Enhancing the resilience of smaller health care facilities in Barbados
The vulnerability of health facilities in Latin America and the Caribbean to adverse events is well documented. Geographically, the region is at risk for natural hazards, but increasingly anthropogenic activity has created other concerns, including the potentiating effects of climate change on adverse weather events and increased risk from exposure to hazardous chemicals and ionizing radiation, some of which are routinely used in health facilities. Within the context of health facilities, vulnerability is amplified if there is insufficient integration of safety measures in the location, design, construction and operations.
Why do smaller health facilities matter in Barbados?
In Barbados a substantial proportion of health care is delivered from smaller facilities: polyclinics and out-patient clinics account for at least 50% of ambulatory primary care visits. Several other key services are delivered exclusively from smaller facilities including the Geriatric and Psychiatric hospitals and the Public Health Laboratory. Thus it is important to enhance the resilience of facilities, in addition to hospitals, ensuring that they are also likely to remain, accessible, structurally sound and capable of delivering basic services in the event of a crisis.
The Process
There are a number of guiding principles in the approach taken by Barbados: voluntarism coupled with appropriate training, collaboration and timely feedback. The Health Disaster Coordinator organised training workshops in December 2011 and June 2012 for a multi-disciplinary target audience that included: public health doctors and nurses, nurse administrators and senior clerks. The PAHO Hospital Safety Index for Smaller Health Facilities was used to introduce the concept of disaster safety assessments, the rationale for and approaches to evaluating smaller facilities.
In July 2012, 15 trained volunteers, divided into two multi-disciplinary teams were deployed to 21 facilities in the north and south of the island, respectively. Facilities were categorized as: ambulatory (14), residential (5) and other (2).
Buy-in was achieved by meeting with management, outlining the benefits of resilience building. Direct selling points included: use of a standardised assessment questionnaire; key informant interviews with varying categories of staff; and delivery of a final report with recommendations to guide preparation of the annual Estimates of Expenditure.
Assessments were conducted between July and August 2012, looking at hazard levels based on geographical location, structural elements, non-structural elements and functional elements. Individual facility assessment reports were disseminated and formed the basis of a Stakeholder Workshop held September 27 and 28, 2012. Each institution developed a bespoke Plan of Action (POA) based on the report, outlining areas for priority action, timelines and funding sources. Most facilities used the PoAs to prepare their estimates documents which were due for submission in October 2012.
Lessons identified
Challenges experienced included adapting the assessment tool to the wide variability of local settings; finding mutually agreeable visiting times; and balancing competing schedules.
The qualitative nature of the assessment tool limited the ability to rank needs within and between groups of facilities, and thus guide priorities at the national level. Therefore, a quantitative scoring system was developed to achieve this objective.
Keys to success included a high level of camaraderie amongst team members, the receptiveness of institutions to the participatory process, their willingness to implement solutions and the unstinting efforts of the Health Disaster Coordinator in championing the process.
This process enabled assessment of factors which, unlike natural hazards, are more amenable to direct intervention and when properly addressed can enhance the resilience of the facility. This is a major step in improving the capability of the health system to strengthen public health practice.
By Dr. Heather Harewood, Medical Officer at the Ministry of Health in Barbados