Safe and green: Smart Health Facilities
The Smart Hospital initiative builds on the Safe Hospital Initiative and focuses on improving hospitals' resilience, strengthening structural and operational aspects and providing green technologies. Energy improvements include solar panels installations, electric storage batteries, and low-consumption electrical systems, which, in addition to reducing energy consumption, reduce health sector carbon footprint in the environment and provide the hospital with energy autonomy, allowing it to continue running during emergencies and disasters.
Piloted in 2012 in Saint Vincent and the Grenadines and St. Kitts and Nevis, the Smart Hospitals project is one of PAHO’s largest partnership initiatives, together with the United Kingdom’s Department for International Development (DFID), now called FCDO.
Smart Hospitals have already shown their cost-effectiveness and resilience to disasters. In St. Vincent and the Grenadines, Georgetown Hospital (benefiting from the intervention of a Smart hospital) was the only one that remained functional after a severe storm-affected 39 clinics and the reference hospital (Milton Cato Hospital). In addition, this hospital became a water supply center for the community after the storm, using rainwater reserves.
Caribbean countries are encouraged to tackle global challenges including climate change and diseases by using smart standards in all health facilities.
Although the Smart Hospital concept has not been implemented in Latin America, countries of the Region are aware of the Safe Hospital initiative, as well as the Hospital Safety Index, which is widely disseminated around the world.
According to the Disaster Risk Reduction Action Plan 2016-2021, 77% (13,566 / 17,618) of the Region's hospitals are located in at-risk areas and require urgent repair measures to protect the lives of staff and patients during and after a disaster. Hospitals follow the building codes of the 1980s and 1990s, focused on seismic resistance, without taking into account climate change.
The International Panel on Climate Change Report AR53 indicates that extreme weather events (heat waves, storms, floods, droughts, wildfires) will occur in the coming years, leading to a decrease in available water, reduced food production, and an increase in vector-borne and other diseases, making the vulnerability of ecosystems and human systems much more evident. Health systems will be among the most vulnerable to climate variability (according to the AR5 Report, with a very high confidence level). The effects of climate change are variable; however, it is necessary to create conditions to reduce vulnerabilities before the effects manifest themselves.
PAHO has been providing technical assistance to Caribbean countries for the implementation of the Smart Hospitals initiative in phases I and 2 (2012-2014 and 2015-2020 respectively).
RESILIENCE (insurance)
Solid roof and foundation
Enhanced security and signage
Safe storage of equipment and fuel
Protected and efficient doors and windows
Good drainage
Backup power
Water backup
Disaster management plans
Comprehensive maintenance planning
Disabled access
SUSTAINABILITY (smart)
Downtime reduction
Resilient structure
Reduced operating costs
Improved safety
Satisfied patients and staff
Environmentally-friendly operations
Improved emergency care and services for the community
ECO-FRIENDLY (green)
Water efficiency
Waste minimization and management
Pollution reduction
Rainwater harvesting
Alternative energy through renewable energy
Efficient lighting and cooling
Improved indoor air quality
Smart Tool Kit
This Smart Hospitals Toolkit is designed for hospital administrators, health disaster coordinators, health facility designers, engineers and maintenance staff to help assess disaster safety levels and energy consumption and provide recommendations and action plans for the implementation of interventions aimed at improving resilience, conserving resources, cutting energy costs and dependency, increasing energy efficiency in operations, and reducing carbon emissions.
This Toolkit is comprised of previously developed instruments such as the Hospital Safety Index, the Green Checklist and other accompanying tools aiming to guide healthcare facilities in the process of linking their structural and operational safety with green interventions, at a reasonable cost-to-benefit ratio and become Smart.
Hospital Safety Index: Guide for Evaluators
CHospital Safety Index Calculator (Small and Medium Facilities)*
REST: Retrofitting Economic Support Tool*
REST: Retrofitting Support Tool User Guide (Cost Benefits Analysis)*
Baseline Assessment Tool 2017 +
Technical Standards for Retrofitting +
A Model Policy for Smart Health Facilities +
*Disponible en inglés
Smart health care facilities in the Caribbean
Natural hazards and climatic extremes, like hurricanes, earthquakes, floods and storm surge can cause significant disruption of health services and economic losses. Downtime, during and after an extreme event, limits the ability of health facilities to provide emergency care to victims and ongoing healthcare for their communities.
Many health facilities in the Caribbean are in areas of high risk and need strengthening in the face of repeated damage or increasing climate threats. Health care facilities can also be large consumers of energy, with a significant environmental footprint. With energy prices in the Caribbean among the highest in the world, savings could be better used on improving services.
The 'Smart Health Care Facilities in the Caribbean' project, funded by the UK Department for International Development (DFID) was implemented by PAHO/WHO in partnership with the Ministries of Health in target countries. A regional building code annex, guideline and toolkit for retrofitting existing or new facilities were developed and tested in two countries. The toolkit provides a step-by-step guide and includes the Hospital Safety Index (HSI), Baseline Assessment Tool (BAT), and Green Checklist and utilizes cost-benefit analysis to support investment decision making. Scale-up of the project, also supported by DFID, is being implemented in seven Caribbean countries: Belize, Dominica, Grenada, Guyana, Jamaica, Saint Lucia and Saint Vincent and the Grenadines.
