When emergencies strike, it is crucial to ensure availability of and access to functioning hospitals. Hospitals help those affected by emergencies while also handling the normal everyday flow of patients, such as those who have had accidents, have a chronic illness or are giving birth. Hospitals play a paramount role in providing health care, but they also help to maintain the population’s trust in the health-care system and state structures.
Moreover, hospital spending accounts for the vast majority of governmental health budgets. This covers the highly qualified personnel needed and the purchase and maintenance of expensive equipment and supplies. A dual-track approach that couples emergency preparedness planning with the strengthening of everyday health systems is therefore in everyone’s best interests.
Protecting flows of water and electricity and the physical structure of buildings are just some of the aspects of hospital resilience; ensuring appropriate financial structures, policies, staffing and up-to-date emergency response plans that are flexible and fit for purpose is no less important. Hospitals must also anticipate increased risk from natural disasters such as flooding and wildfires due to climate change, and the potential for biological outbreaks or the impact of conflict.
With all of this in mind, as part of its Safe Hospital Initiative, WHO has been conducting trainings using specially designed guidance and tools that support hospital staff to address issues of hospital safety and response coordination in times of crisis.
Recently, trainings, policy and technical advice, and strategy and guideline development in Lithuania and Bosnia and Herzegovina have helped build resilience into these Member States’ health facilities.
Lithuania: strengthening the emergency preparedness of health facilities
WHO/Europe and the Country Health Emergency Preparedness and International Health Regulations (IHR) programme, together with the WHO Country Office in Lithuania and the Health Emergency Situations Centre of the Ministry of Health, organized a 3-day training on the Hospital Safety Index (HSI) in Vilnius on 13–15 December 2023.
The training was attended by 26 Lithuanian health-care specialists. It consisted of a mixture of theoretical lessons, group activities and an assessment visit to a hospital in Širvintos District Municipality to teach the practical application of the HSI.
Laura Maldūnienė, Deputy Director of the Extreme Health Situations Centre of the Ministry of Health, explained, “Up until now, there were no such systematic assessments of health-care institutions. The HSI enables this. Practical application of the tool provides opportunities to analyse and evaluate health-care institutions and systems, and the allocation of resources for their targeted improvement.”
Joana Korablioviene, Chief Adviser at the Preparedness Office in the Public Health Department at the Ministry of Health, also acknowledged the importance of the HSI: “The HSI is planned to be integrated into the Order of the Minister of Health, which will regulate personal and public health-care institutions’ preparedness and the organization of their activities during emergency situations.”
Kęstutis Štaras, Director of Širvintos Hospital, which was assessed during the hands-on training, emphasized, “We are very grateful that Širvintos Hospital was chosen for the practical part of the training. Alongside consultations, this will help us to properly form a brief for architects to design the new health centre for Širvintos Municipality.”
This training was one of a number of hospital preparedness initiatives that the country will implement to ensure longer-term health facility preparedness and resilience in Lithuania. The Ministry of Health will now digitalize the WHO tool to guarantee access to a network of safety managers in hospitals and smaller health-care facilities.
In 2024 the Ministry will also conduct a WHO-led training of trainers to roll out HSI assessments to all hospitals in the country and then institutionalize regular safety assessments.
Bosnia and Herzegovina: building the capacity of hospitals to mitigate emergencies
The first-ever subregional training in the Western Balkans on the use of the HSI was held in March 2023 in Durrës, Albania, with technical input from WHO and financial support from the European Union.
Following this, a training was held in Sarajevo, Bosnia and Herzegovina, on 4–5 December 2023, this time focusing on hospital emergency response plans (H-ERPs) in the Federation of Bosnia and Herzegovina, 1 of the 2 entities that make up Bosnia and Herzegovina. Documenting, routinely reviewing and updating these plans are key elements of the WHO Safe Hospital Initiative.
The training was attended by more than 40 participants from 15 of the 19 hospitals in the Federation of Bosnia and Herzegovina, as well as from the Red Cross, the Agency for Quality and Accreditation in Health Care, and the Civil Protection Administration of the Federation of Bosnia and Herzegovina. Hospitals with existing H-ERPs were shown how to update and revise their plans, and hospitals without H-ERPs were encouraged to develop their plans.
Amer Ovčina, Professor at Sarajevo University Clinical Centre, shared practical examples of H-ERPs, and Samir Džihić, Expert Adviser on Programming and Planning of Protection and Rescue for the Civil Protection Administration of the Federation of Bosnia and Herzegovina, provided advice.
Lejla Mujčinović, Graduate Nurse at the Hygiene and Epidemiology Surveillance Unit of the Cantonal Hospital Zenica in Bosnia and Herzegovina, noted, “Hospital safety, meaning safety of patients and health professionals, is extremely important. The recent earthquake in Zenica, with a magnitude of 4.7 on the Richter scale, has been a stark warning to all to assess risks and prepare for disasters, as we do not know when one can strike.”
After the workshop, all participating hospitals were asked to conduct self-assessments using the HSI tool, and to start drafting or updating their hospital plans. To ensure better protection and functioning of health facilities in emergencies, all hospitals have been instructed by the Ministry of Health to conduct an HSI assessment and to draft or update hospital preparedness and response plans.