4f45.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1112,"height":743},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"535524fa-075d-4378-a647-aa8d0cfc84d1","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":11.982570806100219,"y":84.49654427645788,"width":76.25272331154684,"height":8.855291576673867,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Partitions can reduce the air exchange in parts of rooms<\/strong><\/span><\/p>\n"},"subContentId":"e5da327b-73b1-4f53-b8ad-bde67fa90a60","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":19.43844492440605,"width":26.143790849673202,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
2. Mechanical Ventilation<\/strong><\/span><\/p>\n"},"subContentId":"a7f68541-2681-4221-8d48-fa66bc238f19","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":35.947712418300654,"y":15.132289416846653,"width":63.18082788671024,"height":79.91360691144709,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
When the movement of air is driven by a mechanical device, it is called mechanical ventilation.<\/span><\/p>\n\t<\/li>\n\t
\n\t
Exhaust ventilation is especially appropriate in high risk areas where persons tend to close the windows and doors when cold or at night-time<\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\t<\/li>\n\t
\n\t
Exhaust fans fitted in windows\/ ventilators exchange air from inside the facility to the outdoors.<\/span><\/p>\n\t<\/li>\n\t
\n\t
Ceiling fans\/ tabletop fans\/ pedestal fans have rotating blades to circulate air inside the room. Tabletop and pedestal fans can be positioned in the room to allow the directional flow of air.<\/span><\/p>\n\t<\/li>\n\t
\n\t
\u2022<\/span>If mechanical ventilation is used, the system should be <\/span>well designed, maintained and operated<\/span>,<\/span> to achieve adequate airflow rates and fresh<\/span><\/span> air exchange<\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"54f7e31b-c5ca-41ee-be73-1bb2e4218f9f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":6.5359477124183005,"y":30.23758099352052,"width":20.250088594137598,"height":40,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64192857302c5.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"1be7bf7c-43ab-4cf2-899f-1b139e0346a7","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":7.625272331154684,"y":28.077753779697623,"width":19.716775599128542,"height":38.66090712742981,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641924c798370.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"metadata":{"contentType":"Image","license":"U","title":"Untitled Image"},"subContentId":"b4db8b1b-a203-41fe-b234-79e927c579ab"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":3.2679738562091507,"y":15.145788336933045,"width":43.57298474945534,"height":10.799136069114471,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
3. Hybrid\/ Mixed-mode Ventilation<\/strong><\/span><\/p>\n"},"subContentId":"78bedfd5-cabb-4829-9b54-4a2500cf4a6b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":37.03703703703704,"y":36.717062634989205,"width":59.694989106753816,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
In hybrid\/ mixed-mode ventilation exhaust and\/or fans are used in combination with natural ventilation to obtain adequate air dilution when sufficient airflow cannot be achieved by natural ventilation alone.<\/span><\/p>\n"},"subContentId":"baf2c930-0f7a-4ca3-b602-a70e4f03e24f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":14.161220043572985,"y":2.159827213822894,"width":61.00217864923747,"height":73.43412526997841,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641929334939f.png","mime":"image\/png","copyright":{"license":"U"},"width":952,"height":504,"originalImage":{"path":"images\/file-64192909828e6.png#tmp","mime":"image\/png","height":1080,"width":1920}},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"85b29f30-79ee-4081-80fd-0c1a75d3ce27","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":1.3071895424836601,"y":73.43412526997841,"width":98.69281045751634,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Figure: Natural ventilation achieved by opening doors and windows or using mechanical ventilation using fans and an exhaust fan for air mixing and directional flow (A); the flow of natural air should not be restricted by blocking doors and windows (B); Cross ventilation is not adequate if there is only one entry point for outside air (C); Source: Tuberculosis and HIV Co-Management<\/a> and Tuberculosis And Airborne Infection Control<\/a>.<\/span><\/p>\n\n
<\/p>\n"},"subContentId":"35ff3089-93f0-46d7-a71f-b124d495aa23","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":2.178649237472767,"y":88.73650107991361,"width":95.86056644880175,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Table: <\/strong>Summary of Advantages and Disadvantages of Different Types of Ventilation; Source: <\/em>Guidelines on Airborne Infection Control in Healthcare and Other Settings<\/em><\/a>.<\/span><\/p>\n"},"subContentId":"4be1fbf2-661f-4a4d-a57a-71628dcaaa46","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":8.639308855291576,"width":92.5925925925926,"height":79.91360691144709,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-641929eec42a4.png","mime":"image\/png","copyright":{"license":"U"},"width":1019,"height":500,"originalImage":{"path":"images\/file-641929cf81302.png#tmp","mime":"image\/png","height":1080,"width":1920}},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"a11229da-332f-4882-8edf-fcdd82eefd9d","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":16.338126361655775,"y":15.145788336933045,"width":64.27015250544663,"height":74.08207343412528,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-65ae164deeefe.jpg","mime":"image\/jpeg","copyright":{"license":"U"},"width":1412,"height":824},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"a4536e77-5760-42d7-8ffb-64da9b3f9b38","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":4.357298474945534,"y":0,"width":90.41394335511983,"height":67.81857451403887,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Preferences of types of ventillation in health facilities for prevention of air borne transmission of infections.<\/strong><\/h2>\n"},"subContentId":"5390b461-4250-4c69-bee0-353a8fa100c1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":2.178649237472767,"y":90.807343412527,"width":95.86056644880175,"height":9.071274298056156,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Natural ventillation with adequate cross ventillation is the preferred one However, if that is not possible, hybrid methods with mecahnical ventillations need to be carefully designed<\/p>\n"},"subContentId":"99485268-30af-4026-88b2-21d2916387fc","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":1.0893246187363834,"y":53.99568034557235,"width":93.68191721132898,"height":43.196544276457885,"action":{"library":"H5P.SingleChoiceSet 1.11","params":{"choices":[{"subContentId":"94d2654a-828d-47d2-8982-3da3ad385b8d","question":"
Two situations where direction of air flow and doctor-patint seating arrangement in an OPD is shown. Which one is better as far as Air borne infection control measures are concenrned? <\/strong><\/p>\n","answers":["
B<\/p>\n","
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Search

CDST_LT: Airborne infection control

Target Audience

Airborne Infection Control [AIC]

Ventilation as an AIC Measure

Administrative measures for AIC at a Health Facility