The Hospital Safety Index has been adopted worldwide and is being put to use in almost every continent.
The Hospital Safety Index has been adopted worldwide and is being put to use in almost every continent.

The health sector has progressed at a steady pace in disaster risk reduction (DRR) since 1985, when ministers of health in the Region of the Americas included vulnerability reduction in health facilities in their disaster and emergency preparedness programs. In 1989, the first international meeting was held on integrating disaster risk reduction into the planning, design, and construction of hospitals in seismic areas. The health sector has been a pioneer in identifying challenges and setting priorities for intervention and has overcome difficulties encountered one by one.

There was progress in the following decade, particularly in the Caribbean, where it was evident that safe hospitals could be built. Pilot projects in Latin America have shown that by applying existing knowledge and human and financial resources it is possible to reduce vulnerability in hospitals. These advances seemed out of reach in countries where incomes are relatively low.

The enormous challenges of risk reduction prompted the health sector to focus on the single issue of safe hospitals, and in 2004 the PAHO/WHO Directing Council adopted the safe hospitals strategy. The following year, the same initiative was presented at the World Conference on Disaster Risk Reduction where 168 countries adopted the Hyogo Framework for Action. Hospital safety is the only issue affecting the health sector in that framework. In 2011, the health sector stands out because it has put into practice indicators for hospital safety which are being implemented in 27 countries and territories in the Region of the Americas.

The Hospital Safety Index is a tool developed by experts from this region to assess at-risk health facilities. The Index has been adopted worldwide and is being put to use in almost every continent. These advances are important not only because of their impact in the health sector but because of the potential for use in other sectors. For example, the education sector is adapting the Index for assessing the safety of schools.

Despite the gains made, they are limited compared to what still must be done in countries to reduce disaster risk. And to the extent that the issue is better understood, we see more complexity to the challenges we face. But we can overcome these problems in a progressive, organized and sustained process.

To meet commitments made in the Hyogo Framework, in 2010 the Directing Council of PAHO/WHO adopted Resolution CD50.R15 which urges Member States to adopt the Safe Hospitals Plan of Action for 2010–2015. The goals of this plan are first, to ensure that all new hospitals are constructed so that they can continue to function in disaster situations and, second, to ensure that disaster mitigation measures are carried out in existing health facilities.

Health facilities are highly dependent on other sectors for lifeline services. A hospital without water, road access, power, or communications is unable to provide medical treatment. The health sector depends on the capacity of a variety of institutions to continue to provide critical services so that health facilities can provide emergency medical treatment and, indeed, safeguard the health of those charged with maintaining lifeline services.

As part of the Inter-American and United Nations systems, PAHO/WHO has been able to promote policies, forge agreements, and work in cooperation with member agencies and organizations in the interest of hospital safety. Of note has been its work in the framework of the United Nations International Strategy for Disaster Reduction (ISDR), which led to the 2008–2009 “Hospitals Safe from Disasters” Global Campaign. Likewise, the contributions and participation of sub-regional agencies and donor countries and institutions have been instrumental in driving this initiative. However, there are still important barriers among sectors.

National, regional, sub-regional, and global platforms are being developed in the ISDR framework. We believe that these platforms will make it possible to reach the goal set for 2015 whereby all new hospitals will be planned, designed, and constructed so that they can continue to function in emergencies and disasters.

We appeal to all sectors, national and international agencies, and civil society, to review the Safe Hospitals Plan of Action and discuss their respective roles and responsibilities. The aim of the plan is to ensure that every country, regardless of its economic status, can have safe hospitals as symbols of social and economic resilience, thus achieving one of the priorities of the Hyogo Framework of Action.

Presentation by PAHO/WHO’s Area on Emergency Preparedness and Disaster Relief  to the Second Session of the Regional Platform for Disaster Risk Reduction in the Americas.