Disaster Risk Reduction in Health

Each year, disasters cost between US$300-500 billion worldwide, with disproportionate effects on low-income countries. The Americas are the second continent most affected by disasters. Almost a fourth of all disasters that occurred in the world in 2017 took place somewhere in the Americas, representing cumulative damages of approximately US$ 306 billion.

Therefore, the need for comprehensive preparedness of the health sector. For that, a more effective surveillance and a collective rapid response in the Latin America and Caribbean (LAC) Region is required to respond to potential pandemics, outbreaks, more frequent and destructive natural disasters, and conflicts.

Overall, the capacity of LAC countries to manage the response to a minor emergency or small-scale disaster, without seeking aid from the international community, has increased. However, there is a growing demand for different levels of technical cooperation with increased specificity to countries’ particular needs, or to respond to large multi-hazard emergencies, particularly when national capacities are overwhelmed.

In September 2016, the Plan of Action for Disaster Risk Reduction (DRR) 2016-2021 was approved by the Ministers of Health of the Americas, aligned with key recent international instruments including the 2030 Agenda for Sustainable Development, the Paris Agreement on Climate Change and the Sendai Framework for Disaster Risk reduction 2015-2030.

The purpose of the plan is to continue strengthening disaster risk reduction in order to prevent deaths, diseases, disabilities, and the psychosocial impact of emergencies and disasters through people-centered actions and cross-cutting approaches. The plan aims to improve the safety of integrated health services networks through the application of safe hospital criteria and approaches to climate change in the planning, design, construction and operation of such services.

Key facts

The annual losses caused by earthquakes, tsunamis, cyclones, winds, and tidal waves are estimated to represent between 1.2% and 1.7% of the world’s gross domestic product (GDP).
The most common events were of hydrological and meteorological type, which caused the highest percentage of deaths and damages in this period.
More than half of the 16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters.
Climate change means higher average temperatures are recorded each year, and more people are being affected by disasters, climate-sensitive diseases and other health conditions.

PAHO Response

PAHO’s work in disaster risk reduction and response is carried out in an environment of cooperation, in which Member States, health authorities, sub-regional organizations and a wide variety of other strategic partners work together to achieve a more resilient health sector in the Americas and help reduce the health consequences of emergencies, disasters and crises and ease their social and economic impact.

The Disaster Risk Reduction unit of the Health Emergencies Department supports countries in the implementation of the Plan of Action on Disaster Risk Reduction 2016 – 2021, which aims to protect the lives of patients and health workers, shield health equipment and supplies from disasters, and ensure that the health services continue operating effectively during and after emergencies and disasters in order to save lives, reduce disabilities, and enable the health sector to fulfill its continuing responsibilities.

The PAHO PHE DRR area also works in the implementation of the Plan of Action on Safe Hospitals 2010-2015. This plan has contributed to the adoption of national programs and policies for safe hospitals, to the implementation of activities aimed at ensuring that all new hospitals are built with a higher level of protection and to the implementation of measures to cope with climate change in terms both of disaster adaptation and mitigation in order to strengthen existing health facilities.

Additional work under the scope of the DRR area:

Promotion and implementation of climate-smart mitigation and adaptation measures for health facilities;
Development and implementation of emergency risk reduction and management strategies for internally displaced populations (IDP), individuals with disabilities and countries in condition of high vulnerability.

SAFE HOSPITALS

A safe hospital is a facility whose services remain accessible and functioning at maximum capacity and within the same infrastructure immediately following a natural disaster.

The Hospital Safety Index, a tool developed by PAHO and a group of the Caribbean and Latin American experts, provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs.

Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.
Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.
Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

Objectives

Objectives of a safe hospitals program

To develop national policies and regulations on making hospitals safe from disasters.
To protect the lives of the occupants of a hospital or health facility.
To protect the economic investment as well as the functionality of both new facilities and those identified as priorities within the health services network.
To compile, organize and monitor the implementation of policies and national and international regulations on safe hospitals.

Strategies and Action Plan

Strategies that guide a safe hospitals program

Lobby with decision makers to incorporate a safe hospitals program in ministries of health and other institutions that contribute to this goal, as well as in subregional integration organizations (SICA, the Central American Integration System; CAN, the Andean Community; and CARICOM, the Caribbean Community).
Identify other sectors involved in safeguarding health facilities from disasters (drinking water, electric power, finance, disaster response committees, communications media, etc.) and involve them in joint technical and outreach activities.
Develop scientific and academic programs and activities on safe hospitals in universities, research centers, professional associations related to the construction and operation of hospitals.
Incorporate criteria for the protection of health facility into health investment projects so they serve as technical guidelines for incorporating risk mitigation in new health facilities. Include reference to these criteria the solicitation of bids on design, construction and operation of health facilities.
Establish and implement independent mechanisms for control and supervision of projects, with the intervention of skilled professionals that work in coordination with the team executing the project.
Mobilize the national and regional technical capacity in safe hospitals including WHO Collaborating Centers and the Disaster Mitigation Advisory Group (DiMAG).

