A Model Policy for SMART Facilities The Model Policy for SMART Health Facilities was prepared by Dr. Vasantha Chase, et al, (Castries, Saint Lucia), on behalf of the Pan American Health Organization (2013). TABLE OF CONTENTS

Foreword...... 3 Section I – Defining the Problem...... 5 • The vulnerability of health facilities to natural hazards...... 5 • The vulnerability of health facilities to climate change and variability...... 6 • Damage to health facilities from disasters...... 7 • The cost of damage to health facilities in the Caribbean...... 8 • Costs related to climate change and variability...... 9 • Progress is being made...... 10

Section II –Conceptual Framework for a Policy on smart Health Facilities...... 13 Section III – A Model for Developing a smart Health Facilities Policy...... 17 • Purpose of the policy...... 17 • Policy guidelines...... 17 • Components of the policy...... 18 • Policy strategy...... 21 • Implementing the policy...... 22 • Monitoring, evaluation and reporting ...... 23 Conclusion...... 25 Acronyms...... 26 Glossary...... 27 List of Tables • Table 1: Impact of Hurricane Tomas (2010) on health facilities in Saint Lucia...... 7 • Table 2: Categorization of Energy Supply in Health Facilities in Guyana...... 10 List of Figures • Figure 1: smart Health Facilities Policy: The conceptual framework...... 14 • Figure 2: Operationalising the smart Health Facilities Policy...... 16 • Figure 3: Mapping the Policy on smart Health Facilities...... 19

1

FOREWORD

he Caribbean is a highly hazard-prone region. Hurricanes Gilbert, Ivan and Tomas are stark reminders of how the direct and indirect impact of weather-related disasters can significantly Tdisrupt access to health services and the sector’s ability to provide care. However, today it also is becoming increasingly clear that the health sector itself is one of many contributors to the impact of climate change, making it imperative to step up efforts to reduce the environmental footprint and increase the resiliency of its health facilities. The smart Health Facilities Initiative is an important step in this direction. The Pan American Health Organization (PAHO) is spearheading this initiative in an effort to ensure that health facilities in the Caribbean are both safe and green. While there is broad support for the principles of smart health facilities, there are very few actual policies at the national level that call for a shift away from the traditional disaster response model to one that proactively seeks to minimize the health impact of a disaster through climate adaptation, mitigation and preparedness. This publication aims to guide the health sector in developing a policy on smart health facilities, a policy that forms an integral part of the health agenda of PAHO’s Member States; is backed up by earmarked resources in the national budget; and counts on commited leader- ship at the highest level of government. We encourage health authorities throughout the Caribbean to begin the process of developing a policy on smart health facilities, seeking to strike a balance between safety and an environmentally-sus- tainable setting, thereby reaching for the goal of health facilities that are climate-smart and disaster- resilient, that protect the lives of and staff and that continue to function when they are most needed.

3

Section I DEFINING THE PROBLEM

The Vulnerability of Health Facilities to Natural Hazards

ccording to data provided by PAHO/WHO Member States, 67% of their health facilities are located in disaster risk areas. In the last decade, nearly 24 million people in the Americas lost Ahealth care for months, and sometimes years, due to the damage directly related to disasters. On average, a out of service in the Region leaves approximately 200,000 people without and the loss of emergency services during disasters sharply reduces the chance to save lives.1 Many countries in the Caribbean have only one referral hospital. The vulnerability of health facilities in disaster situations cannot be underestimated. There is a widely held expectation that health The loss of a health care facility is facilities are prepared to deal with emergency situations. However, more than a medical issue . It is a the impact of past earthquakes and hurricanes in the Americas has larger issue, a social proven that and other health facilities are indeed vulner- able. Many have been left unable to function and provide not only and political issue, and an eco- emergency services but also routine medical care and public health nomic issue . services. During the San Fernando, California earthquake of 1971, for Source: Safe Hospitals: A Collective Responsibil- instance, four hospitals were damaged so severely that they were no ity, a Global Measure of Disaster Reduction. Pan longer operational, at the time they were most needed. The majority American Health Organization. Date? 2005? of deaths occurred in two of the hospitals that collapsed. It was an ironic feature of that earthquake that the most hazardous place to be in San Fernando was in a hospital!2 In the 1985 earthquake in Mexico, 5,826 hospital beds were lost either to the direct impact of the quake or because of the need to evacuate the three largest health in- stitutions in Mexico City—the Social Security Institute’s National Medical Center, the Hospital General and the Hospital Juarez. Most striking were the collapse of the obstetric complex (six floors) and the medical residences (eight floors) of the Hospital General and the collapse of the 12-story central tower of the Hospital Juarez. Many patients as well as doctors and nurses, who were among the nation’s best prepared to respond to mass casualties, lost their lives. In addition to the need to build new and retrofit existing health facilities so that they are structur- ally sound, there is growing recognition of the need to reduce the non-structural vulnerability of exist-

1. Pan American Health Organization, Progress Report on National and Regional Health Disaster Preparedness and Response, http://www. paho.org/english/gov/cd/CD47-inf4-e.pdf. 2. Pan American Health Organization, Disaster Mitigation Guidelines for Hospitals and Other Health Care Facilities in the Caribbean. http:// www.preventionweb.net/files/1948_VL206305.pdf. Accessed on March 7 2013.

5 6 SMART HOSPITALS INITIATIVE to disseminate information andpromote to theadoptionofpractices prevent and/orreduce exposure Regional Framework for Achieving Development Resilient to Climate Change, for instance, onlyseeks ties. ifnotall, Most, ofthese policies focus ofclimate changeon . on theimpact The Caribbean asuite ofresponses ofclimatearticulated to changeandclimate onhealthfacili theimpact variability is, however, noteworthy that national andregional climate change policiesintheCaribbean have not provide care andongoinghealthcare emergency to for victims limited. theircommunities isvery It (such astheelderly). diseases, dengueanddiarrheal aswell diseaseslikemalaria, borne asheat stress invulnerable groups nation ofwater that suppliesasaresult favour offloods—conditions thespread of water and vector- conditions dueto alimitedinclude worsening water ofsanitary droughts supplyduring orcontami cant threat to countries intheCaribbean. The anticipated negative ofclimate change healthimpacts anddisruptrainfall patternsstorms andhurricanes andthefreshwater supply, representing asignifi sion, increase theintensity oftropical coastal erosion andsaltwater intru quality. new andemerging) andworsen air diseases (vector-, water- andfood-borne, can increase ofsomeinfectious therisk and staff. The effects ofclimate change water) andthesafety ofpatients, visitors access to resources critical (e.g., food and damage infrastructure, compromising etc.) create situations that emergency events (suchasstorms, floods, drought, weather Extreme ofhealthservices. livery hazards create that risks disruptthede The Vulnerability ofHealth Facilities to Climate Changeand Variability for risks anditsoccupants. thehealth facility hurricane-related they are anchored properly. The reinforcement elements cansignificantly ofnon-structural reduce plumbing). Considerations related to theequipment andlifelines focus ontheirlocation andwhether windows equipment, andlifelines anddoors),medicallaboratory and (mechanical, electrical in thebuilding. in architectural systems finishes, andtheequipment andsupplies mechanicalandelectrical contained ing facilities. trueinhospitals, whereThis between 85-90%ofthefacility’s isparticularly value resides to vector-borne diseasesresulting from increased temperatures, extremerainfall andflooding. When healthfacilitiesare destroyed ordamagedby climate-related disasters, to theirability sealevels,Rising together with Health facilitiesintheCaribbean are vulnerable to climate changeandvariability. Climate-related 3 Abuilding’s elements includearchitectural non-structural elements (suchasceilings, 3. Pan HealthOrganization, American Principles inHealthFacilities ofDisaster Mitigation D.C., (Washington, 2000). http://www1.paho.org/english/ped/mitigation3.pdf -

