Dr. Heather Harewood - CDEMA

Small Health Care Facilities Matter: A
country driven collaborative approach to
enhancing the resilience of smaller health
care facilities in Barbados
Presented at 7th Annual Caribbean Conference on Comprehensive
Disaster Management (CDM)
4th December 2012
Dr. Heather Harewood
1

Background to the Safe Hospitals
Initiative (SHI)
• Vulnerability of health facilities to adverse outcomes
– Natural and other hazards
– Insufficient integration of safety measures
• Location, design, construction and operations
• Why is SHI an imperative?
– ‘Disasters’ often result in increased health care demand
– Remediation of impacts from disasters often outstrip the
costs of safety improvements
3

Impacts of Facility Damage or
Disruption of Services
• Direct health impacts/costs
—Impaired provision of necessary care and assistance
—Injuries and other medical problems
• Indirect health impacts/costs
—Economic losses due to hospital and health facility
damage
• repairs, job losses, under-utilization
—Possible disruption of social and developmental gains
4

Steps To Enhancing Health Facility Resilience
• “Hospitals Safe from Disasters”
• Adopted as a national policy for risk reduction
the countries of the Americas
—2008-09 World Disaster Reduction campaign
• ‘Safe’ denotes a facility
– That is accessible
– Has structural and functional integrity
– Maintains availability of basic services (minimum)
• Applicable to all levels of facilities in the
health network
5

Why Small Health Care Facilities Matter
• One public tertiary care hospital
• Polyclinics, out-patient clinics
—Account for at least 50% of ambulatory care visits
—Since 2008 continuous increases in utilization
• Several key services reside in other smaller
facilities
– Geriatric Services
– Psychiatric Hospital
– Public Health Laboratory
– Ladymeade Reference Unit
– National Nutrition Centre
– Children’s Development Centre 6

The Process
• Preparation
◦ Training Workshops:
December 2011, June
2012
• Introduced the
concept of
vulnerability
assessments
• Overview of rationale
and approaches for
evaluating medium and
low complexity health
establishments
◦ Various staff
categories trained
• Public health doctors
• Public health nurses
• Nurse administrators
• Senior Clerks
(administrative)
• Technical
Officers/Works
Supervisors
(engineering)
• Environmental Health
Officers
7

The Process
• Action
– Two multi-disciplinary teams assigned to assess
facilities in the north and south of the island
respectively
• June 7 th 2012
– PAHO Hospital Safety Index: Guidelines for
the evaluation of small and medium sized
health facilities
8

Aims of the Evaluation
• Improve the level of safety and preparedness
• Improve the capability of the health system
to strengthen public health practice
– Essential Public Health Function 11: “Reduction in
the impact of emergencies and disasters on health”
– Build capacity to conduct disaster-related needs and
vulnerability assessments
– National and local facility level
– Matching response to local context
9

Small and Medium Facilities Evaluation-
Assessment Team Composition
Team North
– Environmental Health
Officer
– Health Sister
– public health
– Principal Nursing
Officers (2)
– Medical Officers of
Health (2)
– Works Supervisor
Team South
– Environmental Health
Officer
– Health Sister
– public health
– Principal Nursing
Officer
– Medical Officers of
Health (2)
– Senior Clerk
– Works Supervisor
– Technical Officer
10

Small and Medium Facilities
North Facilities
Ambulatory
• Branford Taitt P/C
• Maurice Byer P/C
• Warrens P/C
• St. Andrew OPC
• St Joseph OPC
• St. Thomas OPC
Residential
• Psychiatric Hospital
• St. Thomas District Hospital
• St. Lucy District Hospital
South Facilities
Ambulatory
• Edgar Cochrane P/C
• Glebe P/C
• Randal Phillips P/C
• St. Philip P/C
• Winston Scott P/C
• St John OPC
• Ladymeade Reference Unit
• Albert Cecil Graham Dev.
Centre
Residential
• Geriatric Hospital
• St. Philip District Hospital
Other :
• Leptospiral Lab
• National Nutrition Centre
11

Geographic Location of Facilities

Key Activities
• June - August 2012
◦ Interviews with health
facility key informants
◦ Assessment of
facilities
• Hazard levels, structural,
non-structural, functional
aspects
◦ Generation and
dissemination of
assessment reports
• Stakeholder Workshop
(Sep. 27, 28, 2012)
◦ Description of process
◦ Discussion of results
◦ Development of Plans
of Action (POAs)
• Assessment report
• Discussions generated at
workshop
◦ Group presentations
of POAs
◦ Final discussions and
next steps
13

Report Format
• General Information
◦ Location, background, capacity
• Evaluation of Safety Level
◦ Hazards due to geographic location
◦ Structural aspects
◦ Non-structural aspects
◦ Functional aspects
• Intervention Plan
◦ Recommendations for improving safety level
(prioritized)
14

Challenges
• Adapting the assessment tool to:
◦ Local context
◦ Variable non-hospital settings
• Agreeing on the approach to scheduling/
finding mutually agreeable visiting times
◦ Split team vs. full team visits
◦ No dedicated time/competing schedules
• Absence of a quantitative ‘scoring system’
◦ Limits ability to rank needs at the national level within
and between groups of facilities
◦ Reaching consensus between teams on some
elements
15

Challenges
• The ‘all or nothing’ criteria for some
aspects
◦ Sense of ‘rounding’ up or down of the level
• Paucity of ‘as-built’ plans made it difficult
to assess
◦ Floor space of facilities
◦ Elevation of buildings
◦ Layout of electrical wiring, plumbing works
16

Strengths/Opportunities
• Camaraderie
• Opportunity to develop assessment skills
◦ Multi-disciplinary learning
• Appreciation for the experiences of others
in the public health care system
• Receptiveness of institutions to the
participatory process
◦ Openness, willing to contribute
◦ Keen to implement solutions
• Timely stakeholder feedback
17

Lessons Identified
• ‘Success stories’ linked to central coordination
◦ Water tanks, generators, back-up telecoms
• Several buildings have major structural issues
◦ Most expensive to fix but most likely to prevent
functioning in a disaster if not addressed
• Need to broaden focus of disaster plans
◦ Multiple hazards, evacuation, simulations
◦ Scheduled reviews and updating
• Weak preventative maintenance planning
◦ Funding constraints and ‘breakdown’ maintenance
• Need to liaise with key external agencies
◦ Barbados Fire Service, utility companies etc.
18

Lessons Identified: Critical Systems -
Communications

Lessons Identified: Critical Systems –
Fuel

Lessons Identified
• Most facilities dependent on small
centralised Technical Management Services
(TMS) team
◦ Limits local ability to address smaller issues
◦ The two larger residential facilities with onsite
TMS received higher safety ranking
• Changes in use or to structural aspects
without access to ‘as-built’ plans have the
potential to create environmental hazards
• Some facilities very vulnerable to locationspecific
hazards e.g. beachfront, land slippage
◦ Unlikely to be safe post-disaster 21

Lessons Identified: Undesirable Setting

Lessons Identified: Preferred Setting

Recommendations
• Development and implementation of
quarterly preventative maintenance
contracts
o Opportunity costs: facility closure vs. safety
investments to improve safety
• Local priorities
o Increased autonomy
o Contingency fund at each facility
o Securing equipment, supplies, materials
o External oxygen tank storage and/or piped
oxygen 24

Recommendations
• Central priorities
o Review structure and function of TMS
o Multi-disciplinary team to be utilized in any
new construction/retrofitting
• Location, structure, access routes
o Coordinate drawing of ‘as-built plans for all
institutions
• Priority to those needing major structural
renovations
o Arrange interval for re-assessment of facilities
25

Final Thoughts: Enhancing Resilience
• The SHI presents a welcome opportunity to
inform the measures necessary to progressively
improve the level of safety and preparedness
locally and regionally
• SHI is an iterative regional activity, hence the
Barbados experience will inform other SHI
assessments
• Anglophone, middle to lower income LAC states
• Small and medium-sized facilities
• Format enables interim re-assessment and
documentation of progress towards improved
safety and resilience
26

Final Thoughts: Enhancing Resilience
Excerpts from the Evaluation Guide
• Ensuring health care facilities safety
during crises is a collective responsibility
• Active participation of local authorities,
other related sectors, institutions
• Health personnel play a key role
◦ Contribute to increasing or decreasing the
risk of their workplace
◦ First response to a disaster occurs locally
with available resources
This is the rationale for having ‘safe’ facilities
27

Acknowledgements
Dr. Elizabeth Ferdinand, SMOH (S), HDC
Team North
• Cheryl Mc Collin
– Medical Officer of Health, Leader
• Wayne Benskin
– Environmental Health Officer
• Cecily Destang
– Health Sister
• Felix Gittens
– Deputy Principal Nursing Officer (ag.)
• Heather Harewood
– Medical Officer of Health
• Brenda King
– Principal Nursing Officer
• Colin Wilkinson
– Works Supervisor
Team South
• Karen Broome
– Medical Officer of Health, Leader
• Brian Green
– Environmental Health Officer
• Ricardo Bourne
– Works Supervisor
• Eudine Sealy
– Health Sister
• Sandreth Godding
– Senior Clerk
• Arthur Phillips
– Medical Officer of Health
• Lolene Rawlins
– Principal Nursing Officer
• Daniel Cumberbatch
– Technical Officer
28

References
• Safe Hospitals, general information. PAHO Available at:
http://new.paho.org/disasters/index.php?option=com_content&task
=blogcategory&id=1026&Itemid=911%20
• International day for disaster reduction. Available at:
http://new.paho.org/disasters/index.php?option=com_content&task
=view&id=1048&Itemid=911
• Hospitals safe from disasters. Available at:
http://www.who.int/hac/techguidance/safehospitals/en/index.html
• Hospital Safety Index: Guidelines for the evaluation of medium and
low complexity health facilities. Available at:
http://www.paho.org/English/dd/ped/SafeHospitalsChecklist.htm
• The Essential Public Health Functions as a Strategy for Improving
Overall Health Systems Performance: Trends and Challenges since
the Public Health in the Americas Initiative, 2000-20071. Available
at: http://www.paho.org/english/DPM/SHD/HR/EPHF_2000-
2007.pdf
• http://www.thefreedictionary.com/resilience
29

THANK YOU!
Acknowledgement to PAHO
and CIDA for technical and
financial support
QUESTIONS?
30

Small Health Care Facilities Matter: A
country driven collaborative approach
to enhancing the resilience of smaller
health care facilities in Barbados
Presented at 7th Annual Caribbean Conference on Comprehensive
Disaster Management (CDM)
4th December 2012
Dr. Heather Harewood
31