National Action Plan for Earthquake Safety of
Health Facilities

January 2013

National Action Plan for Earthquake Safety of Health Facilities

Contents
1.

2.

3.

Backgrounda.

Natural hazards in Bhutan

2-3

b.

Relevant national and health sector policies

3-4

c.

Impact of previous earthquakes on the education sector

4-5

National Action Plan for Earthquake Safety of health Facilitiesa.

Action planning process

5b.

Action plan objectives

5c.

Health facilities earthquake safety framework

6

Priority Areas and Outcomesa.

4.

Priority Area I - Strengthening earthquake safety and disaster management
institutional and policy framework in the health sector

6-10

b.

Priority Area II - Education and awareness

11-13

c.

Priority Area III - Risk reduction and mitigation

14-17

d.

Priority Area IV - Preparedness, response and early recovery

18-21

e.

Priority Area V - Capacity building

22-25

Implementation Review and Monitoring Arrangements

26

Annexure I - Health Facilities Earthquake Safety Working Group Members

27

Annexure II - Terms of Reference of the Working Group28

Annexure III - Guidance Note on Development of Action Plan

30-32

Annexure IV - Health Facilities Earthquake Safety Action Plan Matrix

33-36

National Action Plan for Earthquake Safety of Health Facilities

TablesTable 1 - Estimates as per the Joint Rapid Assessment Report (2009, 2011)

1

Table 2 - Components outlined in the NDRMF, 2009

4

Table 3 - Priority Areas

6

Table 4 - Priority Area I

7

Table 5 - Priority I - Outcomes, Activities and Sub-activities

10

Table 6 - Priority Area II

11

Table 7 - Priority II - Outcomes, Activities and Sub-activities

13

Table 8 - Priority III

14-15

Table 9 - Priority III - Outcomes, Activities and Sub-activities

17

Table 10 - Priority IV

18

Table 11- Priority IV - Outcomes, Activities and Sub-activities

21

Table 12 - Priority V

22

Table 13 - Priority V - Outcomes, Activities and Sub-activities

25

National Action Plan for Earthquake Safety of Health Facilities

I.

Background

The National Action Plan for Earthquake Safety of Health Facilities is the Royal Government of Bhutan'scommitment to reduce future losses in health facilities due to earthquakes and other natural hazards.
GeoHazards International facilitated the formulation of this action plan, in collaboration with the
Department of Disaster Management and the Ministry of Health, with funding from the Global Facility
for Disaster Reduction and Recovery.
This document provides guidance to the concerned governmental departments regarding actions totake, policies to put into place and projects to undertake in the short, medium and long-term, to ensurethat all health facilities in Bhutan are safe from the impacts of future earthquakes and other natural
hazards. The authors recommend that this plan receive regular updates and that progress toward
implementing the plan's priority areas be reviewed annually.
Hospitals and health facilities are among the most important resources in any community.
Communities rely upon them not only to remain safe during hazardous events such as earthquakes, butalso to remain functional and able to provide medical care to the large numbers of people who may
seek treatment after a hazardous event. In prior earthquakes, floods and other natural disasters,
hospitals and health facilities often have proven to be vulnerable to damage to buildings, criticalequipment and contents, and to the loss of staff. The loss of staff further hinders the facility's capacity
to provide an effective medical response to the event. In summary, damaged hospitals and healthfacilities confront real difficulties delivering health care to the communities that they serve; these
difficulties, in turn, hamper the recovery process. Both the M6.1 earthquake of 21st September, 2009 inth
Eastern Bhutan and the M6.8 earthquake of 18 September, 2011 in Sikkim, which principally affected
Western Bhutan, damaged hospitals and Basic Health Units(BHU). A total of 54 health buildings
suffered damage, and losses exceeded Nu.600 million.
Table 1- Estimates from the Joint Rapid Assessment Report (2009, 2011)
Earthquake
Event

HealthBuildings
DamagedEstimated
Loss(Nu. Million)

Estimated Cost for Recovery
and Reconstruction(Nu. Million)

2009

29

123.5

136

2011

22

10.23

17.26

Total

51

133.73153.26

Keeping hospitals and health units functional and safe is crucial to the ability to provide important
emergency and public health services to people, when they need them most. Preserving Bhutan's
health system performance during natural hazard events requires near, medium and long-termplanning, coupled with sustained action to enhance the seismic safety and preparedness of hospitals

1National Action Plan for Earthquake Safety of Health Facilities

and to build the needed capacities. Developing and implementing the National Action Plan for
Earthquake Safety of Health Facilities is an important, time-critical initiative towards this end. Thisinitiative fits into the overall National Disaster Risk Management Framework, which calls for proactive
risk reduction and for integration of disaster management concerns into national programs andpolicies, and supports implementation of key components of the Health Sector Disaster Management
Contingency Plan. This Action Plan serves as a tool to incorporate important risk reduction andpreparedness initiatives/actions into five year and annual plans of the Ministry of Health.
a.

Natural Hazards in Bhutan

Bhutan is vulnerable to earthquakes and several other natural hazards due to its location in the eastern
Himalayas, which, in addition to being one of the most seismically active regions of the world, haslandslide-prone slopes, potentially dangerous glacial lakes, and a climate conducive to windstorms,
floods and wildfires. Among the hazards that Bhutan faces, earthquakes have the potential to cause themost severe and widespread damage, because the entire country lies atop or near the major
earthquake fault that divides the Indian tectonic plate from the Eurasian tectonic plate. Though recent
earthquakes have been moderate in size, geologic evidence shows that the fault is also capable ofbreaking under most of the country in a single massive earthquake; scientists postulate that such a
1
massive earthquake may have last occurred circa 1100 A.D. Bhutan's two previous, moderate
earthquakes (21st September, 2009 and 18th September, 2011) caused 13 deaths, many injuries and2
losses of approximately Nu. 3698.63 million. The much larger earthquakes that the fault is capable ofgenerating would cause unprecedented damage.
Another major natural hazard that Bhutan faces, especially due to the effects of climate change, is therisk of glacial lake outburst floods. Bhutan has 2,674 glacial lakes, 25 of which have been identified as
potentially dangerous. Due to climate change and increasing temperatures, the threat of glacial lake3
outburst floods is increasing, as glaciers melt and retreat at unprecedented rates. In October 1994, a
massive glacial lake outburst floods from Luggye Tsho in the headwaters of Pho Chhu River damaged
the Punakha Dzong, causing numerous casualties. Earthquake shaking can also trigger a glacial lake
outburst flood, by causing the natural dam holding back the glacial lake to crack and fail.
In addition to these two major natural hazards, Bhutan is vulnerable to recurring and seasonal hazards
that include landslides, flooding, wind and hail storms. These hazards are increasing, with changes intemperature and precipitation levels and patterns. The effects of Cyclone Aila, which hit the Bay of
Bengal in May 2009, were felt in all twenty Dzongkhags of Bhutan, disrupting power and water supplies,
damaging roads, irrigation channels, bridges and other infrastructure, including health facilities.

