Designing Healthcare Hub for a City that didn’t exist - Chhatrapati Shivaji Maharaj Hospital, Thane.

In the late 1980s, Shashi Prabhu & Associateswere invited by the Thane Municipal Corporation to build their first Tertiary Care Public hospital on an 11.5-acre site in Kalwa near Thane. The site sat at the fraying edge of one of India’s fastest expanding Mumbai Metropolitan Region, which was undergoing an industrial de-centralization, and pushing population along the railway corridor northward into Thane, Kalyan-Dombivli and Bhiwandi. The city that would eventually surround the hospital in Kalwa didn't quite exist back then.

In hindsight, the client's design input was quite brief and inadequate, and the designers were expected to interpret this brief in its entirety. SPA took a series of decisions that would quietly define the building's entire lifecycle.

Who will this building be serving in fifty years?

We designed a building not just from the brief they had given us, but for the demographic pressure we suspected was coming, says our founder Ar. Shashi Prabhu.

 

A Logic of Thresholds

Walk into any high-volume public hospital in India and one feels an immediately weight of its verticality. The critically ill wheeled through large halls and public spaces, the distressed relatives congregating around elevators and miles of corridors designed for critical movement. Anxiety compounded by logistics.

The building’s intelligence lies in its vertical organization, which maps a programmatic gradient to the clinical and behavioral realities of high-volume public healthcare. The ground and first floors host the highest-traffic zones—Outpatient Departments, Emergency Triage, and Diagnostics—ensuring vulnerable patients face zero vertical transit while significantly reducing the capital and operational costs of elevator infrastructure. The second and third floors act as a semi-public transition band, buffering sterile environments like Operation Theatres, ICUs, and laboratories from the noise below. Finally, the inpatient wards occupy the quietest uppermost floors, maximizing daylight and cross-ventilation to support the slower rhythms of patient recovery.

That this program continues to function even today, serving over 2,200 patients every day in its OPD alone, is testimony to a well-conceived planned space fifty years ago without any forecast of population explosion that would follow. No demographic projection anticipated the scale of migration, industrialization, and urban sprawl that would transform this Mumbai Metropolitan Region over the following decades. And yet the building held through. Not because we predicted the future, but because the building refused to be defined by the present.

The Grid as a Promise

Beneath every floor of the CSM Hospital runs an intelligently framed RCC column and beam structure, and this, more than any other decision, is what has allowed the building to remain relevant across five decades of relentless change.

This grid was deliberately planned after having a thorough understanding of its correlation with Operation Theatres, Parking bays and centre to centre distances between beds. We assessed the advantage of eliminating rigid load bearing structure that would permanently commit the building into a fixed programme and that could inevitably become obsolete one day says Ar. Suhas Sahani, who still plans hospitals with SPA after 50 years of being them the firm. Spaces had to have a provision of flexibility and internal partitions would have to be movable for a building to be future proof. Departments would later expand or contract in response to the demand of time. The building was designed, in other words, to grow inward — absorbing new spatial and technological demands without the need for structural intervention.

Drawing from a study of international healthcare facilities in the USA and the former USSR, our founder Ar. Shashi Prabhu, anticipated that medical practices would change fundamentally over the building’s operational lifespan. Recognizing that rigid internal walls would eventually obstruct future clinical needs, the design prioritized structural flexibility, utilizing a versatile grid that allowed layouts to adapt to shifting spatial demands.

The evidence of that foresight is now visible everywhere. When the hospital was designed, advanced digital radiography technologies such as CT scanning and MRI’s were entirely absent from the vocabulary of Indian Public healthcare. Today, the radiology department processes hundreds of X-rays, ultrasounds, MRIs and CT scans every single day, all within the original building fabric. The imaging equipment arrived; the grid made room. It is seen that, as recently as May 2026, advanced automated diagnostic analyzers were inducted in the hospital under a CSR initiative — another generation of technology in the original concrete frame accepted without complaint.

The eight-theatre operation suite tells the same story. Contemporary surgical theatres are vastly more complex spatial propositions than their 1992 predecessors — populated with anaesthesia bays, laparoscopic towers, C-Arms, Sterilisation suites, student observation areas, and dedicated pre- and post-operative areas. None of that complexity was specified in the original brief. All of it fits within the existing structure today. The grid, conceived as indeterminate, made room for a future it could not have named — and that, in the end, is the most precise definition of long-range architectural thinking.

The Weight of a Region

By 2023, the limits of even the most farsighted structural planning had become legible.

The temporary closure of the nearby Civil Hospital for reconstruction, compounded by the explosive growth of the Thane region — from 472,000 in 1980 to over 2.7 million in 2026 — buckled the public healthcare network, concentrating patient catchments from Kalyan, Dombivli, Bhiwandi, and Ulhasnagar onto the Kalwa campus. A building designed for 500 beds was absorbing over 600 inpatients daily, far exceeding its original design capacity. The wide corridors that had been so deliberately proportioned for unobstructed clinical movement became, in this condition, the sole spatial buffer available to a system under collapse — pressed into service as informal waiting areas for the relatives of patients who had nowhere else to go. The sectional gradient that had been held for five decades began to blur in plan.

This is not an indictment of the design. It is, if anything, its most precise measure. The building absorbed what no single institution should ever be asked to absorb alone — and the grid, engineered five decades earlier to accept change, held.

What Comes Next?

The path forward should begin with an honest diagnosis of where the overload originates.

The concrete frame of the CSM Hospital has been held together for over five decades under conditions it was never designed to face alone. What it requires now is institutional reflection and master planning for long term range spatial thinking with which it was first conceived. It should begin with an acknowledgement of where the overload originates, and an equally honest commitment to addressing it at every scale at which it operates.

At the regional scale, one should evaluate the burden of the growing population on a sole tertiary anchor in a catchment that now extends across Kalyan, Dombivli, Bhiwandi, and Ulhasnagar. At the campus scale, the immediate priorities should be to evaluate the patient, staff and visitor circulation, bed capacities, and logistic movements of goods & materials. A dual-spine movement system — segregation, decoupling of staff and clinical supply chains from the public circulation network would return the building's wide corridors to their original function: unobstructed movement instead of informal waiting areas.

Fifty Years Is Not the Measure

The CSM Hospital belongs to a body of work through which Shashi Prabhu & Associates has consistently argued that civic architecture must be designed not for the conditions of the present but for the pressures of the future one cannot see today.  Structural indeterminacy, programmatic gradient, and long-span organization are all instruments of foresight. They are how a building makes a promise to the people who will inhabit it long after the architects have moved on.

Fifty years of continuous operation at Kalwa have borne that argument out. Not as a statement of comfort, but as an urgent and unambiguous case for the kind of anticipatory, systems-level thinking in civic architecture that the Indian public healthcare landscape continues to demand — and so rarely receives.

That is not a small thing.

• Architects:Shashi Prabhu & Associates
• Location:Kalwa, Thane, Maharashtra, India
• Category:Hospital, Medical College
• Project Year:1992

Author: Amol Prabhu, Sweta Singh