The Hospital Safety Index represents important progress on the road towards improvement of the security of health facilities in emergencies or disasters. Thanks to the contribution of the Pan American Health Organization’s Disaster Mitigation Advisory Group (DiMAG) and the input from other specialists in Latin America and the Caribbean, PAHO/WHO presents this new tool which is a rapid and low-cost method of assessing hospital security.

Determining the Hospital Safety Index ensures a general and approximate view of the security situation relating to the health facility, taking into account its surroundings and the network of health services in which it is to be found, but it does not replace a detailed and in-depth study of the vulnerability of the facility assessed. The Hospital Safety Index is not only a technical measuring instrument; it becomes a new way of managing risk, from the starting point of prevention and mitigation. Security is now not considered as an all or nothing situation, but can be gradually perfected.

The documents published – with are presented in a folder – guide and facilitate the work of the assessment teams to ascertain the index:

  • The “Guide for Evaluators of Safe Hospitals” is a theoretical and methodological document which provides general information on the planning and development of the assessment process and on how questions on the assessment forms should be interpreted and the options for responses. It gives guidance on the calculation of the index and is accompanied by a specialized glossary for those involved
  • There are two assessment forms. The first is “General information on the Health Facility” and should be completed previously by the hospital emergency committee of the centre to be assessed. The second “the Safe Hospitals Checklist” includes 145 questions which need to be answered to be able to calculate the SHI.
  • The Safety Index Calculator which is utilized for the final calculations of the index.

To consult and obtain more information on the index, please visit: 

Application of the Index in the Region, initial results

There are now several countries in the Region which are creating capacities to assess health facilities and obtain an analysis of priority measures and intervention actions.

Mexico has made significant progress. The Government Secretariat, through the National System for Civil Protection (SINAPROC) began the Safe Hospital Programme in 2006 at national level, with the participation of the public, private and social Health Sector, creating the National Evaluation, Analysis and Certification Committee for the Safe Hospital Programme, as well State Committees to carry out initial analysis of the situation of hospital units with high potential for resolving health issues, located in high risk zones. Interdisciplinary and inter-institutional personnel have been trained as hospital safety evaluators, by means of a six hour workshop, complemented by an internet course of sixty hours with national and foreign facilitators, who are specialists in the theme.

The application of the Index also began with several hospitals in Bolivia, Ecuador and Peru as part of a project (financed by ECHO) carried out in three geographical areas in which it is expected to formulate pilot programmes for safe hospitals at national, regional and local levels.
Some of the preliminary conclusions indicate that it is the non-structural elements (architectural elements, basic installations and equipment) which present most vulnerability; it was verified - once again- that a favourable political context is essential for the technical component to work and that it is important to have a legal framework which ensures the implementation of actions which ensure safer health facilities and which in addition include all actions with the health sector designs and implements in this respect; it was re-confirmed that process of assessment and application of the Index requires the formation of a multi-disciplinary team.

The application of the Index requires motivation and advocacy actions which encourage directors of facilities to designate their own resources for works and activities which ensure hospitals safer from disasters. In the Caribbean - thanks to another project financed by ECHO - the Hospital Safety Index is being applied in 8 hospitals in the following islands: Nevis, St. Kitts, Granada, Montserrat, Saint Vincent & the Grenadines, Anguilla, Dominica and Barbados. In addition, Cuba was one of the first countries to apply the Safe Hospital checklist and the results obtained are consistent with the hospitals capacity to continue functioning immediately after hurricanes Gustav and Ike.

The eight hospitals have completed the assessment and have begun to carry out intervention plans in accordance with the recommendations of the evaluation team. In addition, courses for hospital planning have been carried out, and as a result, hospitals are updating their emergency plan, taking into consideration different hazards and including preparedness, response and reconstruction measures. In the same way, in South America, the application of the index has achieved the generation of interest in the issue of safe hospitals, not only amongst the health authorities, but also in other spheres of risk management. In addition, other countries such as Jamaica or Trinidad and Tobago are now planning actions to apply the index in various hospitals. Central America, for its part, has an ambitious work plan for training evaluators and developing a safe hospital plan in several countries, which will begin in October 2008. This practical and simple instrument is generating an infectious effect which will result in the achievement of much more visible results in the short, medium and long-term to have health facilities which are safer from disasters.