1

Kumar, S. Wesnousky, S.G., Jayangondaperumal, R., Nakata, T., Kumahara, Y. and V. Singh (2010). Evidence for surface rupture along the northeastern
Himalayan front, India: Timing, size, and spatial extent of great earthquakes. Journal of Geophysical Research, 115 (B12422), 1-20.
2

Joint Rapid Assessment Report (JRAR), 2009 and 2011

3

Second National Communication, NEC, 20112

National Action Plan for Earthquake Safety of Health Facilities

Bhutan is also susceptible to fire in both settled and forest areas. The country's rugged terrain, highly
combustible forests, erratic wind conditions and shortage of trained fire-fighters and equipment
increase the risk of forest fire outbreaks, especially during the dry winter months. Fires in the humansettlements of Wamrong, Trashigang and Chamkhar, Bumthang in 2011 and 2012 have had devastating
effects on those communities.
In addition to shaking damage, earthquakes can also trigger many of these other hazards, including
glacial lake outburst floods, landslides and rock falls, and fires. Strong earthquakes in mountain areas
invariably cause numerous landslides and rock falls, especially when slopes are saturated by heavy
rainfall. Earthquakes trigger fires that can spread between structures and grow into conflagrations. The
Ministry of Health should describe these hazards by identifying the areas and structures threatened byfloods, landslides, rockfalls, avalanches, Glacial Lake Outburst Floods, and by ensuring measures toreduce the risk from them are incorporated into measures to improve earthquake safety andpreparedness of health facilities.
b.

Relevant national and health sector policies

The Royal Government of Bhutan places a high priority on equitable and quality access to free healthcare services, including referral services outside the country, and has made rapid progress in healthsector development, with sustained primary health care coverage now being provided to more than
90% of the population. Average life expectancy in Bhutan has increased from 37 years (in 1960) to 66
years (in 2005), while childhood immunization (began in 1991) levels now exceed 90%. Today, Bhutan
has 31 hospitals (including 1 national and 2 regional referral hospitals), 181 basic health units and 518
Outreach Clinics.
Several national and health sector policy documents summarized in this section were especiallyrelevant to the development of the National Action Plan for Earthquake Safety of Health Facilities.
These are the National Health Policy 2011, National Disaster Risk Management Framework 2006, theNational Disaster Management Bill, and the Health Sector Disaster Management and Contingency
Plan.
The National Health Policy 2011 of Bhutan aims to "build a healthy and happy nation through a dynamic
professional health system, attainment of highest standard of health by the people within the broader
framework of overall national development in the spirit of social justice and equity." The policy includes
a section on Emergency Health Service and specifies, "All health facilities shall institute appropriate
system of care to deal with emergencies, disasters, epidemics and outbreaks" and "shall provide asystem of emergency for (a) disasters (b) epidemic outbreaks (c) mass casualty (d) routine
emergencies."
The National Disaster Risk Management Framework 2006 incorporates the principles of pro-actively
reducing disaster risks through decentralized and empowered disaster management institutions at
various levels, and through adopting a multi-sectoral approach to disaster management. The
3

National Action Plan for Earthquake Safety of Health Facilities

Framework's Component 4, disaster preparedness, requires concerned Ministries/Sectors to develop
disaster preparedness and response plans at various levels. Component 5 specifically mentions"Mitigation and integration of disaster risk reduction in development plans."
Table 2 - Components outlined in National Disaster Risk Management Framework, 2009
NDRMF components
1

Institutional, legislative and policy framework2

Hazard, vulnerability and risk assessment

3

Early warning system

4

Disaster preparedness

5

Mitigation and incorporation of DRR in development sectors

6

Public awareness and education

7

Capacity development

8

Communication and transportation

Similarly, the draft National Disaster Management Bill requires various sectors/agencies to develop
disaster management and contingency plans. In line with these policies, the Ministry of Health hasdeveloped a Health Sector Disaster Management and Contingency Plan that requires facilities of alllevels to develop emergency management plans.
c.

Impact of previous earthquake events on Bhutan's health sector

The losses attributable to the two moderate earthquakes of 21st September 2009 and 18th September
2011 demonstrate Bhutan's high level of risk in future earthquakes.
1.

Impact of September 21, 2009 Earthquake

In this event, 45 Basic Health Units were damaged. The Joint Rapid Assessment Report estimated thetotal cost of damages to health infrastructure at Nu. 594 million. The report noted that "collapse" and"major damages" to Basic Health Units reflected "poor construction of these buildings," and that
although "building materials used in the construction met the specifications, the design of thesebuildings left a lot to be desired."In fact, damaged Basic Health Units were unable to provide health care services to communities. The
Ministry of Health had to make temporary arrangements for emergency health services.
2.

Impact of September 18, 2011 Earthquake

This earthquake had limited impact on the health sector, though at least one BHU suffered heavy

4National Action Plan for Earthquake Safety of Health Facilities

damage. According to the Ministry of Health's assessment report, nine district hospital buildings(Bumthang, Tsimalakha, Gedu, Dagapela, Paro, Punakha, Sipsu, Gomtu, and Wangdue) developed
cracks and required minor repairs. The affected health facilities were able to deliver public healthservices without disruption. The Joint Rapid Assessment Report estimated the total cost of damages tohealth infrastructure at Nu. 10.23 million.

II.

