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
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
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
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
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)
.
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
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