The purpose of this project will be to provide safer, greener health facilities to deliver care in disasters.
The first result: sanitation facilities will be assessed in terms of disaster safety and water and energy consumption. This will provide a roadmap for investment in risk reduction as well as ecological measures, and will be incorporated into each country's national risk exposure database.
The second output: standards will be applied in selected health facilities in Belize, Dominica, Grenada, Guyana, Jamaica, St. Lucia and St. Vincent and the Grenadines.
The third output: national and regional capacity will be developed to promote climate-smart health facility standards. This includes health workers and facility users; other sectors and climate change platforms or programs; technical stakeholders (construction, engineering, architects, etc.) and the media.
Read the final report of the Smart Health Care Facilities in the Caribbean Phase 2 project.
PAHO has been providing technical assistance to Caribbean countries for the implementation of the Smart Hospitals initiative in phases I and 2.
As part of an external evaluation of the Smart Hospital Project, this video shows and focuses on the aim of the project, its results, lessons, and recommendations for future similar projects to increase the resilience of the health sector.
Smart Hospitals Dashboard
Explore the dashboard to learn how the Caribbean region is retrofitting their health care facilities to make them Safe + Green + Maintained = Smart, to provide care in disasters.
Highlights
The Paramakatoi Health Centre was retrofitted between February 2022 and March 2023 as part of UKaid funded Smart healthcare facilities in the Caribbean project. This very remote facility is located in the Pacaraima mountains in the Potaro-Siparuni region of Guyana. Due to its remoteness the retrofitting was implemented through PAHO by the Guyana Defense Force (GDF) with support from the local community. This video shows the handover of the Safe+Green+Maintained=Smart Paramakatoi Health Centre, which is ready to provide healthcare services to the Amerindian community, even in disasters.
Technical Guidelines
Check lists and other guidelines
- Updated Green Checklist for Smart Facilities 2022
- Final evaluation of SMART health facilities in the Caribbean. Phase 2.
- A Conceptual and Adaptable Model for Disaster Management in the Caribbean - 2018
- Checklist for Check Consultants - 2018
- Hurricane shutters & windows: the dos and don'ts of installation -2020
- LED Lighting in Hospitals - 2019
- Lightning Strikes - Smart Hospitals Protective Measures - 2019
- NOA Rated Materials - Technical Review and Recommendations for Selection of Materials for PAHO Smart Health Facilities Retrofit - 2018
- Off-Grid Photovoltaic System for Small Health Facilities - 2018
- Putting SMART to the Test – Weathering Climate Change in the Caribbean - 2019
- Rainwater Harvesting for Smart Health Care Facilities - 2019
- Retrofit Measures for COVID-19: Smart Hospital Project - 2020
- Smart II Case Study - Roofing Details - 2019
- Preventive Maintenance Manual for Small Healthcare Facilities - 2017
- Hurricane resistant buildings: Building CAT-5 Resistant Timber Roofs
- Caribbean Wind Hazard Maps Aid in Siting of Hospitals
- Design Wind Speed Maps for the Caribbean
Key resources
- Case Study - Smart Hospital Project 2023
- Case Study - Pogson Hospital - St. Kitts & Nevis - 2014
- Case Study - Georgetown Hospital - St. Vincent Hospital - 2014
- Case Study: The Smart Hospital Project - 2014
- A 'Smart' Approach to Building Back Better After Hurricane Irma - Adina Donovan Home - BVI - 2014
The countries of Latin America and the Caribbean are exposed to various natural and manmade hazards. We must be able to rely on our hospitals and health centers in all circumstances to avoid an increase in the number of victims after an event. This material, in French, includes a Guide, a training tool for using the guide, a questionnaire with a list of potential elements that can fail, and a short brochure with the key elements of the guide. The guide and accompanying materials have been designed specifically to aid in the construction of hospitals in Haiti, but the patterns shown may be of use to many countries and communities.
It has been proven that natural light is much healthier than artificial light. This flyer explains the time of the day and locations were people could take advantage of using natural light and with what frequency and what level of brightness artificial light can be used.
The 'Smart Health Care Facilities in the Caribbean' project, funded by the UK Department for International Development (DFID) was implemented by PAHO/WHO in partnership with the Ministries of Health in target countries. A regional building code annex, guideline and toolkit for retrofiting existing or new facilities was developed and tested in two countries. The toolkit provides a step by step guide and includes the Hospital Safety Index (HSI), Baseline Assessment Tool (BAT), Green Checklist and utilises cost-benefit analysis to support investment decision making.
Many Caribbean buildings are built in a way to allow good natural ventilation because they were built at a time when no air condition units were available. This flyer explains the different procedures to be carried out in order to obtain the best climate from natural air and the appropriate use of the air conditioner system.