National Action Plan for Earthquake Safety of Health Facilities

The main focus of the Action Plan is to enhance earthquake safety in health facilities, and to promote
their continued functioning. Whenever possible, the plan integrates safety measures for other natural
hazards such as fire, windstorms, and floods.
The stated goal of the Action Plan is that:
Health facilities are physically resilient and health services remain accessible andfunctioning at the maximum capacity possible during and immediately after hazardous
events and emergencies.
a.

Action planning process

The National Action Plan for Earthquake Safety of Health Facilities represents the combined effort of
the Health Facilities Safety Working Group, formed with representation from key Ministries,
Departments and relevant Donor Agencies (Annexure I - Health Facilities Safety Working Group
Members) and facilitated by GeoHazards International.
At a National Stakeholder Workshop on 8th March 2012, working group members and the participants
endorsed the Terms of Reference (Annexure II) and a Guidance Note on Development of Action Plan
(Annexure III). The Health Facilities Safety Working Group met on numerous occasions, and GHI
facilitated its work using e-mail and other communication tools.
The Working Group presented the action plan development progress, the draft action plan matrix and
immediate priorities and recommendations for incorporation in the Ministry of Health's 11th Five Year
Plan at the Second National Stakeholder Workshop on 23 May, 2012.
b.

Action plan objectives

The National Action Plan for Earthquake Safety in Health Facilities has the following objectives:
1.
Make health staff, patients and the general public safer from earthquakes and other hazards;
2.
Make health facilities and buildings safer and more earthquake-resistant;3.
Enhance earthquake and emergency preparedness in health facilities; and4.
Build overall capacity and awareness of health personnel about earthquakes and other natural
hazards.
5

National Action Plan for Earthquake Safety of Health Facilitiesc.

Health facilities earthquake safety framework

The working group first worked to finalize the Health Facilities Earthquake Safety Matrix or Framework(Annexure IV). The framework identifies five priority areas that cover all aspects of improving
earthquake safety in the health sector.
Table 3 - Priority Areas
Priority Area I

Strengthening Earthquake Safety and Disaster Management Institutional andPolicy Framework in the Health Sector

Priority Area II

Education and AwarenessPriority Area III

Risk Reduction and Mitigation

Priority Area IV

Preparedness, Response and Recovery

Priority Area V

Capacity Building

III. Priority Areas and Outcomes
Priority Area I- Strengthening earthquake safety and disaster management institutional and policy
framework in the health sector
The objectives of this priority area are to formulate and implement various policies, guidelines andministerial directives to improve earthquake safety and disaster preparedness in health facilities and tostrengthen disaster management institutions within Bhutan's Health sector.

6National Action Plan for Earthquake Safety of Health Facilities

Table 4- Priority Area I
Priority
Area I
Strengthening
earthquake
safety anddisaster risk
management
institutional
and policy
framework in
Bhutan's
health sector

Outcomes

Baseline

1.1 Policies,
guidelines,
ministerial
directives
supporting
earthquake
safety anddisastermanagementin Health
Facilities arein place- National
Health Policy,
2011- Review and endorse the Health
Short
Sector Disaster Management andContingency plan

- Health Sector
DisasterManagement
andContingency
Plan, 2011

- Formulate standard guidelines
for emergency planning in all
health facilities

Short- Formulate guidelines to identify
and abate threats tofunctionality and hazards causedby damage to building contents,
equipment and furnishings inhealth facilities

Short toMedium

1.2 Disaster
Management
institutions
within the
Health Sector
strengthened- National
Influenza
Pandemic
Preparedness
Plan, 2010

- Disaster
Management
focal person
identified in
Department ofMedicalServices- Health Help
centerestablished in2010

Recommended Interventions

Timeline*- Adopt higher safety standards for Medium
the design and construction of allhealth facilities- Issue ministerial directives for
implementation of earthquake
safety and emergency
management-related plans,
standards, policies andguidelines, including theincorporation of earthquake
safety, emergency management
and information on otherhazards in the Royal Institute of
Health Sciences/ Medical
University Curriculum

Short toMedium- Appoint/Identify disastermanagement focal persons andestablish establish emergency
management units in all healthfacilities

Short- Strengthen Emergency
Management Services Division in
the Ministry of HealthPerformance
Indicators

Responsible
Agencies- All healthfacilities withfunctional
disastermanagement
andcontingency/
evacuation plans

Lead: Department ofMedical Services,
Ministry of Health- Guidelines to
identify andabate hazards
from building
contents,
equipment andfurnishings
adopted andimplemented inall healthfacilities- A new
engineering
standarddeveloped
specifically for
health facilities
that will bemandated over
and above otherrelevant
national
standards

Short &
Medium- All healthfacilities withdisastermanagement
focal persons
and functional
disastermanagement
units

Medium- Strengthen Health Help Centre
and emergency response
services- Health Help
Centre fully
functional andequipped tofulfill its
mandateSupporting Agencies:
1. Policy and Planning
Division, Ministryof Health
2. Royal Institute of
Health Sciences/
Medical University
management
3. Department ofDisasterManagement,
Ministry of Homeand Cultural Affairs
4. Gross National
Happiness
Commission
5. Dzongkhag/
ThromdeAdministration
6. Ministry of FinanceLead: Department ofMedical Services,
Ministry of HealthSupporting Agencies:
1. Human Resources
Division, Ministryof Health
2. Hospital/ Healthfacility
management
principals
3. Department ofDisasterManagement*Short (1-5 yrs.), Medium (5-10 yrs.), Long (More than 10 yrs.)

The National Disaster Management Framework 2006 and the National Health Policy 2011 required thedrafting of the Health Sector Disaster Management and Contingency Plan 2011. The Department ofMedical Services, the health sector agency responsible for disaster management, conducted a numberof simulation exercises to review and test the 2011 contingency plan.

7

National Action Plan for Earthquake Safety of Health Facilities

The action plan framework specifies two outcomes and eight key interventions to build upon theseearlier actions and further strengthen disaster management institutions and policy framework in thehealth sector.
Outcome 1.1 - Policies, guidelines, ministerial directives supporting earthquake safety and disastermanagement in hospitals and basic health units in placea.

Review and endorse the Health Sector Disaster Management and Contingency Plan

The Ministry of Health drafted the Health Sector Disaster Management and Contingency Plan in 2011;
however, the plan has not yet been reviewed or endorsed. Contingency arrangements outlined under
the plan should be tested and updated, and the Ministry of Health should formally endorse the plan.
That endorsement would authorize the Department of Medical Services to draft various standard
procedures and guidelines for emergency management in health facilities.
b.

