The Application of Hospital Safety Index for Analyzing Primary Healthcare Center (PHC) Disaster and Emergency Preparedness

Abstract

The World Health Organization (WHO) defines the primary healthcare center (PHC) as a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation, and palliative care, and as close as feasibly possible to people’s everyday environment. PHCs are expected to remain operational when disasters occur. This study aimed to assess the PHC disaster preparedness level in Indonesia using The Hospital Safety Index (HSI) from WHO/PAHO. Eleven PHCs located in four provinces in Indonesia, i.e., Jakarta, Yogyakarta, North Sumatera, and West Java, were selected. Data were collected through interviews, focus-group discussions (FGDs), observations, and document reviews. The parameters assessed were all types of hazards, structural or construction safety, nonstructural safety, and functional attributes. The results show that the overall score of HSI for PHCs in Jakarta (0.674) and North Sumatera (0.752) fell into the “A” category, meaning that these PHCs would likely remain operational in the case of disasters. Meanwhile, the overall HSI scores for PHCs in West Java (0.601) and Yogyakarta (0.602) were between 0.36 and 0.65, or in “B” category, meaning that these PHCs would be able to recover during disasters but several services would be exposed to danger. The results suggested that there are several gaps that need urgent interventions to be applied for the structural safety of buildings, water supply systems, fuel storage, disaster committee organization, furniture and fittings, offices and storage equipment, as well as increasing the capacity of workers through a structured and systematic training framework for disaster readiness. The results from this study can be used for prioritizing budgets and resource allocation, cost planning, providing specific solutions for local and national government, and efforts to achieve disaster risk reduction.

Water supply emergency preparedness and response in health care facilities: A systematic review on international evidence

“…It was used to assess the health care facilities' non-structural safety, which included water supply systems, locations of water tanks, water quality control, sanitation systems, heating, ventilation, HVAC, and/or hot water systems. In Greece, Iran and Indonesia, the HSI was also used to formulate recommendations to improve water supply safety ( 15 , 26 , 33 ), whereas in Serbia the usefulness of the HSI for safety assessment of a primary health care center was further evaluated ( 32 ).…”

“…Another example is evacuation plans that do exist but that are not mentioned in preparedness, making actual preparedness partly difficult to assess. Many case studies reported the need to specifically improve water supply preparation, but the assessment of hospital preparedness is often limited to its overall evaluation, e.g., using hospital safety index ( 15 , 26 , 33 ). Health care facilities with reported preparedness and response mechanisms are mostly among the larger ones described, raising the question if smaller facilities are really less prepared or simply less researched and less often rescued during emergencies.…”

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations

“…In addition, the Disaster Risk Reduction (DRR) community is increasingly considering hospital preparedness by developing new tools and frameworks, such as the CADRI tool. By doing so, this community is bringing a new perspective of hospital sustainability into hospital preparedness for disasters, and it is being given more and more consideration [ 36 , 37 , 38 , 39 ].…”

“…However, it is not well known worldwide and has only recently been used more frequently. Despite the recognized importance of strengthening disaster preparedness at all levels of the health system, literature supporting primary healthcare disaster preparedness is scant and lacks rigour [ 39 , 44 ]. There is no internationally recognized and validated method for evaluating the safety of PHC centres in case of disasters.…”

“…Even though the HSI covers many important factors, some PHC-specific elements of disaster preparedness may not be captured by the HSI tool (e.g., PHC team composition, continuity of care for patients with chronic diseases, and the assessment of vulnerable categories of patients). Moreover, studies assessing the relevance of the HSI tool for the PHC setting are lacking [ 20 , 39 ]. An operational framework conceptualising specific characteristics of primary care disaster preparedness, categorised according to the WHO health system building blocks [ 44 ], was recently published by members of this research team [ 45 ].…”