PAHO Smart Hospitals Toolkit to Build Resilience in the Health Infrastructure Sector
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Presentation delivered at UK Caribbean Infrastructure Conference in November 2023.
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PAHO Smart Hospitals Toolkit to Build Resilience in the Health Infrastructure Sector
- 1. PAHO Smart Hospitals Building resilience 2017 - 2023 Eng. Shalini Jagnarine-Azan November 2023 1
- 2. The Smart Team Funding Agency: UK Foreign, Commonwealth & Development Office (FCDO) Implementing Agency: Pan American Health Organization (PAHO/ WHO) Facility Owners: Ministries of Health of Belize, Dominica, Grenada, Guyana, Jamaica, Saint Lucia, St. Vincent and the Grenadines, and others.
- 3. #UniversalHealth The initiative improves the resilience of critical health infrastructure to multiple hazards and the use of green technologies, allowing uninterrupted care, during and after emergencies and disasters.
- 4. Strengthen structural and operational aspects Reduce downtime post-disaster SAFE DISASTER RESILIENT GREEN ENVIRONMENTALL Y FRIENDLY MAINTAINED SUSTAINABLE SMART HOSPITAL Save water Include planned preventative maintenance Improved health services Reduced operational costs Save electricity Improved air quality and lighting
- 5. PAHO/WHO Smart Hospitals: The Smart Tool Kit HSI Hospital Safety Index • Rapid vulnerability assessment of hospitals Green Checklist Green Checklist • Evaluates water, energy, atmosphere, hazardous materials BAT Baseline Assessment Tool • Essential baseline water and energy usage REST Retrofitting Economic Support Tool • Cost effectiveness analysis of the retrofitting
- 6. PAHO/WHO •More than 67% of the hospitals in Latin America and the Caribbean are located in high risk areas. •Hospitals represent close to 70% of the Ministries of Health national budget. •In the Americas, 61% of the impact on health facilities is caused by earthquakes; 17% by hurricanes; 14% by floods and 8% by health emergencies. •Consequence: 45 million people without proper health care and more than 5 billion dollars in direct costs. A region at risk
- 7. #UniversalHealth Floods Photo: Starbroek News Leonora Hospital, Guyana Milton Cato Memorial Hospital, St. Vincent
- 8. #UniversalHealth 8 Landrail Point, Crooked Island, Bahamas Clarence Town Clinic, Long Island, Bahamas Hurricane Joaquin, Bahamas 2015
- 9. #UniversalHealth Boetica HC, Dominica, Hurricane Maria 2017
- 10. #UniversalHealth Central Medical Stores, Dominica, Hurricane Maria 2017 (Photo: Oct17)
- 11. #UniversalHealth Mexico City Earthquake1985 Earthquakes L’Asile, Haiti 2021 Haiti 2010
- 12. #UniversalHealth HSI 12 Green Checklist BAT 39% - Lighting 37% - Air Conditioning 5%- Refrigeration 8%- Medical Equipment 11%- Misc. load Hospital Lighting Air Conditioning Refrigeration Medical Equipment Miscellaneous Load
- 13. #UniversalHealth HSI Rating Definition 13 What should be done? HSI Rating Safety Index Urgent intervention measures are needed. The hospital's current safety levels are inadequate to protect the lives of patients and hospital staff during and after a disaster. C 0 – 0.35 Intervention measures are needed in the short-term. The hospital's current safety levels are such that patients, hospital staff, and its ability to function during and after a disaster are potentially at risk. B 0.36 – 0.65 It is likely that the hospital will function in case of a disaster. It is recommended, however, to continue with measures to improve response capacity and to carry out preventative measures in the medium- and long-term to improve the safety level in case of disaster. A 0.66 – 1
- 15. #UniversalHealth 400 facilities 7 countries HSI B Rating HSI C Rating HSI A Rating
- 16. #UniversalHealth HSI Ratings per Country 16 87.5%, St Vincent & the Grenadines 57.0%, Dominica 58.0%, Grenada 62.0%, Saint Lucia 58.0%, Jamaica 49.0%, Belize 55.2%, Guyana HSI Category B 12.5%, St Vincent & the Grenadines 43.0%, Dominica 42.0%, Grenada 38.0%, Saint Lucia 42.0%, Jamaica 51.0%, Belize 44.8%, Guyana Category C
- 18. un.org
- 19. #UniversalHealth Structural & Non-structural observations Shear walls NOA rated shutters Strengthened roof
- 20. #UniversalHealth Windows inoperable and not hurricane rated Deteriorated handrails Poor surface drainage Uneven surfaces Deteriorated gutters Before
- 21. #UniversalHealth After 21 New roof Hurricane rated emergency doors Handwash stations NOA rated windows New roof gutters Aluminium handrails Surface drains PV and solar water heaters Safe access
- 23. Strengthening columns, NOA rated windows, improved drainage, accessibility between corridors and treatment rooms, etc. Before After During
- 25. #UniversalHealth
- 28. New low- volume, low- flow fixtures installed throughout & fully refurbed bathrooms
- 30. #UniversalHealth Before After Flush valve commercial grade, low-volume toilets
- 31. PAHO/WHO Structural Resilience & Sustainability Before Before During After
- 32. #UniversalHealth Sustainability 32 Richmond Home for the elderly ft2 10,065.24 m2 = 935 Building area = Originally built in 1829, remodelled in 1980's, new roof in 2004/5 Building structure consists of 2-way RC slabs supported by beams and columns/ walls m 0.2032 Slab thickness for carbon calc. = m3 190.0 Volume of concrete = kg/m3 2400 Unit weight of concrete (kg) = kg 455,981 Weight of RHE concrete slab = From IStructE Structural Carbon Tool: tCO2e 91 Embodied carbon in this slab = 41 flights
- 33. Before ST ANN’S BAY HEALTH CENTRE After
- 34. Before PORT ANOTONIO HEALTH CENTRE After • Improved Indoor Environmental Quality (IEQ) • Improved user satisfaction
- 38. #UniversalHealth Smart Benefits 38 451 kW PV Renewable Energy (26 Facilities) 36 (facilities) Backup Generators 138 kVA 131,050 US-gallons Rainwater Storage 186,650 US-gallons Potable Water Storage 652 Hurricane Shutters 1,474 Impact-rated Windows
- 40. PAHO/WHO Energy & Carbon Savings Equivalent kg CO2e / month Average electricity kWh saved Item description 38,738.40 66,577.18 Lighting per month 49,823.67 85,628.70 Cooling (Air Condition) per month 88,562.08 152,205.88 Total savings per month 1,062,744.91 1,826,470.50 Total annual savings 0.2% Barbados 1.5% Dominica
- 41. #UniversalHealth Value for Money A70 retrofits ranged from US$660k to US$2.1 million. An average of US $140 / sqft or US $1,507 /sqm. Building cost for new hospitals, instead of Smart retrofits, is estimated at USD $175 million (4x more expensive) The Smart Hospital initiative expect to save USD $908.081,67 annually in 7 countries. A70 facilities saw 30% to 60% operational savings (water & electricity) .