Formulate standard guidelines for emergency planning in all health facilities

Guidelines for emergency planning in health facilities at various levels should be formulated anddisseminated based on the sector contingency plans. All health facilities should be required to develop
their own emergency plans and to test the plans on a regular basis.
c.

Formulate guidelines to identify and abate threats to functionality and hazards caused bydamage to building contents, backup utility systems and equipment

In order for a hospital to remain functional, critical utilities, such as electrical power and water, andcritical medical equipment must be functional, too. In previous earthquakes, hospitals lost
functionality when electrical power went out and backup systems failed to come online, or whencritical lifesaving and diagnostic equipment fell or became inoperable, due to earthquake shaking.
Another concern is that objects can fall onto staff and patients inside a hospital and can injure them.
Structural measures to limit building damage and protection for critical utility systems and medical
equipment are equally important. Standard guidelines that specify measures to protect critical utility
systems, such as the backup electrical power system, and critical medical equipment fromearthquakes, floods and fires should be prepared, formally adopted and implemented in all healthfacilities.
d.

Adopt higher safety standards for the design and construction of health facilities

Health facilities provide critical health care and services during and after emergency events. People
congregate in health facilities even under normal operating conditions; after an earthquake or otherevent that creates mass casualties, large numbers of people will converge on health facilities. Because
health facilities must keep all of these occupants safe and also remain functional during earthquakes
and other types of emergencies, they should be built to meet higher standards and to provide a greaterlevel of safety. Buildings in health facilities have not performed well in previous earthquakes for a8National Action Plan for Earthquake Safety of Health Facilities

number of reasons, which include inadequate design, use of sub-standard building materials, and lackof construction inspection and quality control. The Ministry of Health should immediately adopt higher
safety standards for health facility construction, along with general safety guidelines for all healthfacilities to follow.
e.

Issue ministerial directives for implementation of earthquake safety and disaster management
plans, standards, policies and guidelines, including incorporation of earthquake safety andemergency management materials in the curricula of the Royal Institute of Health Sciences andthe Medical University

All safety and disaster management-related plans, guidelines, standards and policies for the healthsector should be formally adopted and circulated to all health facilities as a directive that they should
undertake. In addition, the Ministry of Health should issue policy directives that call for including
earthquake safety, emergency management and other information on natural hazards in the RoyalInstitute of Health Sciences' and the Medical University's curricula.
Outcome 1.2 - Disaster management institutions within the health sector strengtheneda.

Appoint/Identify emergency management focal persons and establish emergency
management units in all health facilities

All health facilities should have operative emergency management units and identified emergency
management focal persons. This would support planning, providing and sustaining capacity
development activities. Formally designating and training emergency management focal persons
would also help to facilitate, coordinate and sustain emergency preparedness and response activities
in the health facilities.
b.

Strengthen the Emergency Management Services Division in the Ministry of Health

The Emergency Management Services Division under the Department of Medical Services is
responsible for coordinating emergency management and disaster preparedness and response in the
Ministry of Health. The division now has only one dedicated official working on disaster preparedness
and response. Given the number of health facilities in Bhutan and the important role of the Ministry of
Health, there is need to strengthen this division. The division should work with a multi-sector disastermanagement committee and report to the Secretary, Ministry of Health, in order to ensure that theunit is not isolated and to facilitate mainstreaming of risk reduction measures into the Ministry's plansand programs.
c.

Strengthen Health Help Centre and emergency response services

The Ministry of Health instituted the Health Help Centre in 2011 to improve access to health services
and to provide round-the-clock healthcare services. The Centre offers a broad range of medical
assistive services—ranging from medical emergency services, medical triage, health counseling, and9National Action Plan for Earthquake Safety of Health Facilities

information on health services and facilities to SMS prescription for over-the-counter drugs—througha toll free number, responding within one hour to calls made at anytime from anywhere, so long as
telephone/mobile network coverage is available. The Centre currently manages 101 ambulances and69 emergency medical teams in twenty Dzongkhags. The Centre's near-term priorities are to increase
its number of paramedics and to build their capacities systematically. In the long-term, the Centre
needs to be strengthened institutionally and its infrastructure developed, to fulfill its importantmandates.
Table 5 -Priority I - Outcomes, Activities and Sub-activities
Outcome
1.1 Policy
guidelines
andministerial
directives
supporting
disastermanagement
in hospitals
and basic
health units
in place

Activitya. Review and endorse Health
Sector Disaster Management andContingency Plan

Sub-Activity
1. Conduct stakeholder meetings and table top exercises toreview and test contingency plan
2. Present reviewed plan for endorsement by the Ministry of
Health. Formulate and disseminate standard guidelines toall hospitals/ basic health units

b. Formulate standard guidelines
for emergency planning in all
health facilities

1. Draft emergency planning guidelines
2. Disseminate guidelines to all health facilities and support
them in formulating emergency plans
3. Set up formal monitoring and evaluation mechanisms
1. Conduct assessment of threats to functionality andhazards caused by damage to building contents, backup
utility systems and equipment in all hospitals
2. Formulate standard guidelines for abatement of falling
hazards and threats to functionality
1. Disseminate guidelines to all health facilities andimplement mitigation measures
1. Review needs, gaps, current standards, etc.
2. Conduct stakeholder consultations
3. Formulate and agree on safety standards
4. Disseminate to all health facilities
1. Evaluate all activities and identify requirements for formal
directivesc. Formulate guidelines to identify
and abate threats tofunctionality and hazards causedby damage to building contents,
backup utility systems andequipment
d. Adopt higher standards for thedesign and construction ofhealth facilities

1.2 Disastermanagement
institutions
within thehealth sector
strengthened

10e. Issue ministerial directives for
implementation of earthquake
safety and disaster management
related plans, policies, guidelines
and standards
a. Appoint/identify disaster focal
persons and establish disastermanagement units in all healthfacilities
b. Strengthen establish emergency
management units in the Ministryof Healthc. Strengthen Emergency Services
Division in the Ministry of Health