- Climate Change Disaster andReducing Risk . - - - A MODEL POLICY FOR SMART HEALTH FACILITIES 7

- - - 2,950 3,460 30,000 4,914,818

(in USD) Cost of damage Cost As climate variability and climate change variability and climate climate As Economic the UN by A report prepared are becoming increasingly observable increasingly becoming and as are of in the number increase an to points science it makes in the Caribbean, events hazard-related these critical protect facilities at good sense to protec investment protection; of life the levels protection. tion; and operational from Facilities Health Damage to Disasters America and the Carib Latin for Commission than lost more the Region that bean estimates period to due US$ 3.12 billion in one 15-year Indirect losses health infrastructure. damage to higher when be significantly to estimated are Description of damage to facilities Description of damage to damage to the roof and flooding. the roof damage to was flooded. interior of the MicoudThe Health Centre Although the health facility function, continued to as a for several was no running water of flooding there result facilities. storage a lack of water due to days, damaged. was of the Laborie Health Centre fence The Damage to the roof of the small operating theatre in Gros in Gros of the small operating theatre the roof Damage to Islet Polyclinic. was There functionUnable to and out of commission. 4 8 8 10 17 served % of total % of total population population http://bit.ly/17mRMrG 15,758 27,092 13,033 13,351 served Population Population Table 1: Impact of Hurricane Tomas (2010) on health facilities in Saint (2010) on health Lucia 1: ImpactTomas Hurricane of Table Region In the Caribbean, hurricanes have severely damaged hospitals in Dominica, Jamaica, Montserrat, hospitals in Dominica, damaged Jamaica, Montserrat, severely In hurricanes the Caribbean, have on Vulnerability Reduction in Health Facilities. (Mexico, 1996). (Mexico, ReductionVulnerability in Health Facilities. on UN/ECLAC, Economic Impact of Natural Disasters in Health Infrastructure, Report to the International Conference Impact Report in Health Infrastructure, Economic Disasters of Natural UN/ECLAC, Conference the International to Vieux Vieux Fort Gros Islet Gros Dennery Micoud 4. and St. Kitts. Hurricane Gilbert prompted the evacuation of some hospitals in Jamaica in 1988. There There Hurricane Kitts. and St. of some hospitals in Jamaica in 1988. Gilbert the evacuation prompted because flooded were that hospitals and other health facilities of Caribbean examples also many are the damage 1 summarizes Table and/or poorly maintained. areas in vulnerable located they were Lucia. health facilities in St. to Tomas Hurricanecaused by measuring the increases in health care costs for the millions that have been left been without health ser have that the millions for costs in health care measuring the increases period of time. a prolonged for vices Protecting Health from the Impact the Change from Health of Climate Protecting 8 SMART HOSPITALS INITIATIVE Tomas: a geo-environmental disaster; towardsTomas: disaster; resilience. http://bit.ly/1c0rgDN ageo-environmental . Source: andenvironmental UNECLAC. assessmentofthedamageandlossescaused SaintLucia: by Macro Hurricane socio-economic The Cost to ofDamage Health Facilities intheCaribbean TOTAL Castries Anse LaRaye Soufriere across theglobe. This isreflected inthehugejumpfrom US$53.6 billioninlossesthe1950’s to During thepastseveralDuring decades there hasbeenamajorincrease inthecosts ofnatural disasters US$620.6 billionbetween 2000and2008. Region what hasoccurred intheCaribbean, which hasalsoseenasimilarpattern inlossesfrom disasters. unreuther, et al. Michel-Kerjan 5. Population

served 52,788 19,957 19,034 K (Cambridge, MITPress, Massachusetts: 2009). population % oftotal served Grenada’s Homefor Richmond theElderly 33 12 7 age to itsroof. by afallenwall. The Entrepot HealthCentre suffered dam- heavily flooded. Mental The Wellness Centre wasblocked water.damage dueto leaking was The X-Ray department wardThe paediatric ofthe HospitalsufferedVictoria Jachmel HealthCentreJachmel –damageto theroof. roof. Etang HealthCentre wasbadlydamageddueto aleaking impossible. nearly cess to thefacility roof.leaking Damageto theroad infrastructuremadeac - HospitalsufferedSoufriere damagebecauseofabadly At War withtheWeather: Managing Large-ScaleinaNew Era Risks ofCatastrophes. 5 This globalupward trend inlossesisnodifferent from Description ofdamagetoDescription facilities US$5,642,257 Cost ofdamage (in USD) 192,000 314,352 76,352 91,352

A MODEL POLICY FOR SMART HEALTH FACILITIES 9 - - - In the 8 6 Governments are often with the task challenged are Governments of financing post-disaster recovery efforts. Whilst deal- recovery efforts. of financing post-disaster such as operations, relief demands of ing with the fiscal ensuring of emergency the availability and assistance and medical attention food shelter, funding for sourcing also must contend, governments persons, displaced for with the challenge of mobilising sufficient simultaneously, undertake to recov long-term the medium- to resources can include tasks that This ery process. and reconstruction critical services. clearing restoring debris to from range balanced often expectations precariously are above The - subsidise the recon to governments with the need for struction assets such as the homes of displaced of private in which must be accomplished all of families, low-income declining revenue. of dramatically an environment . 2003. Adjusted for infla- for Survey Consumption . 2003. Adjusted Buildings Energy Commercial - organ health Every non-profit dollar a needs. meet to each year on energy 7 . Accessed . Accessed - but funding and regulatory potential energy obstacles, http://bit.ly/15Pi1EN renewable Huge Not only are utility costs high, the resources used to pay for energy consumption could be put to be put to could consumption energy for pay used to utility high, the resources costs Not only are Health facilities use a great deal of energy because of how they are run and the large number of run and the large they are because of how deal of energy Health facilities use a great For Caribbean countries, the impact of natural hazards is particularly pronounced, given the size of of the size is particularly given the impact hazards of natural countries, Caribbean pronounced, For The cost of energy in the Caribbean is among the most expensive in the world: in 2006 it cost be in 2006 it cost in the world: is among the most expensive in the Caribbean of energy cost The plentiful greenhouse gas, ‘traps’ the sun’s heat and contributes to global climate change. global climate to and contributes heat the sun’s ‘traps’ gas, greenhouse plentiful on May 2013. on May tion to 2008 dollars. tion to A car U Clean

