sector disaster mitigation activities focus on reducing the physical
and functional vulnerability of all types and levels of health facilities
and water and sanitation systems. At the regional and national level,
PAHO advocates for and collaborates with Ministries of Health to establish
regulatory agreements that contribute to making hospitals safe in disaster
situations. Progress has been noted and several countries in the Region
have begun to reduce the vulnerability of their health facilities.
"Safe Hospitals" Initiative
January 2005, the Second
World Conference on Disaster Reduction was held in Kobe, Japan.
Nations around the world met to evaluate advances in disaster vulnerability
reduction and identify priorities for the next decade that would contribute
to creating disaster-resilient communities.
efforts of PAHO/WHO and Latin American and Caribbean countries, were
pivotal and resulted in the inclusion of a specific indicator on vulnerability
reduction in the health sector in the final Conference the reads: (see
4 for the complete Hyogo Framework for Action 2005-2015)
Integrate disaster risk reduction planning into the health sector;
promote the goal of "hospitals safe from disaster" by ensuring that
all new hospitals are built with a level of resilience that strengthens
their capacity to remain functional in disaster situations and implement
mitigation measures to reinforce existing health facilities, particularly
those providing primary health care.
commitment calls on governments to develop mechanisms that ensure that
health facilities continue to function following a disaster. It has
already had an impact on PAHO’s work, as many countries have requested
technical cooperation to meet this goal, both in new and existing structures.
Chile hosted a meeting to clarify the concept of “safe hospitals”
and set goals, objectives, strategies and activities for countries to
implement. The document resulting from this meeting was discussed at
the Andean Meeting of Safe Hospitals, where other countries contributed
their own national experiences to produce a brochure
with a proposed model national program for safe hospitals. (Annex
support was provided to Bolivia, which is now developing a legal framework
for safe hospitals and to El Salvador, which is striving to ensure that
hospitals presently under reconstruction (from the 2001 earthquakes)
incorporate all necessary measures to ensure their safety. Peru has
advanced in developing regulations on the topic, while Paraguay, is
incorporating the subject into the construction of new hospitals.
safe hospitals a reality presents multisectoral and multidisciplinary
challenges, and requires the support of other actors. There were many
successful efforts in 2005, as governments, civil defense systems, ministries
of planning, universities, and others joined forces, in one way or another,
to promote and support this initiative. As previously mentioned, a significant
achievements was CAPRADE’s initiative to organize6
the Andean Meeting on Safe Hospitals, which resulted in an Andean
strategy for Safe Hospitals and guidelines on its implementation.
Other non-health actors translated the conclusions into a commitment
from the countries to implement the Andean strategy for Safe Hospitals.
Several months later, CAPRADE included the results of this major meeting
in its annual meeting, providing a political platform and visibility.
However, it will still be necessary to support the countries of this
Region for some time to come as they work to incorporate this issue
into national agendas.
This meeting was jointly organized with the Andean Regional Health
Agency–ORAS/CONHU, the Ministry of Health of Peru, and the
technical and financial support of PAHO/WHO.
the water sector, PAHO/WHO has worked with UNICEF, the International
Strategy for Disaster Reduction (ISDR) and the International Federation
of Red Cross (IFRC) and Red Crescent Societies to reduce vulnerability
in water and sanitation services and most importantly, to ensure that
this topic received maximum visibility at the 4th
World Water Forum, which took place in Mexico in March of 2006.
As a contribution to the implementation of the Hyogo Framework for Action
2005-2015, planning was underway to organize a joint session on the
sustainability of water and sanitation services in the context of disaster
WORK TO REDUCE VULNERABILITY TO DISASTERS
mitigation in health facilities targets two types of infrastructure:new
buildings, where measures can be included as investment projects
are prepared and at the design and construction stages; and existing
facilities, where vulnerability reduction measures can be applied
according to a hospital’s priority in the health services network
or through accreditation and certification processes.
are some of the Region’s contributions to the goal of "safe
hospitals in disaster situations."
Ministry of Health requested collaboration to prepare technical
guidelines guaranteeing: a) aspects of disaster prevention
will be included in investment projects under the responsibility of
the health sector and, b) the incorporation of vulnerability reduction
indicators will be a common part of the accreditation and certification
of first-level health facilities. PAHO supported the Ministry to prepare
the content outline of both guidelines and collect regional experiences.