Reduction of vulnerability on health facilities

The vulnerability of a health facility and the health services network in general can be reduced by carrying out a functional diagnosis, identifying priorities components, including aspects of vulnerability and risk reduction in national processes of accreditation, certification and licensing in the health facilities and ensuring the availability of essential resources for the hospital's response in disasters.

Other objectives to be included in a safe hospitals program

Strengthening emergency preparedness and disaster relief through preparedness efforts and updating national, local and hospital plans for disasters.
Training the health workforce and those from other sectors in order to strengthen the response capacity of health facilities.
Ensuring the availability of essential resources for the hospital disaster response.

Follow up on safe hospitals

Once the criteria, goals, and indicators are defined, safe hospitals can serve as a model.
The designation of 'model' safe hospitals will provide an incentive for establishing a safe hospitals program and working to achieve its achievable goals.
The experiences and lessons learned from this process must be documented and shared at the global level.

The Hospital Safety Index

The Hospital Safety Index, a tool developed by PAHO and a group of Caribbean and Latin American experts, is being widely used by health authorities to gauge the probability that a hospital or health facility will continue to function in emergency situations.

More than half of the 16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters. The Hospital Safety Index helps health facilities assess their safety and avoid becoming a casualty of disasters.

The Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital's Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. However, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country's investments in hospital safety.

Determining the Hospital Safety Index is a new way of managing risk in the health sector. It allows a health facility's level of safety to be monitored over time. Safety no longer has to be a 'yes-or-no' or an 'all-or-nothing situation, but can instead be improved gradually.

The Hospital Safety Index was developed through a lengthy process of dialogue, testing and revision, over a period of two years, initially by the Pan American Health Organization's Disaster Mitigation Advisory Group (DiMAG) and later with input from other specialists in Latin America and the Caribbean.

Calculating the Hospital Safety Index

There are a number of steps to calculating a health facility's Safety Index. First, an Evaluation Team uses the standardized Safe Hospitals Checklist to assess the level of safety in 145 areas of the hospital. Once the Checklist has been completed, the Evaluation Team collectively validates the scores and enters them into a scoring calculator, which weights each variable according to its relative importance to a hospital's ability to withstand a disaster and continue functioning. The safety score is calculated automatically.

The final Safety Index score places a health facility into one of three categories of safety, helping authorities determine which facilities most urgently need interventions:

Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations.
Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk.
Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters.

Calculating the safety score allows health facilities to establish maintenance and monitoring routines and look at actions to improve safety in the medium term. This quick overview will give countries and decision makers a starting point for establishing priorities and reducing risk and vulnerability in healthcare facilities.

Components of the Hospital Safety Index

Evaluation Forms

Form 1: General information about the health facility. This form should be completed prior to the evaluation by the hospital's disaster committee. It includes information on a health facility's level of complexity, the population it serves, specialty care and other available services, and health staff.

Form 2: Safe Hospitals Checklist. A trained team of Evaluators then uses the Safe Hospitals Checklist to assess the level of safety of 145 areas of the health facility, grouped by location, structural, nonstructural and functional components.

You can download the EVALUATIONS FORMS Version 1 (2008)

You can download the EVALUATIONS FORMS and GUIDE FOR EVALUATORS - Version 2 (2015)

Guide for Evaluators

The Guide for Evaluators is the principal training tool. It provides guidance and standardized criteria for evaluating the components of a health facility individually and as part of the health services network. The Guide is used by a multidisciplinary team of Evaluators, which can include engineers, architects, health staff, hospital directors and others who have undergone previous training. The Guide explains the methodology and rationale for the Hospital Safety Index as well as how to calculate and interpret the health facility's safety score.

Safety Index Calculator: The scores or values obtained for each component on the Checklist are recorded onto an Excel spreadsheet that uses formulas to automatically calculate a numerical score for each of the 145 assessed components. The results place the facility into one of three safety categories: high, medium, or low. It is important to note that the values given to each component are weighted according to an agreed-upon formula, which has been endorsed in Latin America and the Caribbean, but may not be applicable worldwide. The Calculator module is made available to evaluation team members as they complete their training.

You can download the GUIDE FOR EVALUATORS Version 1 (2008)

You can download the EVALUATIONS FORMS and GUIDE FOR EVALUATORS - Version 2 (2015)

Resolutions

Disaster Mitigation Advisory Group

The Disaster Mitigation Advisory Group (DiMAG) is an international, not-for-profit body of experts that is available to provide advice and services to PAHO/WHO member countries on risk and vulnerability reduction projects in the health sector. Learn more about the DiMAG and what it has to offer.

What is the DiMAG?

The Disaster Mitigation Advisory Group (DiMAG) is an international, not-for-profit body of experts from Latin America and the Caribbean, supported by the Pan American Health Organization/World Health Organization (PAHO/WHO). The DiMAG is available to provide advice and services to PAHO/WHO Member Governments-at their request-on risk and vulnerability reduction projects in the health sector. Although the DiMAG's expertise focuses on health sector issues, the Group is composed of experts from many disciplines-engineering, architecture, disaster management, emergency services, economics and others-with a proven track record of working in developing countries.

