Protecting the health services network

Citation

(2002), "Protecting the health services network", Disaster Prevention and Management, Vol. 11 No. 1. https://doi.org/10.1108/dpm.2002.07311aab.007

Protecting the health services network

Protecting the health services network

The knowledge gained by the countries of Latin America and the Caribbean in reducing the vulnerability of their hospitals to disasters must be extended and applied to all health services in the country. The past has demonstrated that less complex (although no less important) health infrastructure such as health centres, the offices of co-ordinating authorities, warehouses and blood banks are just as likely to be affected by floods, earthquakes, hurricanes and other natural hazards.

The health sector's response to a disaster depends in part on its level of preparedness. But it is also conditioned by the level of damage caused to health infrastructure – hospitals as well as smaller health centres, laboratories, blood banks, warehouses, etc. –all components of what is referred to as the country's health services network.

Planning an integrated health sector response to disasters requires knowledge of the physical vulnerability of its facilities. Emergency preparedness plans that have been tested and updated become meaningless when a hospital is unable to function following a disaster.

Well-established epidemiological surveillance programs are of little use if the laboratories required to process the information cannot function. It is not practical to maintain a stock of emergency medicines and supplies if the warehouse is vulnerable; likewise, it is useless to establish a hospital referral system to care for disaster victims if the health services network collapses. Evacuating patients from well-built health facilities where structural damage is unlikely can be costly and dangerous to the occupants. For all these reasons, health sector planning and preparedness should be based, to large degree, on the physical and functional vulnerability of its infrastructure as a whole.

Recent examples point to the need to focus on the health services network. During the 1997-1998 El Niño phenomenon in Ecuador and Peru, more than 34 hospitals and 485 small health centres were affected by floods –many of these were the only health facilities for miles around. The December 1999 floods in Venezuela indiscriminately affected health facilities, both large and small. Hurricane Keith, in Belize, in 2000, seriously affected the Karl Heusner Memorial Hospital.

The loss of the contents of the Central Medical Laboratory and the Blood Bank, the only institutions of their kind in the country, produced much more serious consequences. More recently, the earthquakes in El Salvador forced major hospitals in the affected areas to provide services from makeshift tents. How the health services network fares following a disaster has a significant impact on health, as it affects both the quality of and the access to health services. For this reason, it is necessary to consider overall vulnerability of the health services network when planning and preparing for disaster response.

Determining how the health services network will function in disasters involves identifying what facilities are key to meeting emergency needs, taking into account their level of security, complexity, available human resources, strategic location and specialized services. The functionality of these key areas must be guaranteed if the health sector's emergency response plan is to be successful. For this to happen, the level of damage they sustain must be minimized. It is not prudent to select certain hospitals or health centres randomly as targets of disaster mitigation measures. It is imperative to select the right facilities. By identifying the key components of the health services network at the regional and national level, countries can focus their resources on studying vulnerability and implementing the necessary disaster mitigation measures to ensure they are functional following a disaster, thus guaranteeing that emergency plans are able to meet the needs they were designed for.

Although it is hoped that damage to all infrastructure can be minimized in the wake of a disaster (an elusive goal given the recent experiences in the Americas), it is essential that emergency response plans take into account the physical and functional vulnerability of the health services network. Only in this scientific manner will we be able to determine if we can count on the infrastructure that is key to the success of the emergency plan and avoid costly mistakes such as evacuating facilities that, in the eyes of the occupants, appear unsafe but that, from an engineering or architectural point of view, may be sound. The appropriate design and construction of all new health infrastructure and the carrying out of vulnerability studies in existing structures will yield the necessary insight and facts to ensure that health sector facilities plan and execute a realistic emergency response plan.

(Disasters – Preparedness and Mitigation in the Americas, July 2001, editorial)