2. Disseminate to all health facilities
1. Finalize Terms of Reference
2. Issue ministerial directives for appointment or
identification of focal persons and establishment ofdisaster management units
1. Assess human resources need, detail out responsibilities
etc.
2. Discuss and submit to the Royal Civil Service Commission
1. Develop training curriculum for paramedics and otheremergency staff
2. Recruit and trainparamedics and other required staff
3. Review and formulate institutional and standard
procedures for the Centre and its functions
4. Review resources, budget, equipment and infrastructure
requirements and formulate a long-term plan for
implementation on prioritized basis

National Action Plan for Earthquake Safety of Health Facilities

Priority Area II - Education and AwarenessThe objective of this priority area is to enhance knowledge and share information related toearthquake safety in health facilities, and to increase awareness among health personnel about risks
from natural hazard events. Increased awareness can lead to positive changes in behaviors andattitudes regarding the importance of risk reduction and preparedness.
Table 6 - Priority Area II
Priority
Area II

Outcomes

Education and 2.1 Enhanced
Awarenessknowledge
andinformation
sharingmanagement

2.2 Increased
awarenessand education

Baseline- Knowledge
andinformation
shared throughpast andongoingtrainings
programmes- Existing
information
and awarenessmaterials
developed by
the Ministry of
Health and theDepartment ofDisasterManagement- Awarenessprograms
throughvarious media

Recommended
Interventions

Timeline

Performance
Indicators- Establish earthquake safetyand disaster risk reduction
knowledge sharing
network among healthfacilities

Medium- Share Information with
communities

Ongoing- Conduct awarenessactivities on a prioritizedbasis

Ongoing- Increased awareness on Lead: Department ofdisaster risks among
Medial Services,
health staff
Ministry of Health- Observe International Day
for Disaster Reduction (orcommemoration of pastearthquake events) andconduct preparedness drill
in all health facilities as a
National event

Short- Development of acomprehensive
awareness strategy for
health sector- Develop information andeducation materials (riskcommunication, dos anddon'ts, hazard-specific,
family preparedness, etc.)

Ongoing- No.of knowledge
sharing activities- No. of community
campaigns, etc.

- No. of awarenessactivities carried out atvarious levels- Information andeducation materials
formulated anddisseminated in all
health facilities- Incorporate safety
Medium,information on
longearthquakes and otherhazards and emergency
management materials into
Royal Institute of Health
Sciences and Medical
University curricula- Carry out awarenesstrainings on family
preparedness for all healthstaff- Mechanism for
information sharing
developed

Responsible
Agencies

Short

Lead: Department ofMedial Services,
Ministry of HealthSupporting Agencies:
1. Health Institutes/
Universities
2. Management of
hospitals/healthfacilities
3.Department ofDisasterManagement,
Ministry of Homeand Cultural Affairs

Supporting Agencies:
1. Health Institutes/
Universities
2. Management of
hospitals/healthfacilities
3.Department ofDisasterManagement,
4. Dzongkhag/
ThromdeAdministrations- Risk reduction materials
incorporated intoRoyalInstitute of Health
Sciences/University
curricula- All health staff havefamily disastermanagement plans

11National Action Plan for Earthquake Safety of Health Facilities

Outcome 2.1 - Enhanced knowledge and information sharing managementa.

Establish knowledge sharing network

Forming a network of disaster management focal persons and units in health facilities would promotesharing of knowledge and experience, as well as joint implementation of activities and programs. A
virtual platform could be used to share information on hazards, risks, preparedness and response
guidelines, awareness materials, and risk mitigation options. The platform would provide a place todiscuss common issues and challenges and would foster solidarity and motivation.
b.

Share information with communities

As important community nodes and public service providers, health facilities can share knowledge andraise awareness in their immediate communities about natural hazards and the need for risk reduction
and preparedness. The training of village health workers should integrate information on earthquake
safety, other hazards, disaster risks, their impact on the health sector, and the preparedness measuresthat the health sector is putting into place.
Outcome 2.2 - Increased awareness and educationa.

Conduct awareness programs and activities

There is a need to conduct awareness activities and programs on a prioritized basis, targeting decision
makers, focal persons, disaster management units, emergency health staff and others, at various
levels. Content should include various hazards, dos and don'ts, health emergencies, and preparedness
measures being put into place.
b.

Observe International Day for Disaster Reduction

Bhutan has observed the International Day for Disaster Reduction since 2008. All health facilities
should observe this day and also mark past earthquake events that have affected Bhutan. These dayspresent significant opportunities to enhance preparedness and to share the message of earthquake
safety and risk reduction. Health facilities across Bhutan could use the International Day for Disaster
Reduction as a time to reflect on their role in emergencies and to conduct emergency drills.
c.

Develop information and education materials

Easy-to-use and understand educational materials should be developed for disaster management
units, emergency medical teams, focal persons and other health staff. These materials should provide
basic information on various hazards, dos and don'ts, family preparedness, simple maps identifying
hazard zones (glacial lake outburst flood red zone areas, landslide prone areas, flood inundation zones,etc.) and other relevant topics.

12

National Action Plan for Earthquake Safety of Health Facilities

d. Incorporate safety information on earthquakes and other hazards and emergency
management materials into Royal Institute of Health Sciences and Medical University curricula
Incorporating appropriate materials on emergency management, as well as information on various
hazards and disaster risks, into the Royal Institute of Health Sciences and the medical university
curricula would help to promote a culture of preparedness and resilience and would represent a longterm investment in risk mitigation.
e.

