From report to action: Rapid diagnostics for disaster risk management of health systems

In January 2021, amidst the pandemic, a 6.2-magnitude earthquake struck the Indonesian island of Sulawesi. The four largest hospitals in the area where affected, with damaged and collapsed buildings obstructing critical relief and treatment efforts. Events like this highlight the importance of strengthening the disaster resilience of health systems to provide continued care during emergencies.

Even before the pandemic, many countries struggled to meet routine healthcare demands due to various resource and capacity constraints.  In coming years, disasters, climate change, pandemics, demographic change, and chronic diseases will further increase pressures on already strained health systems.

A recent World Bank report, Frontline, offers a blueprint for how countries can prepare healthcare systems for shocks – from disasters to pandemics. World Bank report emphasizes the need for countries to evaluate health systems capabilities to absorb, respond, and adapt to shocks, and thus identify priority actions for boosting the disaster risk management (DRM) in health systems. 

The Frontline Scorecard for disaster resilient health systems translates the report’s principles into a data-driven, country-specific gap analysis that can help identify major risks and areas for action. Focused on low- and middle-income countries, the scorecard can act as a first step towards identifying and prioritizing investments, reforms, and areas for further analysis.

The scorecard provides a rapid diagnostic by evaluating 85 independent capabilities (i.e. indicators).  These are organized around the five pillars that contribute to the climate and disaster resilience of health system outlined in the Frontline report:

1. Foundations – baseline care: This pillar focuses on a wide range of enabling factors that enable healthcare delivery, including equipment, financing, skilled staff, and efficient management and leadership.
2. Health facilities: This pillar examines capabilities at the level of individual healthcare facilities, including design and construction standards, operational capacity, staffing, contingency planning and protocols, and preparedness to serve at-risk populations. 
3. Health systems: This pillar focuses on system-wide coordination of health facilities and services by assessing capabilities for flexible and shock-responsive service delivery modalities, including the staff and resources required.  
4. Integrated response systems: This pillar examines the interoperability between the health system and a country’s emergency response network, including civil protection and non-governmental groups, which are crucial to manage emergencies.
5. Resilient infrastructure: This pillar covers interdependent infrastructure components whose disruption or failure would have an immediate impact on the capacity of healthcare systems – especially the roles water, electricity, and transport systems.

The 85 indicators are evaluated based on data from multinational institutions—including the World Bank, the World Health Organization (WHO), and Organization for Economic Cooperation and Development (OECD)— national public reports, and other authorities on health, disaster risk reduction, emergency response, and infrastructure.

The indicators are also presented in relation to phases of the Disaster Risk Management (DRM) cycle and the WHO’s building blocks of health systems. Scoring the indicators with DRM and WHO criteria is intended to highlight the interdisciplinary applicability of the scorecard and to provide an additional analytical lens to interpret results. The scorecard’s results also clarify the limits of the tool, including how data for each indicator are collected, the rationale for assigned scored, and the justification for each indicator’s inclusion in the assessment.

Although timelines may vary depending on data availability, a country diagnostic using the scorecard can be delivered in two days for an initial assessment from open-source data, and within few weeks for more in-depth country assessments with direct engagement with stakeholders.

Early results and conclusions

The team of the Global Program on Climate and Disaster Risk Management for Health Systems is now in the process of piloting the tool for several countries. Early results indicate that independently derived results from this scorecard can replicate the conclusions from more comprehensive studies. Although this scorecard is not a substitute for a detailed study, these preliminary results suggest that it can offer reliable rapid assessments. Some advantages include:

• Speed: An initial scoring can be completed within days to inform evolving decision making for projects and policy dialogues.
• Reliability: It is developed from reliable sources and undergoes a multi-stage review process.
• Flexibility: Based on priorities and available data, the scorecard can be adapted to include additional aspects for analysis.
• Applicability: International data and the availability of country specific data make this assessment applicable to most countries.

The Frontline Scorecard can help countries to identify the most urgent needs for strengthening their health systems – and thus prioritize investments and reforms that boost people’s resilience in uncertain times.