better use to improve health services. In the U.S., it is estimated that health care organisations spend organisations health care that it is estimated health services. In the U.S., improve use to better nearly $8.8 billion people that use them. In fact, hospitals expend about double the amount of energy per square foot as foot them. In use people that per square fact, of energy about double the amount hospitals expend footprint. carbon a significant have health facilities Therefore, buildings. office ating effect on the wider economy of the country, whilst also exacerbating the level of poverty the level among exacerbating whilst also country, of the effect on the wider economy ating survivors. the countries and their GDP. For the purpose Hurricane of comparison, Katrina, which is often used as For and their GDP. the countries On the U.S. GDP. of the less than a 1% for accounted event, catastrophic a significant a benchmark for Is- of the Cayman the GDP loss to than a 200% more in Hurricane Ivanother hand, (2004) resulted catastrophic loss of life, and tragic the immediate It beyond clear that lands and Grenada. has become finance ability effectively to hinder a government’s that unleash a set of circumstances can also events impactThis has a further reverber processes. redevelopment longer-term and recovery its immediate face of this reality, Table 2 describes the challenges faced in Guyana. in 2 describes the challenges faced Table of this reality, face 6. 7. themost dioxide, activities. Carbon everyday from created ofcarbon istheamount dioxide bon footprint Administration. Information .S. Energy 8. tech. Costs Related to Climate Change and Variability Variability Change and Climate to Related Costs isation saves on energy has an impact on operating margins: it is equivalent to increasing revenues by by revenues increasing to it is equivalent has an impact margins: on energy on operating saves isation $20 in hospitals or $10 in medical offices. tween US$0.24-0.37 per kilowatt hour as compared with US$0.08 per kilowatt hour in the U.S. US$0.24-0.37 per kilowatttween hour as compared The Cost of the 2010 Earthquake in Haiti Cost The 10 SMART HOSPITALS INITIATIVE and non-structural issues(e.g.and non-structural ofdamageto risk roofs, water andgassupplies, etc.) tended to bethe staff, andthefacility’s adisaster. andafter during to function ability inbothfunctional Weaknesses oftheassessedfacilitieshadasafety scoreone-third that revealed potential for risks patients, hospital disaster during situations.remain functional Latin andtheCaribbean. America The assessesthelikelihoodthat ahospitalcan HospitalSafety Index ganization’s Group (DiMAG) Advisory Disaster Mitigation andlater withinputfrom otherspecialistsin through alengthy process ofdialogue, testing andrevision, initiallyby thePan HealthOr American not occur again. experienced at thesite oftheJuárez HospitalinMexico andinahostofCaribbean countries, would of healthfacilitiesandto promote comprehensive mitigation policiessothat losses, suchasthose Progress Made isBeing issues, PAHO/WHO towards isworking thegoalofhealthfacilitiesthat are notonlysafe butalso ‘green.’ social benefits, includingbehavioural changes, inaddition to those relatedIn light ofthese to health. energy use, adaptation andenvironmental protection. Investing hasfinancialand intheseefforts Source: USAID (2007)Powering athealthfacilitiesinGuyana. Health:Improving energy services predominant causeofincreased vulnerability. III. No-Grid III. No-Grid II. Quasi-Grid I. Grid-connected When the Hospital Safety Index wasWhen usedto theHospitalSafety Index assesshospitalsandhealthfacilitiesregion-wide, One ofthemostwidelyusedtools to achieve developed thisend istheHospitalSafety Index, For more thanadecade, PAHO/WHO’s disaster program to address hasbeenworking thesafety Health facilitieswillachieve multiplegainsby integrating withlow disaster reduction risk carbon Category Category In the Caribbean, the Hospital Safety Index was theCaribbean, applied in45hospitalsand59smallfacili theHospitalSafety Index In ties in St. Kitts and Nevis,ties inSt. Kitts Grenada, Montserrat, Saint Vincent andtheGrenadines, Anguilla, Dominica andBarbados.Dominica Basedontheresults andrecommendations from theevalua Table 2:Categorization ofEnergy inHealth Facilities Supply inGuyana Small loads. able. Remote facilities. avail No grid electricity loads.Medium grid. locally-operated Connected to IPP, or Usually alarge load. grid (or similarlarge grid). Connected to thenational Description Description - and NGOoffices. healthclinics Hinterland gional hospitals. andre district interior andothersimilar Mahdia Lab, Warehouse.ence Refer Linden, BloodBank, Amsterdam,GPHC, New Examples - - • • • • • • • • • • • vaccine refrigerator radio lighting refrigerators radio, computer lighting small laboratory x-ray machine refrigerators lab full service air conditioning Typical Loads • • • • • • • • been sustainable systems havePV not expensive Generators are hours aday Not available 24 quality poorpowerVery hour) than $3perkilowatt Expensive (more problems Reliability Power issues quality hour $0.30 perkilowatt Expensive ($0.25- Challenges - - - A MODEL POLICY FOR SMART HEALTH FACILITIES 11 - - - - The best argument for demonstrating demonstrating for argument best The 9 Disasters: Preparedness and Mitiga Disasters: Preparedness Hospitals Initiative in the Caribbean builds on in the Caribbean Hospitals Initiative smart The The . Accessed on August 21 2013. on August . Accessed tion team, 15 facilities have begun to make needed im begun to facilities have 15 tion team, of the the application from results Preliminary provements. suggest and Peru IndexSafety Hospital in Bolivia, Ecuador, non-structuralthat features, factors architectural such as to more contribute and equipment basic installations, also point results The vulnerability structural than factors. action for to the importanceto a legal framework having of vulnerability. reduce is hospitals in the Caribbean safe have it is possible to that vision than actual with greater of the countries, a few that actually this. are accomplishing resources, Index, bridgethe Hospital Safety the gap be and aims to performance or climate-proofing and environmental tween risk reduction and disaster in health facili resilience hazard http://bit.ly/15sqTTt (December 2008), (December In this context, the construction of safe, disaster-resilient health facilities must take into account account health facilities must take into disaster-resilient Inthe construction of safe, this context, tion in the Americas Pan American Health Organization, “New PAHO Tool Measures Hospital Safety,” Hospital Safety,” Measures Tool “New PAHO American Health Organization, Pan Hospital Safety Index at a Glance a Glance at Hospital Safety Index 9. to build safe hospitals not only exists, but also is readily available. available. but also is readily hospitals not only exists, safe build to need to be smart about what is useful, needed and cost effective. be smart effective. need to needed and cost is useful, about what footprint, environmental a reduced variability for and the need change and climate the risk of climate but also staff and other occupants, patients, of the lives goal not only of protecting with the ultimate the knowledge of how Fortunately, after a disaster. operate to such facilities continue of ensuring that ties. However, the best design criteria for safe hospitals are not always the most beneficial for climate for climate beneficial the most not always hospitals are safe criteria for best design the However, ties. and construction it is necessary higher design develop to and therefore, mitigation and adaptation expected help withstand use to and water energy lower incorporating hospitals, new for standards Countries resiliency. efficiency Energy variability combined with disaster must be and change. climate