The success of these steps led to the Ministry receiving a non-reimbursable
loan to apply these tools on a pilot basis in selected national health
establishments. The decision of the Andean
Development Community (CAF) to lend support to the Ministry of
Health should be replicated with other financial entities committed
to this issue. (Annex
is a leading proponent of reducing the vulnerability of health
facilities and has been working on the topic at different
levels and with different actors. The Ministry of Health has identified
intervention priorities, placing emphasis on efforts to ensure that
all new investment projects are sustainable. Another priority considers
disaster risk and vulnerability reduction as obligatory for all health
investment projects. These efforts are backed by a manual that outlines
requirements in terms of disaster prevention and mitigation in new
investments, as well as a vulnerability analysis of existing health
facilities. Chile has made great strides with professional associations
and has established a procedure for the independent supervision of
public works (the check consultant mechanism). This mechanism, popular
in the Caribbean, should lead to buildings that are better designed
and of high-quality construction.
El Salvador (Annex
8), the Ministry of Health announced that the reconstruction
of the seven hospitals affected by the 2001 earthquakes will
be completed under the framework of "safe hospitals” to
ensure they can continue providing services in the event of future
disasters. Technical measures, such as the application of the Salvadorian
Design and Construction Code for Hospitals and Health Facilities7.
Prepared with the support of the Salvadorian Association of Seismic
Engineering and PAHO/WHO.
Peru, in order to plan and build hospitals in the least vulnerable
areas and to ensure compliance with construction and design
norms, the Ministry of Health promoted new legislation-the
National Building Code-which sets standards for health facilities,
including building sites and architectural and functional aspects.
office of infrastructure in the Ministry of Health formed a committee
on standards for health facilities to bring together the
country’s technical expertise in order to protect investments
in health infrastructure. Well-regarded experience from neighboring
El Salvador and from other countries is being used to bolster the
MITIGATION ADVISORY SERVICES
field of earthquake engineering received a significant amount of attention
following the massive earthquake in south Asia in October 2005. PAHO/WHO
shared regional knowledge and experience with this and other affected
regions. Regional experts from the Americas took part in a workshop
on disaster mitigation in Jakarta, Indonesia and assisted Pakistan to
conduct a diagnosis of building failures. These experts form part of
the PAHO/WHO Disaster Mitigation Advisory group (DiMAG), which held
its 2005 meeting in Tobago (West Indies). The group has been expanded
to include representatives from the “bureau de control.”
A bureau de control is an engineering firm in the French-speaking
Caribbean in charge of reviewing construction standards and their application.
The bureau de control is commonly contracted by insurance companies
and PAHO/WHO has encouraged countries to utilize a similar method—check
consultants—to review design and construction criteria for new
PAHO also supported the participation of selected engineers and other
members of DiMAG at the Conference of the International Association
of Structural Engineering, the world’s largest professional body
dedicated to structural engineering. The Caribbean section of this Association
organized a meeting on earthquake engineering in Tobago and the topic
of safe hospitals was on the agenda. At the previously mentioned DiMAG
meeting, which took place immediately after the international engineering
conference, participants discussed indicators to measure national progress
in mitigation and began to develop a set of indicators to certify existing
hospitals as safe. All aspects of vulnerability (structural and functional)
were included and work will begin to apply the matrix of indicators
to evaluate a few hospitals. The purpose of this mutually-agreed-upon
measurement system is to be able to monitor progress, report on and
share results with other countries within and outside the Region (Annex
advisory group supports Latin America and the Caribbean in vulnerability
reduction and damage assessment in the health sector through:
to the preparation and/or review of regional technical documents and
manuals (see section on publications below).
damage assessments of health facilities affected by disasters (floods
in Costa Rica, earthquake in Pakistan, earthquake in Chile, etc.)
countries to define a model national program for "Safe Hospitals."
in technical cooperation activities requested by the countries, including
presentations at seminars and workshops.
site selection services for new hospitals.
