How can we tell whether a hospital is safe? What does “safe” really mean? What can we do when we know that it isn’t? For many years there have been more questions than answers about these issues. It has been difficult to agree on the indicators for baseline information and measure the progress that countries are making in this critical area. These concerns are being addressed by experts from the PAHO/WHO Disaster Mitigation Advisory Group (DiMAG). Their objective is to create an instrument that allows assessment or diagnosis of the existing safety level in hospitals should they be affected by a disaster. It will help to develop a list of priority facilities for intervention and to monitor progress in hospitals in the Region.

In each facility general information is gathered on variables such as: level of complexity, population served, specialties, health staff, available services, location, hazards, and the history of disasters at the site. An assessment is then made of the level of safety of the structural and nonstructural components and functional and organizational aspects of the hospital. For each component specific features are assessed, and each receives a high, medium, or low safety rating according to established standards. Values are given to these ratings depending on the importance of each feature. These are then used to determine what actions to take and the timeframe of those actions in order to improve the safety of a specific facility.

This approach to verifying hospital safety provides a way to train multidisciplinary teams of assessors, including engineers, architects, health personnel, hospital directors, and others. A health facility can be evaluated in just a few hours and the cost is low. This makes it possible to assess a large number of health facilities in a short period of time. While this index does not replace detailed vulnerability studies, it does provide for rapid accrual of preliminary information that will identify facilities that need immediate intervention, and those that need measures to be taken in the short-term. The facilities that have a satisfactory rating should establish maintenance and monitoring routines and can improve their level of safety by taking action in the medium-term.
This methodology has been used successfully in Mexico and to a lesser degree in Costa Rica, Cuba, Dominica, Peru, and Saint Vincent and the Grenadines. Readers are invited to view the Index and obtain a copy from the PAHO website: