5.3 Strategies and activities

  • Share

a. National and international political agreements

  • National civil defense/protection systems should be made aware of the multisectoral nature of the challenge and collaborate on this issue.
  • Subregional agencies involved in disaster risk reduction should be involved.
  • The topic should receive visibility and should be presented to ministers, congressional health committees, national directors of health, and those responsible for providing health services.

These agreements should reflect a political will to implement these measures, including a policy with work plans and clear strategies and a national safe hospitals program that makes it possible to carry out action, allocate resources and monitor and evaluate progress.

b. Promote the conclusions of the World Conference on Disaster Reduction (WCDR): the Hyogo Framework for Action

  • Disseminate information on the results of the World Conference and the goal related to improving the safety of health facilities.

    From the Hyogo Framework for Action: 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.


  • Propose practical alternatives to enable countries to effectively meet the challenge.

c. Ensure that vulnerability reduction is incorporated at all stages when building new health facilities

  • Identify investments that countries are making in new health infrastructure (construction, expansion, remodeling, etc.).
  • Promote the use of norms, standards and building codes when designing new health facilities.
  • Prepare guidelines or models for incorporating vulnerability reduction into bids for new construction projects (terms of references, rules governing calls for proposals, etc.).

d. Establish independent monitoring, audit, and oversight mechanisms

  • Establish a mechanism for competent independent check consultants to review the work being done, in coordination with the project’s design team.
  • Take advantage of the support of the Disaster Mitigation Advisory Group (DiMAG) in these tasks.

e. Create regulatory instruments that formalize processes

  • Prepare a model legal framework on disaster risk reduction in the health sector.
  • Develop national building standards, codes, procedures, manuals, protocols, regulations, etc. that provide a framework for incorporating risk reduction policies into all aspects related to health infrastructure.

Legislation is required for the design, construction, and operation of health facilities that are disaster-resilient, with up-to-date standards, control mechanisms and administrative accountability to ensure their uninterrupted operation in disaster situations.

Several countries in Latin America, such as Colombia, Costa Rica, Ecuador, Mexico, Paraguay and Peru have issued directives and set standards for the implementation of a safe hospitals program at the national and subnational levels. Click here for examples of current legislation (in Spanish).

In addition, Argentina, Chile, Colombia, El Salvador, and Peru, among others, have legal frameworks with controls to guarantee that new health services infrastructure will be disaster-safe.

The Caribbean’s Design Manual for Health Services Facilities provides benchmark standards for the design, construction, and operation of safe establishments. Caribbean wind hazard maps also provide important standards for engineers, developers, and others whose work requires knowledge of wind hazards in structural design and risk assessment, which is key in this hurricane-prone region. The U.S. has developed a number of guidelines, particularly for hospital safety in seismic areas.

Finally, Mexico has developed a manual for accreditation of the capacity, safety, and quality of public facilities that provide health services (Spanish only).

f. Mobilize the participation of other sectors

Ensuring that hospitals are safe is a job that goes beyond the health sector. The responsibility should be shared by the country’s multisectoral disaster reduction organizations, involving actors both in and outside of the health sector. Under the Plan of Action on Safe Hospitals, other actors may include:

    • Subregional coordination platforms such as CAPRADE (the Andean Region Committee for Disaster Prevention and Response), which approved the Andean Strategic Plan for Health Sector Preparedness and Response 2005-2010 (in Spanish); the Central American Center for Coordination of Natural Disaster Prevention (CEPREDENAC); the Caribbean Disaster Emergency Management Agency (CDEMA); RESSCAD (in Central America, the twenty-fifth Meeting of the Health Sector of Central America and the Dominican Republic agreed on a regional safe hospitals strategy); and REMSAA (the twenty-sixth Meeting of Ministers of Health of the Andean Area endorsed and approved the Andean Health Plan for Disasters cited above). Also, at a South American Safe Hospitals Meeting (Chile, 2010) a Plan of Action 2010-2015 was developed for the implementation of safe hospitals in the Andean countries.
    • Participation of other sectors: national disaster management organizations, planning entities, financial institutions, local officials, and communities, including providers of basic services.
    • Partnerships with specialized agencies and centers of excellence in the field of disaster risk reduction (universities; scientific and research centers).
    • Advocacy in the form of promotional activities—for example, the U.N. Office for Disaster Risk Reduction campaign, photo exhibits, promotional materials, videos, etc.
    • Making resources on the subject available by preparing technical material, executing DIPECHO projects, or using other financing mechanisms.
    • Making the subject visible in newspapers and magazines, websites, bulletins, promotional materials, and so on. PAHO/WHO devoted World Health Day 2009 to the subject of safe hospitals in emergencies.