The DiMAG works both prior to and following a range of natural and manmade disasters, including earthquakes, hurricanes and torrential rains, storm surges, tsunami, volcanic eruptions, floods, fire and explosions.

What does the DiMAG offer?

At the request of Member States, the DiMAG can provide independent advice on general matters of disaster vulnerability and risk reduction in the health sector and health facilities such as:

Reviewing terms of reference for design, standards, and construction of disaster-resilient health facilities at the pre-conception stage and proposing quality assurance mechanisms.
Advocating for independent reviews of the design and construction of hospitals (check consultants).
Making recommendations on topics to be included in undergraduate and post-graduate university curricula to raise awareness about risk reduction and impart technical skills.
Serving as resource experts or facilitators at capacity building events related to disaster mitigation.
Assessing national norms and standards or advising on the development of health sector mitigation policies.
Providing advice on the management of health infrastructure projects (without being part of the project team).
Conducting post-disaster evaluations of health facilities and recommending suitable courses of action.
Contributing to or reviewing PAHO/WHO technical publications.

How does the DiMAG operate?

The membership of DiMAG is multidisciplinary, by invitation from PAHO/WHO, which serves as the DiMAG's Secretariat.
The DiMAG meets annually. Any DiMAG member may call for an ad hoc meeting to address specific issues.
Costs related to assessment missions by DiMAG members (transportation, per diem, related costs) will be covered by the requesting country or institution. DiMAG members do not receive a salary or other compensation for short consultations at the pre-project stage, thus maintaining independence and neutrality.
All information resulting from DiMAG missions will be handled in a confidential manner.

DiMAG contributions to safe hospitals

Helping to develop the Hospital Safety Index, a diagnostic tool to assess a health facility's level of safety and promoting its use in the Americas and through other WHO regional and country offices.
Contributing to the development of new Caribbean Basin Wind Hazard Maps to guide engineers when designing and evaluating risk in critical facilities such as hospitals and health clinics.
Serving as members of PAHO and WHO rapid response teams for post-disaster diagnostic assessments of health facilities.
Preparing an extensive assessment report of the concept of 'Turn-key' projects for public health facilities.

Why was the DiMAG created?

The DiMAG grew out of a 2003 international meeting on disaster mitigation for health facilities. It was conceived as a technical resource to which Ministries of Health could turn for advice when building new health facilities or renovating, expanding or retrofitting existing facilities. It was created to address the fact that:

New hospitals continue to be designed and built without due consideration of the risk of natural hazards.
Many existing hospitals perform unsatisfactorily in disaster and emergency situations; health services must be able to continue functioning.
Countries and institutions must be able to count on independent technical advice.

Where to request DiMAG's support

Governments, ministries of health or other health organizations may request support from the DiMAG by contacting any PAHO/WHO country office in Latin America and the Caribbean or by emailing dimag@paho.org.

SMART HOSPITALS

Natural hazards and climatic extremes can cause significant disruption of health services and economic losses.
Many health facilities in the Caribbean are in areas of high risk and need strengthening in the face of repeated damage or increasing climate threats.
Health care facilities can also be large consumers of energy, with a significant environmental footprint.
The Smart Hospital initiative focuses on improving hospitals' resilience, strengthening structural and operational aspects and providing green technologies.

Improve hospitals readiness levels in disaster and emergency situation

Multihazards aproach

Special emphasis in people with disabilities

INGRID-H METHODOLOGY

The INGRID-H methodology assesses the status of the accessibility chain, to allow the arrival of people with disabilities, from their point of origin to the safe or least risky area based on their autonomy or the capabilities of the organization to support them

It allows knowing the levels of inclusiveness in the hospital's preparation for disasters response.
Identify the gaps to prioritize.
Follows the progress in order to allow adjustments in the installation.

Key Resources

THE PARIS AGREEMENT

2030 AGENDA FOR SUSTAINABLE DEVELOPMENT

SUSTAINABLE HEALTH AGENDA FOR THE AMÉRICAS 18-30

Sendai Framework for Disaster Risk Reduction

Networks

Indigenous Knowledge and Disaster Risk Reduction Network

The Indigenous Knowledge and Disaster Risk Reduction Network collaborates with Indigenous peoples and disaster risk management professionals to promote coordination and engagement.
The network focuses on collecting, producing, maintaining and sharing information to advance DRR with an emphasis on health and resilience in Indigenous communities in the Americas and Caribbean.
PAHO's Department of Health Emergencies and the Department of Family, Gender and Life Course are taking the lead on issues related to the health of Indigenous peoples. Together, these departments are working to address the vulnerabilities and capacities of Indigenous populations to protect and improve their health before, during and after disasters.

Disaster Risk and Disabilities Inclusive Management Network for Latin America and the Caribbean

The Disaster Risk and Disabilities Inclusive Management Network for Latin America and the Caribbean promotes the inclusion and full participation of people with disabilities and their families in all phases of disaster risk management.