2. Disaster Mitigation

Health 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.


The "Safe Hospitals" Initiative

In 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.

The joint 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 Annex 4 for the complete Hyogo Framework for Action 2005-2015)

(e) 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.

This 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 5)

Direct 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.

Making 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.

6. 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.

Water and Sanitation

In 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 risk reduction.


Disaster 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.

Following are some of the Region’s contributions to the goal of "safe hospitals in disaster situations."

  • Bolivia’s 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 7).
  • Chile 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.
  • In 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.

  • 7. Prepared with the support of the Salvadorian Association of Seismic Engineering and PAHO/WHO.

  • In 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.
  • Nicaragua’s 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 process.


The 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 hospitals.

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 9).

The DiMAG advisory group supports Latin America and the Caribbean in vulnerability reduction and damage assessment in the health sector through:

  • contributing to the preparation and/or review of regional technical documents and manuals (see section on publications below).
  • conducting damage assessments of health facilities affected by disasters (floods in Costa Rica, earthquake in Pakistan, earthquake in Chile, etc.)
  • supporting countries to define a model national program for "Safe Hospitals."
  • participating in technical cooperation activities requested by the countries, including presentations at seminars and workshops.
  • reviewing hospital plans.
  • offering site selection services for new hospitals.



  • Safe 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.
  • Safe 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 specifications.

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.

Institutions will use this document when implementing rural drinking water projects, and for risk management and in training activities linked to water and sanitation.

At 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.

  • Hospital 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 regionally.
  • Safe 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.
  • Disaster 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.
  • Principles 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.

Due to 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.


During this past year, non-health actors demonstrated a growing interest in becoming involved in disaster mitigation activities.

  • Professional 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.
  • The VII Ibero-American Meeting of Engineers, Architects, and Surveyors of 2005 included Safe Hospitals and the Salvadoran norm on hospital construction.
  • Costa Rica organized a seminar that included multidisciplinary experts that make up the national teams involved in the design, construction and operation of health facilities.
  • The 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.
  • Bolivia's 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.
  • Increasingly, 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.
  • To 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.
  • At 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 situations.

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.

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