- 42. #UniversalHealth SMART HOSPITALS IMPACT 858,005 persons Improved staff and patient satisfaction
- 43. #UniversalHealth Check Consultants Role of Check Consultants I. To assist a design consultant in achieving a better and more reliable project by providing independent assessments of the work II.To reduce the incidence of errors III.To identify sub-standard work IV.To assist in the development of the construction industry
- 44. #UniversalHealth REMARKS REVIEWED CHECKLIST ITEM Criteria for carrying out Review (context, performance, or design criteria) Applicable codes, standards, and other requirements Geographical and/or environmental conditions and requirements Test and analysis procedures and results Quality control and quality analysis procedures Calculations or analysis of representative elements Review of representative details Integration of third-party components and artifacts Hazards (current and future) identified in the *Risk Assessment Adequacy and implementation of risk mitigation measures Concerns discussed with the Design Engineer of Record For iterative design, recommendation for intervals of Check Consultants Checklist for Check Consultants 44
- 45. #UniversalHealth Civ/Struct Check Consultant ToR • Structural Safety – - Ensure appropriate site-specific loads (seismic, wind, gravity) used - Ensure appropriate and consistent codes used for loading, analysis and detailing - Check appropriate use of materials for durability and maintenance - Geometry has significant impact on resilience, particularly roofs • Civil – - check drainage design and mitigation of flood impact • Applicable Codes: - OECS Building Code, Smart Hospitals Standards, etc. 45
- 46. #UniversalHealth MEP Check Consultant ToR • Mechanical – - AC and ventilation needs differ depending on use of space: offices, patient areas, and laboratories, ORs, kitchens, etc. - Check refrigeration needs in blood banks, mortuary, pharmacy, kitchens, etc. - Potable water storage system – check hot water supply, water treatment, filtration, constant circulation of stored water for infection control, water softening - Rainwater harvesting – treatment, design of storage volume - Check steam plants, if used in sterilisation department, Kitchens, etc. - Wastewater systems – septic tanks, treatment plants • Fire Safety – - Fire suppression system – water storage, pumps, piping, hoses, sprinklers, etc. - Check appropriate materials for fire resistance - NATIONAL FIRE PROTECTION ASSOCIATION (NFPA) codes for life safety useful for detailing and checks - Emergency egress/ access and signage 46
- 47. #UniversalHealth 47 MEP Check Consultant ToR Checked Electrical Check safety and design of electrical distribution and transmission – cables, panels, circuit breakers, transformer, etc. Generator and back-up fuel supply (storage to be designed by structural engineer) Photo Voltaic (PV) systems UPS Lighting and low voltage power Other: Information and communication systems (PA system), WiFi, Servers, etc.
- 48. #UniversalHealth Checked Plumbing Services Sanitary ware with consideration for infection control and low-volume flow Medical sanitary ware: bedpan washers, sluices, etc. Sanitary piping systems Grey water traps: kitchens, laundries, etc. Wet wells & sewage transfer pumps Testing and commissioning of MEP services included prior to works approval 48 MEP Check Consultant ToR
- 49. #UniversalHealth Checked Greening Reduce heat load on building to see significant savings: insulation, direct solar impact, etc. Renewable energies extremely cost effective in the Caribbean Region – PV, wind, solar water heaters, etc. (the economics decides the size of the PV system) Low flow WC’s – consider existing sewerage piping so that adequate volumes used Incorporate natural lighting and natural ventilation Use of energy and water efficient fixtures and appliances – target the highest consumers identified in the BAT (electrical and water audit) Advise on water and energy conservation plans 49 Green Check Consultant ToR
- 50. #UniversalHealth La Paix ‘Smart’ Ambulatory A&E 50
- 51. #UniversalHealth New smart facilities – St. Maarten 51 Hope Estate Shelter, Sint Maarten
- 52. #UniversalHealth New facilities – St Vincent & the Grenadines 52 Health Security Unit 1st seismically base-isolated structure in the English-speaking Caribbean
- 53. Smart Hospitals were put to test • Hurricanes Irma and Maria (2017), British Virgin Islands • Hurricane Lisa (2021), Belize • Volcanic eruption and COVID-19 (2021), St. Vincent and the Grenadines • 5.4M Earthquake (October 2023), Jamaica La Soufriere Volcanic Eruption Saint Vincent
- 55. #UniversalHealth Questions Maintenance = Make Smart last