Section II THE CONCEPTUAL FRAMEWORK OF THE SMART HEALTH FACILITIES POLICY

The policy on smart Health Facilities builds on established principles and priorities that govern- ments in the Caribbean are using to improve the resilience of these facilities. Most of the plans, values and guidelines fall under the umbrella of the regional Safe Hospitals Initiative, which was endorsed by the Ministers of Health of Latin America and the Caribbean at the 27th Pan American Sanitary Confer- ence in 2007. A number of complementary initiatives is underway to strengthen the goal of disaster- resilient hospitals:  The PAHO/European Commission (ECHO) initiative ‘Caribbean Health Services Resilient to the Impact of Emergencies and Disasters,’ which aims to improve the capacity of health services to respond to emergencies. One of the expected results is that all large- and medium-size health facilities in the Caribbean are safer.  PAHO/WHO and the UN Environment Programme (UNEP) have developed a tool to assess vulnerability and climate adaptation. It provides guidance on conducting assessments of cur- rent and future vulnerability and health risks stemming from climate change and policies and programmes that can increase resilience, taking into account the multiple determinants of climate-sensitive health outcomes.  The smart Health Care Facility Initiative, which builds on the Ca- ribbean Hospital Safety Index (see smart Hospitals Toolkit), bridges the gap between environmental performance, climate-proofing, hazard resistance and disaster risk reduc- tion in health facilities. (A higher standard of design and construction as well as energy and water use and service delivery capacity will be established to help withstand expected climate variability and change.) The intended impact of the Smart Health Facility Initiative is to build and/ or retrofit climate-smart and disaster-resilient health facilities in the Caribbean. Under this initiative, PAHO is developing a cost-benefit framework to determine the feasibility of making a health facility ‘smart.’ Two World Health Day 2008 demonstration projects are underway at the Georgetown Hospi- tal in St. Vincent and the Grenadines and the Pogson Medical Centre St. Kitts and Nevis. Both demonstration projects aim to establish an integrated approach to health facility design, fea-

13 14 SMART HOSPITALS INITIATIVE objectives asshownobjectives inFigure 1. under development. methodology to guidecountries onhow aCost-Benefit to conduct ofthe Analysis, whichispart Toolkit and improved access to safe water. The results ofthecited demonstration willhelpdefinea projects improvedincreased improved staffandpatient satisfaction; productivity; physical access to hospitals reduced infectionsandaggravation transmissions ofairborne air quality; ofrespiratory conditions; billsandtravelings onhealth,utility expenditure; reduced greenhouse gas(GHG) emissions;improved The conceptual on framework ofthepolicy thelongrun, In target areas include: bothenvironmentallyturing green anddisaster-resilient institutions. The projects’ four main 4. 3. 2. 1. Carrying outdemonstration of projects Carrying health facilitiesbytrain conducting toEnhancing national deliver capacity climate-smart Development ofthe ‘SMART Hospitals Toolkit’ to guideimplementation ofmeasures to Preparation ofanAnnex on ing workshops to andproviding strengthen policies. advice andsupport adapt to climate ofdisasters changeandmitigate inexisting healthfacilities. theimpact dards andcodes for newfacilities. Figure 1:AConceptual Framework for the smart HealthFacilities Initiative to isexpected yieldbenefits, including: cost sav smart HealthFacilities to accompany national buildingstan smart HealthFacilities isbuiltaround three principal smart healthfacilities smart Health Facilities Policy - - - A MODEL POLICY FOR SMART HEALTH FACILITIES 15 - - - - - Health Facilities. smart – Appropriate environmentally sound actions include the green environmentally – Appropriate – Actions include energy-efficient equipment and energy conservation, and energy – Actions include energy-efficient equipment climate proofing and instituting best practices such as the use of less-toxic and instituting best practices such as the use of less-toxic proofing climate 11 - Appropriate actions at all points in the process will lead to greater prevention, prevention, greater will lead to actions in the process all points at - Appropriate health facility (safe and green) will protect the lives and health of patients and health and health of patients the lives will protect and green) health facility (safe health facility has a small carbon footprint (through energy efficient operations) and operations) efficient energy (through health facility has a small carbon footprint health facility is structurally, non-structurally and functionallywithstand the to able health facility is structurally, framework is described as follows: framework environmental footprint environmental carbon footprint smart green safe smart through proper building design, etc. building design, proper through ing of operations, metals (mercury, and clinical products; removing example) for free, (fragrance personal care etc. pharmaceuticals; cadmium) from lead, Disasters of the health facilities’ the role and strengthen measures adaptation climate and mitigation, committees. risk management disaster by generating cost savings; and improves strategies to adjust to and cope better with future with future better and cope adjust to to strategies and improves savings; cost generating by change. and climate hazards to reduce water use and manage storm water more sustainably; more etc. water use and manage storm water reduce to equipment and infrastructure hospital to the damage reduce to has taken measures workers; function to as part continues of the health network, environment; as the surrounding as well there efficiently, more services resources providing under emergency uses scarce conditions; an equally small environmental footprint (through sustainable and sound environmental and sound environmental sustainable (through footprint an equally small environmental (medical) waste; bag red reduced management; waste practices such as proper management effects toxic have may that materials use of conservation; reduced water recycling; increased landscaping green batteries); pesticides, heavy in electronics, metals (PVC, cleaning materials, impact of all types of natural hazards and mitigate the impacts associated with climate change impacts the with climate impact and mitigate associated hazards all types of of natural and variability. A A A The The b) c) The a)    Figure 2 represents the operationalization of the policy the operationalization on 2 represents Figure As noted in Figure 1, this framework will be delivered through: advocacy; through: will be delivered partnerships; 1, this framework toolkits in Figure noted As This framework represents a seamless set of activities and interventions—from preparedness to to set of activities a seamless preparedness and interventions—from represents framework This The The ants, finishes; green cleaning chemicals; enhanced recycling programs; lawn and garden care; pest control; and control; pest care; and garden lawn recycling programs; chemicals; enhanced cleaning green finishes; ants, and loading dock, prior offer entrance emergency at room signs “No Idling” post of transportation (e.g., greening ity parking car pooling. for For example: water conservation; less toxic environmental services and maintenance products (e.g. paints, seal paints, services products (e.g. and maintenance environmental conservation; less toxic water example: For 11. and guidelines; training; and resource mobilisation. Chapter 3 on developing a policy 3 on developing Chapter on SMART mobilisation. and resource and guidelines; training; they will help to in-depth and how about these elements more information provides Health Facilities objectives. the policy’s achieve sustainability. Through this ongoing process, Caribbean health facilities, in collaboration with govern in collaboration health facilities, Caribbean this ongoing process, Through sustainability. the impact of: and reduce can plan for society, and civil ments mitigation; planning to prediction; and response to recovery—all directed towards achieving disaster achieving disaster towards directed recovery—all to prediction; and response to planning mitigation; environmental and improving carbon the footprint; change; reducing climate adapting to resilience; 16 SMART HOSPITALS INITIATIVE and that it has the leadership and support ofthehighestlevels ofgovernment.and that ithastheleadershipandsupport State’sthe Member politicalagenda;that resources itisbackedby earmarked inthenational budget; tal footprint) andpreparedness. Consequently, isincorporated itisessential that into thishealthpolicy mate adaptation, mitigation oftheenvironmen measures and (includingclimate-proofing reduction response modelto onethat proactively seeksto of adisaster minimizethrough thehealthimpact cli The smart HealthFacilities Initiative represents aparadigm shift—away from thetraditional disaster Figure 2 - Operationalising the Smart HealthFigure Facility 2-Operationalising theSmart Policy - - Section III A MODEL FOR DEVELOPING A POLICY ON SMART HEALTH FACILITIES