Raise awareness on family preparedness

During earthquakes and other emergencies, the staff at a health facility is responsible for far more thandelivering routine health services: staff must also deliver critical emergency health care and ensure thesafety of patients. To fulfill this responsibility, both staff and their families need to be prepared fornatural hazard events and emergencies. When staff members' families are prepared and able to takecare of themselves, staff members feel able to continue their work at the hospital. Health facilities must
place a high priority on sensitizing staff on the need for family preparedness. Such sensitization
programs can help health personnel and their family members to change attitudes, prepare their own
disaster management plans, and assume their respective responsibilities during emergencies.
Table 7 - Priority II -Outcomes, Activities and Sub-activities
Outcome2.1 Enhanced
knowledge
andinformation
sharingmanagement
2.2 Increased
awareness andeducation

Activitya. Establish knowledge
sharing network among
health facilities
b. Share information with
communities
a. Conduct awarenessprograms and activities
b. Observe International
Day for Disaster
Reductionc. Incorporate safetymaterials onearthquakes and othernatural hazards andemergency management
materials into RIHS anduniversity curriculad. Raise awareness onfamily preparedness

Sub-Activity
1. Develop suitable information technology platform and othercoordination mechanism
2. Conduct knowledge- and experience-sharing activities (quiz,
exhibitions, newsletters, etc.)
1. Carry out community-based awareness activities
2. Train village health workers
1. Conduct needs assessment and planning activities per target
audience
2. Implement awareness-raising activities
1. Participate in National Shakeout
2. Commemorate past earthquake events, the role of healthfacilities during emergencies and other awareness activities
1. Review existing curriculum for emergency management andinformation on hazards and health emergencies, etc.
2. Formulate appropriate materials
3. Carry out capacity building activities
4. Incorporate into curricula
1. Formulate materials
2. Conduct sensitization programs

13

National Action Plan for Earthquake Safety of Health Facilities

Priority Area III - Risk Reduction and Mitigation
The objectives of this priority area are to reduce loss of lives and property damage in the event of anearthquake or other natural hazard event, such as a glacial lake outburst flood, fire, or landslide.
Specific risk reduction and mitigation measures differ, depending on the hazard. For earthquakes, risk
reduction and mitigation involve ensuring that health facilities are structurally sound, located on stableground and able to withstand the expected level of earthquake shaking with limited damage; thatcritical utility systems and equipment are protected from damage; and that furnishings, decorative
finishes and parts of the building are anchored or braced to prevent them from falling onto patients or
staff members. The table below focuses on risk reduction and mitigation measures for earthquakes,
but similar measures can and should be delineated for the other hazards that Bhutan's health facilities
face.
Table 8 - Priority Area III
Priority
Area III
Risk
Reduction
andMitigation

Outcomes

Baseline

3.1 Structural
measures
implemented- Vulnerability
assessment
training
conducted for
HealthInfrastructure
Development
Divisionengineers

Interventions
New Construction:- Prepare standard
earthquake-resilient
designs for health facilities

Short toMedium- Review existing guidelines
for health facility
construction andincorporate earthquake
safety and risk reduction- Existing
concerns, including
designs for
identification of sites
hospitals basedoutside of hazard zones
on standard(glacial lake outburst floodbuilding codes
red zones, flood andlandslide prone areas,- Basic healthwindstorms, etc.)
unit
construction- Institute construction
guidelines
quality control andinspectionmechanisms for,- Vulnerability
and adherence to,assessment ofstandards and designs
Jigme Dorji
Wangchuck
Existing Buildings:
National
Referral- Conduct
Hospitalvulnerability/safety
conducted inassessment of existing
2012
health facilities/buildings

Short toMedium- Cary out recommended
Replace/Repair/Retrofit
measures14

Timeline

Performance
Indicators

Responsible
Agencies- All new health facilities
constructed per
earthquake resilient
designLead:Health
Infrastructure
Development
Division, Ministry of
Health- Health facilities
constructed per
guidelines outside ofhazard zones- Quality and standardsof all new construction
ensured- All health facilities
assessed andstrengthened
accordingly

Short toMediumShort toMediumMediumto Long

Supporting agencies:
1. Department ofMedical Services,
Ministry of Health
2. Management of
hospitals/healthfacilities
3. Department ofDisasterManagement,
Ministry of Homeand Cultural Affairs
4. Dzongkhag/
ThromdeAdministrations
5. Ministry of Worksand Human
Settlement
6. Dzongkhag/
ThromdeEngineers

National Action Plan for Earthquake Safety of Health Facilities

3.2 Criticalutility systems
andequipment
protected andfalling hazards
abated- Carry out fixing, bracing
and other non-structural
measures in all healthfacilities (e.g., electric
systems, proper use ofelectrical appliances, etc.)

Medium- Falling hazards in health Lead:Healthfacilities identified and Infrastructure
abatedDevelopment
Division, Ministry of
HealthSupporting Agencies:
1. Department ofMedical Services,
Ministry of Health
2. Management of
hospitals/ healthfacilities
3. Department ofDisasterManagement

3.3 Risk
insurance inplace forhealthfacilities- Explore and institute risk
insurance for healthfacilities/ buildings

Short toMedium- Health facilities andbuildings insured on aprioritized basis

Lead: Department ofMedical Services
Supporting agencies:
1. Royal Insurance
Corporation of
Bhutan and otherinsurance agencies
2. Ministry of Finance
3. Department ofDisasterManagement

Outcome 3.1 - Structural Measures
For New Constructiona.

Prepare standards for earthquake-resilient designs for health facilities

Health facilities must remain functional, in order for health personnel to deliver important emergency
medical services and to ensure the safety of patients and the public. Therefore, higher performancestandards should be maintained for health facility buildings, especially with regard to earthquakes.
b.

Review existing guidelines for health facility construction

Existing health facility construction guidelines and procedures should be reviewed, in order todetermine how to incorporate higher design standards so as to limit damage from earthquakes,
windstorms and other natural hazard events. Guidelines should also specify how to identify safe sites
for construction and should prohibit building in hazardous areas (glacial lake outburst flood red zone
areas, flood zones, landslide prone areas, etc.).
c.

Institute construction quality control and inspection mechanisms

Past assessments and experiences from previous earthquake events illustrate the importance ofensuring construction quality by testing materials, inspecting workmanship, and confirming that thebuilding is constructed according to the design drawings. The Health Infrastructure Development

15

National Action Plan for Earthquake Safety of Health Facilities

Division should institute a special quality control and inspection mechanism independent of thebuilder for the construction of health facilities.
Existing Constructiond.

Conduct vulnerability/safety assessment of existing health facilities

At present Bhutan has 31 hospitals (including Jigme Dorji Wangchuck National Referral Hospital), 184
Basic Health Units and 517 outreach clinics. Some of these facilities were built before Bhutan adopted
requirements for special seismic detailing of reinforced concrete buildings, along with other seismic
safety requirements. It is therefore necessary to assess the vulnerability of existing health facilities, todevelop a clear understanding of the level of vulnerability and the possibilities for strengthening or
replacing structures to reduce and mitigate risk.
e.

