7.1. Assessment of the level of safety

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7 1 diagnostico del nivelThe absence of accurate and up-to-date information on safety levels and conditions in the health facilities and the fact that many facilities are located in difficult to reach areas have often hindered quantitative assessments of unsafe health facilities and their vulnerability.

To begin, the safety level of health care facilities before a disaster must be determined in order to make necessary improvements in priority facilities that, because of their type, location, or importance, must continue functioning during a disaster.

There are various tools for vulnerability studies, based on qualitative or quantitative methods, but only a few are specifically designed for health facilities, which, due to the characteristics of their operations and way of delivering services are especially vulnerable. For a time, complex vulnerability studies such as those carried out in a variety of countries in the Americas were promoted.

PAHO and a group of Caribbean and Latin American experts, worked together to develop a low-cost and easy-to-use tool to help health authorities gauge the probability that a hospital or health facility will continue to function in emergency situations. The result was the Hospital Safety Index, which provides a snapshot of the health facility’s ability to function post disaster, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital’s Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The Hospital Safety Index does not replace costly and detailed vulnerability studies. However, because it is relatively inexpensive and easy to apply, it is an important first step toward prioritizing a country’s investments in hospital safety.

Determining the Hospital Safety Index is a new way of managing risk in the health sector. It allows a health facility's level of safety to be monitored over time. Safety no longer has to be a 'yes-or-no' or an 'all-or-nothing situation, but can instead be improved gradually.

The HSI uses a Checklist to assess a hospital’s geographical location, building structure, nonstructural components, and organization, assigning a numerical value that gives an idea of the facility’s probability of continuing to function after a disaster. The scores or values obtained for each component on the Checklist are recorded into a safety index calculator that uses formulas to automatically calculate a numerical score for each of the 145 assessed components. The results place the facility into one of three safety categories: high, medium, or low. The values given to each component are weighted according to an agreed-upon formula, which has been endorsed in Latin America and the Caribbean, but may not be applicable worldwide. The safety index calculator module is given to evaluation team members as they complete their training.

The Hospital Safety Index is also used to strengthen health networks, as the safety of their individual components—large and small—must be known if the health sector is to plan a coherent disaster response. Therefore, a tool has been developed to complement the Hospital Safety Index and focus on less complex health care facilities.