Purpose of the Policy

The policy on smart Health Facilities provides a platform for integrat- Becoming SMART ing initiatives currently underway that seek to make facilities safe (struc- tural and non-structural resilience to disasters) and green (a small environ- mental footprint). Committing to the following will contribute to making Caribbean health facilities ‘smart’:  Becoming resilient to the risks related to climate change and variability and natural hazards.  Proper management of critical resources (e.g., pharmaceuticals, food, transportation, medical supplies and equipment) based on climate change considerations.  Committing to sustainable environmental practices such as water and energy conservation, promoting active transportation, and local food procurement.  Engaging in ongoing communication, education and awareness to bring about behavioural changes.

Policy Guidelines

The following parameters will guide development of the smart Health Facilities Policy:  The policy will be implemented within the framework of existing PAHO and Ministry of Health work programmes.  The policy does not require renegotiations or amendments to existing strategic partnerships that national Ministries of Health and/or PAHO have with public and private sector agencies, other civil society organisations, and regional and international organisations.  Although the policy may generate new funding requirements, Ministries may consider reallo- cating existing sectoral budgets and identifying new funding sources.  The policy will contribute to the national government’s priorities and directives in disaster risk reduction, adaptation to climate change, and sustainable environmental management.

17 18 SMART HOSPITALS INITIATIVE outcome of this policy willbethesustainabledevelopmentoutcome oftheCaribbean healthsector. ofthispolicy Components onSMART ofthePolicy Health Facilities sound decisionmaking. andinformation andtheapplication ofknowledge through andtraininginternationally; for advocacy green that have healthfacilities;theuseoftechnical guidelinesandtoolkits beentested regionally and nationally, regionally andinternationally. advances Importantly, thebuildingofsafe thepolicy and The include: The components ofthepolicy statementThe comprises avisionstatement, policy andtheobjective. thepurpose The impact The       

Must enact legislation financial andearmark resources enact Must to renovate and retrofitcritical themost ofexisting facilities through vulnerability reduceMust and functional thenon-structural adhere,Must to indesign buildingcodes, and construction, fire safety guidelinesandother Is onlyaseffective asthedegree to whichotherareas andsectors, suchasoperations and may besubmittedThe to policy thePAHO Council Directing for endorsement. willhelpsafeguardThe policy healthfacilities, assetsofacountry’s whichare important critical willhaveThe policy acost-neutral onhouseholds. impact infrastructure, and ultimately contribute to national security. facilities to increase protection levels andsafeguard thehealthworkforce, patients and their greening strategies. andenergy-efficient risk-reduction measures. and addressing theseconcerns. architecture andengineering, are involved ofhealthfacilities indetermining thevulnerability maintenance, disaster management organizations, planning, and finance, publicservices smart smart families inthesefacilities. HealthFacilities Policy: HealthFacilities Policy isbasedonanumber ofPAHO/WHO place initiatives taking Policy Objective Policy Goal Vision A MODEL POLICY FOR SMART HEALTH FACILITIES 19 -

smart

Resource Resource Mobilisation retrofitting of retrofitting facilities. Public and private Public sector investment in mitigation. Allocation in national budget and retrofitting for operations. External funding aligned sources construction/to • • •

Operations Protection Operations smart & Knowledge & Knowledge Management Training potential potential Training use the users to toolkits, guidelines, technologies. in design, Training construction, and operations of health facilities. Capacity Building • • - - - - - facilities. , climate-resil safe Guidelines Toolkits and Toolkits In consideration of the limited resources available to to available resources of the limited In consideration green of projects. man Guidelines for and operat aging ing Structural and non-structural as sessments. Benefit Cost Analyses. ient technologies. Guidelines for construc design, tion and inspection Health Facilities Policy. Policy. Health Facilities • • • • • Investment Protection Investment the health sector in the Caribbean, the long-term costs of sectorthe health costs the long-term Caribbean, in the the structuralmitigating and non-structural vulnerability of the short-term will far outweigh health facilities investment, function to in di health facilities continue ensure helping to losses of health assets. and sustain limited situations saster green energy-efficient and other use of appropriate The can further these costs. and processes reduce technologies smart Partnerships sector; other public sector agencies; communities and the private sector. Coordination among national and regional agencies and IFIs and development partners. Joint responsibility and partnerships between health • • Figure 3: Mapping the SMART Health Care Facility Policy Facility Care Health 3: Mapping the SMART Figure , green Life safety Life , concepts SMART health facilities resilient to disasters and climate change, and with a small environmental footprint. and with a small environmental change, and climate disasters to health facilities resilient SMART safe Citizens receive safe, high-quality safe, in structurally health care health facilities. and non-structurally receive and green Citizens safe smart Advocacy toolkits. regularly sensitized sensitized regularly the to and and operational best practices. of Promotion guidelines and Advocating for for Advocating SMART facilities at regional national, and international levels. All stakeholders • • • Figure 3 maps the development of a 3 maps the development Figure Commitment of the Health Sector of the Commitment 20 SMART HOSPITALS INITIATIVE The Policy’s willbeachieved objectives through: d. c. b. a. e.