Carry out recommended strengthening, replacement or relocation measures

Vulnerability and safety assessment recommendations for strengthening or replacing existing healthfacilities/buildings should be carried out in a prioritized and phased manner.
Outcome 3.2 - Critical utility systems and equipment protected and falling hazards abateda.

Carry out fixing, bracing and other non-structural measures in all health facilities

During an earthquake, falling contents, equipment and building elements such as parapets and ceilings
cause the most injuries. Damage to critical utility systems, such as electrical power, and to expensive
life-saving and diagnostic medical equipment can impede the delivery of medical services. Equipment
and utility distribution systems must be braced and anchored, so that they will remain functional
following earthquakes and other emergencies. Hospitals have more complex utility systems andequipment than do most other buildings; for that reason, they need special guidelines and standards
for protecting those systems and pieces of equipment against natural hazards. The Health
Infrastructure Development Division and Biomedical Engineering Division should work with engineers
who are experienced in protecting these systems to formulate such guidelines and standards. They
should also develop guidelines to abate potential hazards caused by contents or architectural elementsthat can fall during an earthquake, along with guidelines for electrical safety and fire hazards. Once
guidelines are available, the Ministry of Health should train appropriate personnel and implement
required measures.
Outcome 3.3 - Explore and institute risk insurance for health facilitiesa.

Explore and institute risk insurance for health facilities

Insuring health facilities and buildings (on a prioritized/selective basis) can ensure funding for recovery
and re-construction activities, if required. Insurance can also be a way of ensuring and encouraging
buildings to be constructed per design.
16National Action Plan for Earthquake Safety of Health Facilities

Table 9 - Priority III - Outcomes, Activities and Sub-activities
Outcome3.1 Structural
measures
implemented

Activitya. Prepare standards forearthquake-resilient designs
for health facilities
b. Review existing guidelines forhealth facility construction

c. Institute construction quality
control and inspection
mechanisms
d. Conduct vulnerability andsafety assessments of existing
health facilities and buildings

3.2 Criticalutility systems
andequipment
protected andfalling hazards
abated

3.3 Risk
insurance inplace forhealthfacilities

e. Implement recommended
measuresa. Carry out fixing, bracing andother non-structural
abatement measures in all
health facilities

Sub-Activity
1. Review existing designs and gaps
2. Include non-structural elements (fixtures, ceilings,
partitions, equipment, etc.)
3. Formulate enhanced standards and designs and disseminate
1. Review existing guidelines
2. Include seismic considerations, site assessment and otherrisk reduction concerns (glacial lake outburst flood riskzones, landslide and flood prone areas, recurrent
windstorms, etc.)
3. Update guidelines and disseminate
1. Review existing inspection mechanisms
2. Formulate and mandate quality control of construction(including construction materials) and inspection
mechanisms
1. Formulate vulnerability assessment checklists and guidelines
2. Train engineers and assessors
3. Consolidate assessment report and present to decision
makers
1. Prioritize recommendations and plan implementation
2. Implement measures in phased mannera. Prepare guidelines for the protection of critical utility
systems and guidelines for abating potential falling hazards
b. Train maintenance staff and engineers in implementing the
mitigation measuresc. Implement the measures in all health facilities

a. Explore and instituteinsurance against damage tohealth facilities and buildings

1. Explore risk insurance options
2. Put mechanisms in place

17

National Action Plan for Earthquake Safety of Health Facilities

Priority Area IV - Preparedness, Response and Early Recovery
The objectives of this priority area are to strengthen preparedness planning and to enhance response
and immediate recovery capacities.
Table 10 - Priority Area IV
Priority
Area IV

Outcomes

Baseline

Preparedness,
Response and
Early
Recovery

4.1
Preparedness
planning
strengthened- Health Sector
DisasterManagement
andContingencyPlanformulated in
2011- National
Influenza
Pandemic
Preparedness
Plan, 2010

4.2 Response
and
immediate
recoverycapacities
strengthened18- Health Help
Centreestablished in
2011

Recommended
Interventions

Timeline- Review and adopt Health
Sector Disaster
Management andContingency Plan

Short

- Formulate and adopt
guidelines for emergency
management plan for
health facilities

Short- Issue ministerial directives
for formulation of
emergency plans in all
health facilities

Short toMedium- Carry out table top
exercises to test plan, train
participants and sensitize
participants on plan andtheir responsibilities

Short toMedium- Conduct preparedness andevacuation drills in all
health facilities

Short toMedium- Establish clear chain ofcommand andcommunication flow

Short

- Maintain stockpile of- 69 Emergency
materials required for
medical teams
emergency response andacross theimmediate recovery periodcountry- Establish/institute pre-101
arrangements forambulances
emergency requirements,
available
including arrangements formutual aid andcoordination between
health facilities

Performance
Indicators

Responsible
Agencies- Functional healthsector contingency planin place

Lead: Department ofMedical Services,
Ministry of Health- Functional disastermanagement/
contingency plan for all
health facilities in place- All health facilities,
Dzongkhags, healthsector agencies awareof contingency plan
procedures andarrangements

Lead: Department ofMedical Services,
Ministry of Health- Stockpile of emergency
materials and prearrangements in place
and pre-positioned for
effective response andrecovery

1. Management of
Hospitals and
Health Facilities
2. Department ofDisasterManagement
3. Health Help
Centre, Ministry of
Health- Health facilities
equipped with basic
equipment andmaterials- Standardize
equipment/materials
requirements in healthfacilities and at local andnational levels

Short toMedium- Strengthen emergency
medical response
capacities

Medium

1. Management of
Hospitals/ HealthFacilities
2. Department ofDisasterManagement,
Ministry of Homeand Cultural
Affairs- Effective
communication andcommand system inplace for emergencies

MediumShort toMedium

Supporting Agencies:- Health Help Centre
equipped withmanpower andcapacities to deliver
effective emergency
medical response

Supporting Agencies:National Action Plan for Earthquake Safety of Health Facilities

Outcome 4.1 - Preparedness planning strengtheneda.

Review and adopt health sector disaster management and contingency plan

Since 2011, the Ministry of Health has formulated a health sector disaster management andcontingency plan that details emergency arrangements, communication protocols, etc. At this time,
the Ministry of Health should review, update and formally adopt the plan and disseminate it at alllevels, in order to familiarize all health personnel with the plan's procedures and provisions. Reviewing
the contingency plan could also help to guide health facilities in drafting their own contingency plans.
b.