DISASTER MITIGATION PUBLICATIONS AND CAPACITY BUILDING
hospitals: A collective responsibility. A world indicator of disaster
reduction: an advocacy and awareness-raising publication that
presents clear and compelling justifications for the Safe Hospital
Initiative. The document outlines the social, economic and political
importance of applying disaster measures to protect the health facilities
from the avoidable consequences of the disasters.
hospitals: Practical recommendations. This brochure, in Spanish,
offers a more in-depth look at challenges and strategies for safeguarding
these critical facilities, either for new investments in health services
infrastructure or for existing structures. These recommendations include
site selection, application of building codes, and enlisting the participation
and technical assistance of skilled professionals in preparing technical
Thanks to a joint effort of the IFRC, PAHO/WHO, UNICEF, and the
OAS, a community manual was prepared and validated for natural
disaster mitigation in rural drinking water systems.
will use this document when implementing rural drinking water
projects, and for risk management and in training activities linked
to water and sanitation.
the local level, the responsibility for disseminating this material
falls to the National Societies of Red Cross, while PAHO/WHO and
UNICEF will promote its use at the central level or in the sector’s
ongoing training programs.
planning for disasters. These materials have been reviewed
and updated to organize and carry out the course Hospital Planning
for Disasters (2nd edition), which has been extremely well received
hospitals in flood situations. This publication aims to reduce
the vulnerability of health facilities to floods, the most frequent
natural hazard worldwide. It presents recommendations and technical
proposals to incorporate prevention and mitigation measures in new
or existing health care facilities.
mitigation in health facilities: wind effects. This CD offers
technical information on the effects of hurricanes on the structural
and non-structural elements of health facilities, and includes basic
mitigation aspects that can be implemented.
of disaster mitigation in health facilities. The revised edition
of this publication presents a platform for conducting vulnerability
studies and applying practical mitigation measures. It collects multiple
experiences from hospitals in Latin America and the Caribbean.
requests from English-speaking countries (the Caribbean and other parts
of the world) for the Spanish-language CD "Disaster
Mitigation in Drinking Water and Sewage Systems," the material
was updated, translated and distributed.
this past year, non-health actors demonstrated a growing interest in
becoming involved in disaster mitigation activities.
schools such as the Guatemala's College of Engineers, the Federated
College of Engineers and Architects of Costa Rica and the School of
Nursing in Ecuador, organized activities on "Safe Hospitals" to raise
awareness among members and contribute to their professional development.
VII Ibero-American Meeting of Engineers, Architects, and Surveyors
of 2005 included Safe Hospitals and the Salvadoran norm on hospital
Rica organized a seminar that included multidisciplinary experts that
make up the national teams involved in the design, construction and
operation of health facilities.
Ecuadorian Armed Forces included a "Safe Hospitals Day" in the National
Health Congress to encourage the Navy and Air Force to incorporate
aspects of vulnerability reduction in their work plans.
University of San Andres held a seminar on "Vulnerability, governance
and management of risk." Presentations illustrated to other sectors
that disaster mitigation is more than just a health topic and showed
how they can contribute to this initiative.
the lack of preventive maintenance is a key contributing factor to
hospital vulnerability. This leads to interruptions in services and
can contribute to fires that threaten the lives of patients as well
as the infrastructure itself. Faced with this reality, Ecuador's Ministry
of Health organized a workshop for directors of maintenance at the
country's principal hospitals to demonstrate how they can reduce structural,
non-structural and functional vulnerability of these critical facilities.
The participants, who are part of the hospital emergency operations
committees, were provided with information on low-cost steps to reduce
vulnerability. Since the initial workshop, an Internet-based discussion
group has been used to form an ad hoc advisory panel and exchange
information, converting what could have been simply an isolated training
activity into a sustainable platform that has attracted the attention
of other countries who are planning to replicate this experience.
mark the one-year anniversary of the supermarket fire in Paraguay,
the Ministry of Health organized a course on hospital planning where
the Minister of Health presented the "Safe Hospitals" initiative herself.
the International Seminar on Hospitals, Cuba's Ministry of Health
organized a Pre-Congress course on Safe Hospitals. Presentations were
also made at plenary sessions during the Conference. Because of the
multidisciplinary nature of the participants, the seminar brought
together the health sector and professional associations to discuss
the challenge of maintaining safe health networks during disaster
In addition to offering a number of ad hoc courses on the topic in 2005, the drinking water and sanitation sector has systematically incorporated this topic into their training strategy. Now, permanent training programs of technical rural water supply and sanitation projects include aspects of disaster mitigation. A training of trainers initiative has also been developed as well as technical material for diploma programs at two Peruvian universities (San Antonio Abad National University in Cuzco and the National University of Cajamarca) to that ensure sustainability and proliferation of actors at the local level knowledgeable in the subject.