which healthfacilitiesare located andthenation ingeneral; theprivate (contractors, sector planning andpublicworks; environment andsustainable development, etc.); communities in disaster management agencies offices;between thehealthsector; otherpublicsector (e.g. Partnerships facilities. SMART concepts andoperational andover bestpractices time, become satisfied usersofthe agencies; communities; andtheprivate are sector regularly sensitisedto theSAFE, GREENand Advocacy Resource Mobilisation tential usersoftheguidelinesandtools. Potential targets for training include, amongothers: reminded oftheneedfor managementCapacity buildingandknowledge of existing facilities. tools when developing for projects ofnewhealthfacilitiesortheretrofitting theconstruction National healthauthorities, planners, andfundinginstitutionsmustusetheseguidelines projects. ofhealthfacility ties includethemanagement, andinspection design, construction for useby healthadministrators, technical advisorsandotherprofessionals whoseresponsibili Toolkits andguidelines providers);engineers, andbilateral otherservice agenciesproviding sources offunding. lies inconvincing ofincorporating prevention countries oftheimportance andmitigation iii. ii. i. Financing projects: construction bodiesincharge offundinghealthfacility projects: construction ofhealthfacility Executors andsupervisors projects: construction Initiators ofhealthfacility measures theallocation during ofresources for infrastructure investments. Onereason The private (includingprivate sector banking) • Nongovernmental organizations • • • • • • • • • • • • • • • Government International sources: development banksandbilateral andmulti-lateral donors ofFinance ofHealth,intandemwiththeMinistry Ministry Public bodiesthat have sector identified theneed for newfacilities Private sector Subcontractors entrusted control, withthemanagement, quality design and/orex Subcontractors entrusted withhospitalmanagement Government offices orindependent agenciesincharge ofenforcing buildingstan of ofFinanceWorks; ofHealth;Ministry Ministry Ministry ofFinanceMinistries governmentsMunicipal Civil society Private sector Authorities etc.) ofHealth,HealthServices Public (Ministry sector ecution oftheproject dards –allstakeholdersinthehealthsector, makers; otherpublicsector including:policy –a smart health facility is the joint responsibility and outcome of partnerships isthejoint responsibility andoutcome healthfacility ofpartnerships - The mainchallengeto mobilising resources for –PAHO hasdeveloped acomprehensive suite oftools andguidelines smart healthfacilities, training mustbeprovided regularly to thepo –Justasallstakeholdersshouldberegularly smart HealthFacilities - - - - A MODEL POLICY FOR SMART HEALTH FACILITIES 21 - - - - Health Facility smart If of the non-structural the cost 12 . Accessed on July 27 2013. . Accessed 13 ‘Greening’ Strategies for a for Strategies ‘Greening’ Energy efficiency:Energy building design: Green generation: energy Alternative Food: Waste: Water: - - - - - . www.paho.org/English/Ped/ws-chapter6.pdf Proper maintenance not only reduces the degradation of the health facil of the health degradation the not only reduces maintenance Proper 14 health facilities. carbon footprint, with immediate with immediate carbon footprint, benefits. health and economic the social and eco to civil society, green and of safe nomic significance ous operations in times of emergen ous operations cy and disaster. and methods technologies resilient and the environmental reduce that hospitals or health facilities that can can hospitals or health facilities that emergency or disaster. withstand any ensure facilities to ting of existing and continu safety their resilience, health facilities in terms of structural, of structural, health facilities in terms non-structural functional and vulner ability. emergency. emergency. for less than 4 percent of the initial investment. of the less than 4 percent for budget of a facility. and non-structur and electricity, gas, public services that ity but can also ensure such as water, function to during an properly continue etc., doorways, roofs, such as detailing, al components ing the costly investment demands high safety and performance high safety demands standards. investment ing the costly than 1-2 percent. no more construction by total costs crease the of the facility) cost is added, of the total about 80 percent for (which account elements the construction facility of a new health into accounts measures of mitigation incorporation is the belief that these measures will significantly increase the cost of the initial investment, investment, cost of the initial the increase will significantly these measures that is the belief the part on reticence governments This of budgets. or health profits eventual affecting thereby expensive, or scarce are resources when financial sectoraggravated alike is and the private In of priorities. the list projects fact, down mitigation true: protect is just the opposite forcing Sensiting all stakeholders, including including Sensiting all stakeholders, Introducing green and climate- green Introducing Planning for renovations and retrofit renovations for Planning Assessing existing hospitals and hospitals existing Assessing construction of new for Advocating The cost of preventive maintenance is not high if it is considered part is considered is not high if it of the normal operating maintenance of preventive cost The The cost of mitigation measures that increase the structural of a health facility integrity increase will in that measures of mitigation cost The e. d. c. a. b.