g. Incorporate key actors in the construction and design of health facilities

  • Identify who make decisions on new works (location, design, construction, etc.), and identify others involved in the process, including investors, in order to disseminate information on the topic of safe hospitals.
  • Make universities, research centers, and professional associations aware of the issues related to safe hospitals, particularly those working in fields related to the construction of buildings and hospitals.
  • Present the topic in other forums in and outside the health field.

h. Provide technical material and publications to guide implementation measures.

  • Compile and share technical information that already exists regarding: building design and construction regulations, methodology for studying vulnerability, techniques for strengthening buildings, guidelines for evaluating buildings, etc.
  • Develop technical specifications for both for structural and nonstructural elements that can be adopted later as standards.

i. Take measures to reduce vulnerability in existing health facilities and networks

In order to provide health services to the populations affected by disasters, networks should be organized so that they can continue operating. This means strategically identifying the facilities that are critical to maintaining a functioning network. Given the current vulnerability of health care facilities, studies should look at the possibility of distributing risk by creating a group of facilities that are spatially separated and can, among them, provide care. Their location in different areas will help ensure that even if some are affected, the functional threat will not be total:

  • Inventory all health facilities in a country.
  • Assess the vulnerability of those facilities that have broader treatment capacity.
  • Definir criterios de priorización de los establecimientos por intervenir (intensidad de fenómeno vs. nivel de protección)
  • Assess the functioning of the health care networks.
  • Define criteria to prioritize the facilities that merit interventions (intensity of phenomenon versus level of protection.
  • Have the technical tools needed to assess the vulnerability of health facilities.
  • Conduct vulnerability studies with a level of complexity that depends on the facility being studied.
  • Implement measures to reduce vulnerability, focusing primarily on nonstructural and functional areas.
  • Create response plans that facilitate reorganizing health networks in a disaster.
  • Train health workers on risk management and hospital safety.
  • Optimize the distribution of resources among the main health care entities of both the public and private sectors, such as health facilities, laboratories, providers of drugs and supplies, etc.

j. Include vulnerability reduction issues in the accreditation/certification of health facilities, following national practices

  • Propose that accreditation/certification entities include vulnerability reduction standards.
  • Prepare technical guides that can be used.
  • Involve health care services in the process.

k. When opportunities for risk transfer arise, include vulnerability reduction

  • Include the concept of safe hospital when insuring health facilities.

l. Train human resources on vulnerability reduction issues

  • Train health workers at different levels—from decision-makers to technical and operational personnel—on the issues.
  • Conduct technical training for staff involved in construction (maintenance, infrastructure, etc.).
  • Encourage work in this area by national, provincial, local, and hospital-based emergency committees.

m. Incentivar aspectos de preparativos para una respuesta adecuada frente a una emergencia, como parte de la reducción de vulnerabilidad funcional

  • Promote the development and implementation of national, local, and hospital-level disaster plans.
  • Make patients and staff aware of emergency-related signage in health facilities.
  • Publicize the results of these measures so that they are familiar with the issues.

n. Movilize resources

Apply to the international community for aid.

o. Measure progress being made

Setting goals and indicators is necessary to effectively monitor progress on strategic activities. Monitoring will yield information, which in turn, can be used to document the experiences.

  • Define criteria, requirements, and indicators that include minimum values, and design monitoring and evaluation instruments to track the progress of the safe hospitals program.
  • Use international technical standards for developing countries to evaluate health facilities in relation to safe hospital benchmarks.
  • Share best practices and practical advances made at the national level toward the goal of safe hospitals.

p. Generate evidence

  • Conduct analysis of the cost-effectiveness of vulnerability reduction measures.
  • Promote research protocols and define areas of interest.
  • Promote the identification of “model hospitals” to promote awareness and encourage attention to the subject.
  • Sistematize experiences as they occur.

q. Share success stories and lessons learned with other countries