Posted by: ihfgeneva | July 29, 2013

SAFER HOSPITALS: PREPARED FOR EMERGENCIES: Progress Report on the Safer Hospitals Initiative

Rationale for Safer Hospitals

The vital role played in communities and health emergency responses by hospitals, means they are expected to remain functioning in full capacity, immediately after a large-scale disaster. The loss of a functioning hospital leads to a substantial impact on the availability of medical services available to the population during the post disaster period. Given that hospital systems represent a major investment – 70% of the ministry of health budget – it is critical therefore that such expensive and essential entities be protected for their economic and social value.


The 1985 Mexico earthquake was a catalyst for action to include disaster prevention in national disaster management programmes and solicit policy commitments for Safe Hospitals across all of WHO’s Regions. Member States by the adoption of a resolution in 2011 by the World Health Assembly, were urged to “develop programmes on safe and prepared hospitals that ensure that new hospitals and health facilities are located and built safely so as to withstand local hazards; that the safety of existing facilities is assessed and remedial action is taken; and that all health facilities are prepared to respond to internal and external emergencies.”


Furthermore, damages to health facilities in conflicts and attacks on health facilities have underscored the need for increased security of health facilities, health workers and patients alike. Damage and destruction due to hostile actions, looting of clinics and health centres and targeted attacks on health facilities in conflicts and terrorist acts have in some cases severely disrupted healthcare delivery. There are reports of health professionals, including doctors and nurses, having to flee from hospitals, leaving few trained professionals to deal with the medical crisis. The lack of access and closure of many pharmaceutical companies due to destruction and lack of resources has also caused serious shortage of drugs and medical equipment.


In 2012, the World Health Assembly (WHA65.20), requested WHO to “provide leadership at the global level in developing methods for systematic collection and dissemination of data on attacks on health facilities, health workers, health vehicles, and patients in complex humanitarian emergencies, in coordination with other relevant United Nations bodies, other relevant actors, and intergovernmental and nongovernmental organizations, avoiding duplication of efforts.”


Smart, Green Hospitals

As a major consumer of water, computers, medications, food and other resources, the health sector  is a significant contributor to a country’s climate footprint and can as a result, play a major role in reducing climate change effects around the world.


In 2009, WHO established an objective to develop “programmes for health systems that will contribute to reducing their own greenhouse gas emissions”. Responding to this and the World Health Assembly Resolution on climate and health (WHA61.19), Caribbean countries are tackling climate change hazards by integrating environment friendly criteria in safety requirements for health infrastructure to create resilient and green health facilities, known as “smart hospitals”.


International cooperation

Development cooperation partners have shown an increasing interest in safer hospitals initiatives. This has significantly increased within the last four years as a result of the International Strategy for Disaster Reduction (ISDR) campaign on safe hospitals safe cities. The campaign in Asia on one million safe schools and hospitals has engaged countries and regional banks in the process as well as provide advocacy and support to the Safer Hospitals initiative. The World Bank, Asian Development Bank and Inter-American development bank have included a specific reference to safe hospitals in their financial monitoring system. The United Nations Office for Projects has instituted technical assessments in the aftermath of major disasters, such as the Haiti earthquake, and have conducted projects to re-build hospitals in Haiti, Pakistan and Sri Lanka. The International Hospitals Federation has featured Safer Hospitals in a session at its 2013 38th World Hospital Congress in Oslo, Norway. Several donors, including USAID have recognised Safer Hospitals in policies on disaster risk reduction, and have provided support for project implementation.

Assessment tools

The Hospital Safety Index (HSI), developed by WHO, is a rapid diagnostic tool, used to assess hospitals’ vulnerabilities, promote low-cost/high-impact mitigation measures, and strengthen emergency preparedness to ensure that hospitals keep functioning in times of emergencies. It has been adopted and implemented by many countries in WHO regions.


HSI assessment outcomes assist decision makers in prioritizing and allocating limited resources to specific areas in specific hospitals deserving attention within the network of health services. It also identifies major recommendations on necessary actions and provides direction on how to optimize available resources to increase hospital safety. It is a tool to guide national authorities and international cooperation partners in planning to improve hospital safety and delivery of health services after disasters.


Countries within regions have adapted the HSI to meet the specific considerations which prevail in the region. For example, the Eastern Mediterranean Region (EMRO) country assessment tool has included items to assess the availability and training of the health workforce and the security of health facilities, staff and patients.  The HSI is an integral part of the risk assessment component of the Disaster Risk Management Strategy for the African Region.


In light of this in order to make the tool applicable to all hazards and for all regions, a revision of the HSI is now under way by WHO and partners, and is expected to be field tested in 2013 and released in 2014.


Small Health Facilities Manual and Assessment Tool

Small health facilities, defined as those of low complexity along with the major hospitals that make up the health networks, are key to an effective and comprehensive response. Such facilities, in many areas in the world, provide a significant proportion of essential health care that include primary care, psychiatric care, and public health laboratory services. Enhancement of the resilience of these smaller health facilities is therefore vital in order to ensure their accessibility, structural soundness and capability in delivering basic services in the event of an emergency.  


Country implementation of the Safer Hospitals Initiative

Although still a relatively young initiative, more than 50 of the 195 WHO member states in the Americas, South-east Asia, Central Asia, Eastern Mediterranean Region and Europe have already implemented actions under the Safer Hospitals initiative, and a large proportion of these have adopted safer hospitals policies and programmes.


By the end of 2012, 32 countries in the Americas Region had already adopted the safe hospitals initiative and had started assessing the safety of their hospitals using the Hospital Safety Index (HSI). In the African region, consultations among member states regarding the region-wide implementation of the safe hospital initiative are ongoing, for an anticipated launch in 2013.


Progress has also been made on legislation, although still limited to few countries, such as Croatia, Colombia, Moldova, Pakistan, where special decrees, laws or regulations for safe hospitals have been introduced. Several other countries, have also integrated the application of the hospital safety index into the processes for accrediting or licensing hospitals, or planning new facilities.


The creation of a national committee on safer hospitals is recommended by WHO for all countries. Some country initiatives on Safer Hospitals are led by non-health sector agencies, such as civil protection, thus reflecting the deep multi-sectoral nature of safer hospitals. The support of United Nations International Strategy for Disaster Reduction (UNISDR), WHO and partners has engaged country agencies and donors to focus attention on turning the goal of safer hospitals into reality.  




In conclusion, the Safe Hospital initiative is making progress in assessing, building, retrofitting and strengthening preparedness of health facilities in times of disaster. More than 50 countries have engaged in investing in this initiative, more than 1,800 hospitals have been assessed, and specific legal support exists in more than 15 countries. Hospitals in some countries, including low-income countries have been retrofitted to withstand the forces of natural hazards, demonstrating the practical feasibility of making hospital safer. The progress made under this initiative has already equipped countries with tools and strategies, allowing them to improve the level of safety, within the financial restrictions that exist. Large gaps, nevertheless need still to be filled in regard to the commitment made by 168 member states in 2005 to have safe hospitals by 2015 and beyond. In order to build on the current momentum in achieving the goal of safer and better prepared hospitals and take the initiative to the next level of action, countries and the international community are called upon to continue, and where possible, to increase their political and technical support and investment in safer hospitals for the health of people across the world.



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