The elements of the policy elements The strategy Caribbean. (Washington, D.C., 1994). (Washington,Caribbean. D.C., http://www1.paho.org/english/ped/mitigation3.pdf 1996). (Mexico, Facilities. Pan American Health Organization, Principles of Disaster Mitigation in Health Facilities, (Washington D.C., 2000). (Washington D.C., Mitigation of Disaster in Health Facilities, Principles American Health Organization, Pan ReductionVulnerability in Health on Report American Health Organization, the International Conference to Pan America Journey and the of Latin The Disasters: Natural from Safe World A American Health Organization, Pan 12. 13. 14. Policy Strategy include: 22 SMART HOSPITALS INITIATIVE these same building blocks in the tourism sector andcommunities.these samebuildingblocksinthetourism sector applied thetools andguidelinesto anddiscussionsare theeducational to sector nowuse underway as schoolsandtourism plants, ‘ health sector. These andelements objectives canbeusedto infrastructure, makeothercritical such (OECS); theCaribbean Development the Bank; World andtheInter-American Development Bank; Bank. (CDEMA);Agency theCaribbean Community (CARICOM); theOrganization ofEastern Caribbean States the Caribbean Community Climate ChangeCentre; Management theCaribbean Disaster Emergency alsorequires ofHealthtakeleadership,mitment. It that theMinistries by: Implementing thePolicy The and elements objectives ofthePolicy on At theregional andinternational level, PAHO willchampion thestrategy withagenciessuchas the Implementing h. g. f. e. d. d. c. b. a. Inserting this policy into otherrelevant thispolicy national policiesandstrategiesInserting and, where appropri Collaborating withotherpublicandprivate agenciesto introduce sector green andclimate- Encouraging ofFinance Ministries andPublic Works to ensure that thecost ofaCheckConsul Encouraging agenciesthat ofnewhealthfacilities finance external to incor the construction thatEnsuring financingis available to implement,recommenda at aminimum,thepriority acampaign on Actively supporting Expanding themandate ofthe ‘Safe Hospitals’ Committee, underthecoordination oftheMin asub-programme on Including ofHealth to develop pro adisasterrisk Ministry reduction Assigning ineach aspecific entity istry’s Disaster Coordinator, to become a gramme. ate, that ensuring itisincorporated into thegovernment’s legislative agenda. heath sector. resilient technologies andmethodsto achieve immediate healthandeconomic benefitsinthe tant porate setoutinthispolicy. theprinciples tions identified followingIndex. applicationSafety oftheHospital iii. ii. i. 15 Encouraging assessment ofdisaster inexisting healthfacilitiesto vulnerability develop andsignificant andimplementing onpractical Sharing best practices progress towards including(a)stakeholderswithinandbeyond thehealth Involving ofpartners avariety long-term plans. the (b) national andinternationalsector; financialinstitutionsand(c)otherkey contributors. isincorporated into thetender documents. smart 15. A CheckConsultant provides ofplans, anindependent technical calculations, inspection buildingrequirements project management.project behalf oftheclient oftheHealthFacility and/orthe ofHealth)andnotthecontracting authority (eg., theMinistry for theCheckConsultant shouldcome from thefinancierofplannedfacility. The Check on Consultant acts have proven experience, broader thanthat manager, oftheproject ineachoftheareas to bemonitored. Funding Consultant(s) must beengineers incharge oftheproject orotherprofessionals ofthetechnical inspection who rors. anddoesnotreplaceThe theContractor’s CheckConsultant assupport acts manager. project The Check completely theinspection. independent of thebuilders, mustperform This willimprove ofer thedetection and allassociated works related to facility. planninganewhospitalorcritical Ahighlyqualifiedpersonor team, HealthFacilities level. Initiative at thecountry smart HealthFacilities Policy willrequire, above all, politicalandfinancial com smart ’. Indeed, theGovernment oftheBritish Virgin Islandshasalready smart smart HealthFacilities programme. reduction therisk aspart HealthFacilities: smart smart Committee. HealthFacilities are applicablebeyond the ------A MODEL POLICY FOR SMART HEALTH FACILITIES 23 - - - 16 Checklist provides an indication of improvements that Caribbean hospitals and health Caribbean that of improvements an indication Checklist provides green services risk. at are risk during disasters. tinue functioning situations. in disaster Category C designates a health facility where the lives and safety of occupants are deemed at deemed at are of occupants and safety the lives a health facilityCategory where C designates Category A is for facilities deemed able to protect the life of their occupants and likely to con and likely to of their occupants the life protect to facilities deemed able Category A is for and critical but in which equipment a disaster, can resist facilities that Category to B is assigned

   The The The BAT includes criteria for selecting an appropriate health facility that can be made ‘smarter.’ This This ‘smarter.’ health facility selecting can be made that includes criteria an appropriate for BAT The The Baseline Assessment Tool was designed to achieve cost savings by reducing the consump reducing by savings cost achieve to designed was Tool Baseline Assessment The Calculating the safety score allows health facilities to establish maintenance and monitoring and monitoring establish maintenance facilities to health allows score safety the Calculating The Hospital Safety Index is a tool that helps to determine the probability that a hospital or health that the probability determine helps to Index that Hospital Safety is a tool The PAHO is currently developing a Toolkit to help achieve SMART health facilities. The guidance docu guidance The health facilities. SMART help achieve to Toolkit a developing is currently PAHO The Hospital Safety Index for Small and Medium-Sized Health Facilities, has been adapted for the Caribbean. for has been adapted Health Facilities, Small and Medium-Sized Index Hospital Safety for The footprint. The Green Checklist identifies areas that can conserve resources, cut costs, costs, cut conserveresources, can Checklist that Green areas The identifies footprint. carbon emissions. a hospital’s reduce efficiency and increase in operations 16. 3. The GREEN Checklist and Discussion GREEN Checklist The Guide 3. and carbon their environmental reduce to facilities can make in their daily operations staff with: a) the general building; b) air quality; c) ventilation; d) acoustics; and e) lighting. Another b) air quality; building; staff with: a) the general and e) lighting. d) acoustics; ventilation; c) in the covered areas The conduct to the assessment. required the baseline information section covers checklist include: energy; of the property; condition quality; water; indoor environmental fire waste; to gauge the can be applied periodically The BAT accessibility; floor area. and egress; safety and gross ‘smarter.’ becoming towards progress health facility’s resources efficiently, creating favorable working conditions, generating community goodwill, avoiding community goodwill, working generating conditions, favorable creating efficiently, resources the of caring for the users of health facilities about the value and educating liability problems future environment. Satisfaction Survey the satisfaction and determine to of patients a Patient/Occupant by is followed Safety Index can be used to monitor and evaluate the extent to which the health facility which the health to the extent safe. is and evaluate Index monitor Safety can be used to (BAT) Tool 2. Baseline Assessment using efficiency increasing of operations, costs, and water on energy saving tion of good and supplies, routines and look at actions to improve safety in the medium term. Periodic application of the Hospital application Periodic in the medium term. safety actions and look at improve to routines 145 areas of the hospital. The Safety Index score places a health facility into one of three categories of categories one of three a health facility places into Index Safety score The the hospital. of 145 areas need interventions: helping authorities which facilities most urgently determine safety, 1. The Hospital Safety Hospital The Index 1. function non-structural to facility on structural, based emergency in and will continue situations, in Checklist of safety assess the level to standardized uses a Team functional Evaluation An factors. Monitoring, Evaluation and Reporting Evaluation Monitoring, include: that of tools a number comprises ment 24 SMART HOSPITALS INITIATIVE agement reporting at thenational andregionalagement reporting levels, through the: these tools. frameworkThe mustbereflected reporting andincorporated into ongoingdisaster man whether theadvantages (benefits)oftheproject exceed thedisadvantages (costs). It involvesand benefits. the comparing value of since itprovides greater ofalternative interms ofcosts understandingoftheimpact courses ofaction 4. Cost-Benefit Analysis tocan thenbeusedperiodically determine ifwater measures have conservation madeadifference. terns ofpotablewater useinthefacility. After puttingwater saving measures inplace, thesameaudit consumes electricity.facility Similarly, a Water and patto determine quantity Audit isfirstperformed technologies, theEnergy Audit canbeusedonan been madetowards becoming SMART. For example, introducing after measures energy-efficient and A simplemonitoring andevaluation framework canbedeveloped, useof basedontheperiodic The Cost-Benefit Analysis (CBA) framework decisionmaking, isaneconomic tool used to support The  

Reports on the protection of critical infrastructure and the impact of climate change; reports ofclimate change;reports infrastructure ontheprotection andtheimpact ofcritical Reports oftheNational Disaster ofHealth;Pan Organisations; Ministries Annual Reports American to CDEMA Caribbean Disaster Conference. Management Health Organization; green checklist canbeusedregularly oftheimprovements to monitor checklist theimpact that have smart annual basisto determine changesinthehow the Hospital interventions andisdesigned Hospitalinterventions to assess - - CONCLUSION

Health care facilities in the Caribbean represent a great social value to communities, offering an essential sense of security. Although the social, political and economic justification for maintaining a health facility’s ability to function in the aftermath of disasters is strong enough, there is an even stronger justification within the health sector itself. The cost of running hospitals in the Caribbean rep- resents approximately 70% of the budget of the Ministries of Health, with most of the money going to salaries.17 In remote areas and in small island nations, frequently there is only one facility of this type; if it is not functioning, this represents a 100% loss. Every day the health sector invests large sums of money in building, remodeling or expanding its health infrastructure. When the status of the vulnerability of the health sector to disasters was reviewed in 200418 in Nicaragua and Trinidad and Tobago, reports pointed to the fact that low and middle-income countries have demonstrated, through pilot projects, that it is possible to significantly reduce vulnerability to disasters, making health facilities safe, with existing technical and financial resources. The same is true when it comes to smart health facilities. For the most part, technical and financial considerations are not standing in the way. Making significant advances towardssmart health facilities will require committed support from other sectors, a strong political commitment and higher international visibility. The opportunity to draw attention to the importance of incor- porating disaster mitigation climate adaptation measures to con- tribute to the sustainability of these investments cannot be let pass. Countries are encouraged to recognise the importance of formulat- ing a national smart Health Facilities Policy and incorporating this policy into the national Health Disaster Reducing the vulnerability of Management Policy. Caribbean health care facilities is a goal we can achieve .

17. Pan American Health Organization, Report on reducing the impact of disasters in health facilities, (Washington, D.C., 2004). http://www1. paho.org/english/gov/cd/CD45-27-e.pdf. 18. Ibid.

25 ACRONYMS

GDP Gross Domestic Product UNECLAC United Nations Economic Commission for Latin America and the Caribbean USD United States Dollars PAHO Pan American Health Organization WHO World Health Organization USAID United States Agency for International Development ECHO European Commission for Humanitarian Aid and Civil Protection GHG Greenhouse gasses CARICOM Caribbean Community OECS Organisation of Eastern Caribbean States CDB Caribbean Development Bank IADB Inter American Development Bank UK United Kingdom

26 GLOSSARY

Disaster A serious disruption of the functioning of a community or a society involving widespread human, ma- terial, economic or environmental losses and impacts, which exceeds the ability of the affected com- munity or society to cope using its own resources.

Disaster Management A systematic process that includes planning, organization, management, and control of all disaster- related activities. Disaster management is achieved through prevention, mitigation, preparedness, response, rehabilitation, and reconstruction activities.

Disaster Risk Management The systematic process of using administrative decisions, organization, operational skills and capaci- ties to implement policies, strategies and coping capacities of the society and communities to lessen the impacts of natural hazards and related environmental and technological disasters. This comprises all forms of activities, including structural and non-structural measures to avoid (prevention) or to limit (mitigation and preparedness) adverse effects of hazards.

Disaster Risk Reduction The concept and practice of reducing disaster risks through systematic efforts to analyse and manage the causal factors of disasters, including through reduced exposure to hazards, lessened vulnerability of people and property, wise management of land and the environment, and improved preparedness for adverse events.

Emergency The affected community generally has the resources to respond to an emergency.

Hazard A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disrup- tion, or environmental damage.

27 28 SMART HOSPITALS INITIATIVE Provisional restoration (lifelines) ortemporary affected inacommunity ofessential services by adisas Rehabilitation damaged infrastructure, systems, andservices. isted to prior anevent. incorporates Reconstruction measures disaster reduction risk whenrestoring Complete repair ofphysical, social, andeconomic damageto alevel ofsafety that ishigherthanex Reconstruction tions that canbetakenindividuallyand collectively to reduce exposure to andvulnerability hazards. The aboutdisaster extent ofcommon risks, that knowledge leadto thefactors disasters andtheac Public Awareness by eliminating thehazard, thevulnerability, orboth. aimedatActions avoiding damageasaconsequence ofadverse phenomena.Prevention isachieved Prevention ties. plans, training resources concerned out response personnel, activi and establishingnecessary to carry from damagecausedby adverse events. Preparedness isachieved by developing disaster response andmeasuresActions takento increase to effectively thecapacity anticipate, respond to, and recover Preparedness as power system, water anddrainage, distribution heating andcooling systems, staircases, etc.). equipment andsystems andfurnishings), laboratory that are essential for thefacility’s operation (such elements (suchascladding, ceilings), equipment interior (suchasindustrial, partitions, medical, and system ofthestructure. ofthesupport Elements that donotform part These includearchitectural elements Non-structural by theGovernor, Prime orHeadofgovernment Minister intherespective country. mitigation, preparedness andresponse andrecovery andrehabilitation. The NDOisgenerally headed ofattendingpurpose to thelegal, ofdisaster institutionalandoperational prevention aspects and The NDOinthisdocument refers to thenational organizational ofagencieslinkedfor structure the National Disaster Organisation (NDO) andhurricanes. ards suchasearthquakes achieved by reducing thehazards, vulnerability, general, orboth.In onecannotmitigate natural haz thatActivities aimto lessenthelikelihoodofdamageresulting from hazards. ofdamageis Mitigation Mitigation ter. levels. Rehabilitation isachieved by at providing pre-disaster services - - - - - A MODEL POLICY FOR SMART HEALTH FACILITIES 29 - - - Vulnerability the predisposi to corresponds This a hazard. to exposed a person, object, risk factorThe or system for hazard. that from damage resulting of susceptibility to tion or level its own infrastructure during and after an adverse event. during infrastructure and after an adverse its own Structural components load bearing walls, beams, Supporting including the columns, building, of a or load bearing elements etc. slabs, foundations, a given period of time with a magnitude, intensity, cost, and duration determined by the interaction the interaction by determined and duration cost, intensity, period of time with a magnitude, a given vulnerability. and hazard between SAFE Hospital and can depend on function is able to full capacity, at A health services accessible, facility remains that order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs the basic subsistence and meet public safety health impacts, ensure reduce lives, save to order of the people affected. Risk community damage occurring in a specific and in and economic environmental, of social, Probability vices and goods to be affected by said phenomenon. This relationship can be expressed in the formula in the expressed be can relationship This by said phenomenon. be affected and goods to vices is vulnerability. V and R is risk, where H is hazard, V, R = H × Response of emergency services in after provision a disaster duringThe or immediately and public assistance Relationship between risk, hazard, and vulnerability risk, hazard, between Relationship relation complex is a dynamic and This and vulnerability. hazard of the interaction of Risk result is the and place time a given occurring at event of an adverse probability the to according changes ship that ser infrastructure, of people, and the predisposition and duration, intensity, magnitude, with a given