Formulate and adopt emergency management plans in health facilities

All health facilities need their own contingency plans to be able to respond effectively during
emergencies. The Ministry of Health should formulate guidelines to assist health facilities in coming up
with and adopting their own contingency plans. Ministerial directives mandating that all healthfacilities formulate their own contingency plans would encourage facilities to create and adopt suchplans.
c.

Conduct tabletop exercises to test plan and train and sensitize participants on plan and their
responsibilities

A number of tabletop exercises should be conducted at various levels, in order to test both the healthsector contingency plan and contingency plans made at the health facility level. Tabletop andsimulation exercises can also serve as an effective tool to sensitize health personnel and to make themaware of their roles and responsibilities during emergencies.
d.

Conduct preparedness and evacuation drills in all health facilities

Once the contingency plan is formulated and has been tested through various tabletop exercises,
regular mock drill/ evacuation drills should be conducted to ensure preparedness and to review andupdate contingency arrangements and procedures.
Outcome 4.2 - Response and immediate recovery capacities strengtheneda.

Establish clear chain of command and communication flow

Formulating and instituting a clear chain of command and information flow during emergencies will
facilitate effective response. All levels within the health sector should establish a clear communication
flow.
b.

Maintain stockpile of materials required for emergency response and immediate recovery

Effective emergency preparedness and response require maintaining a stockpile of emergency
materials at various levels. As emergency medical services are a vital component of first response, theMinistry of Health should ensure that adequate capacities (trained personnel, equipment, and other19National Action Plan for Earthquake Safety of Health Facilities

resources) exist at all levels and that arrangements are put into place to support rapid provision of
emergency medical services. Facilities at Dzongkhag or regional levels should also maintain emergency
recovery materials (CGI sheets, tarpaulin, education materials etc.), to help ensure the swift recovery
and functionality of health facilities.
c.

Establish/Institute pre-arrangements for emergency requirements, including arrangements
for mutual aid and coordination between health facilities

Effective emergency management means having emergency plans and contingency arrangements inplace and practiced, well in advance. Health facilities should put in place on a prioritized basis all prearrangements and procedures that the health sector disaster management and contingency plan andemergency plans formulated by individual health facilities (related to manpower, communication,transportation etc. for response and recovery) require. All referral and district hospitals should
establish a network and should develop and maintain protocols for mutual aid and coordination in
emergencies.
d.

Standardize equipment/materials requirements at all levels

The Ministry of Health should standardize emergency and disaster management equipment andmaterials requirements at various levels-basic health units, Dzongkhag hospitals, regional referral
hospitals/region and at national level-and procure them on a prioritized basis.
e.

Strengthen Emergency Medical Response Capacities

All health facilities should review existing medical response systems and capacities and should develop
a plan to adopt and strengthen these systems and capacities, as needed. Facilities should establish
emergency medical response and disaster management units and should train staff in mass casualty
management, trauma and psychosocial care, triage and other related skills. In the case of the HealthHelp Centre, more paramedics and emergency medical teams should be added. The Centre should
provide continuous skills/refresher trainings to the teams, strengthen its emergency communication
facilities, and develop its infrastructure in a phased manner.

20

National Action Plan for Earthquake Safety of Health Facilities

Table 11 - Priority IV- Outcomes, Activities and Sub-activities
Outcome
4.1 Preparedness
planning
strengthened

4.2 Response andimmediate
recovery capacities
strengthened

Activitya. Review and adopt Health
Sector Disaster
Management andContingency Plana. Formulate and adopt
emergency plans inhealth facilities

Sub-Activity
1. Review and discuss plan at various levels and withvarious stakeholders

b. Conduct table top
exercises to test andsensitize on contingency
arrangements

1. Develop/design scenarios
2. Conduct table top exercises at various levels and draw
up standard procedures
3. Formulate the contingency plan
1. Disseminate emergency plan and guidelines
2. Sensitize at all levelsc. Conduct preparedness
andevacuation drills inall health facilities
a. Establish clear chain ofcommand andcommunication flow
b. Maintain stockpile ofmaterials requiredc. Establish and institutepre-arrangements for
emergency requirements

2. Update plan and formally disseminate
1. Formulate emergency planning guidelines anddisseminate to all health facilities
2. Each health facility develops its own plan

1. Identify need and gaps
2. Formulate standard communication procedures atvarious levels
1. Identify and standardize materials required to be
stockpiled for response and immediate recovery
2. Stockpile materials on prioritized basis
1. Identify gaps and requirements
2. Discuss and formulate pre-arrangements to be put inplace
3. Establish pre-arrangements as requiredd. Standardize equipment
and material
requirements at various
levels

1. Assess equipment andmaterials needs at various levelsof hospital administration
2. Standardize equipment and material requirements

e. Strengthen emergency
medical response
capacities

1. Review requirements, establish system and proceduresand provide relevant training in health facilities
2. Increase manpower, strengthen emergency
communication system, provide training andinfrastructure requirements, etc. for the Health Help
Centre3. Procure on prioritized basis

21National Action Plan for Earthquake Safety of Health Facilities

Priority V - Capacity Building
The health sector must develop human and material capacities at various levels, in order to reduce risk
and increase preparedness. Carrying out a capacity needs assessment and implementing capacity
building programs to build technical, managerial and emergency skills on a prioritized basis, will help
the sector to implement risk reduction and action plan priorities effectively.
Table 12 - Priority Area V
Priority
Area V
Capacitybuilding

Outcomes
5.1 Capacity
building forrisk reduction

Baseline- Past andongoingtrainings- Vulnerability
assessment
forms training,2012

5.2 Capacity
building for
preparedness
and response- Table top andsimulation
exercises
conducted totest the Health
Sector Disaster
Management
andContingency
Plan- National
Influenza
Pandemic
Preparedness
Plan simulationand table top
exercises- Emergency
management
trainings
undergone by
Ministry of
Healthpersonnel

22

Recommended
Interventions

Timeline- Build capacity of engineers
and maintenance staff toassess vulnerability andsafety of healthfacilities/buildings and tocommunicate risk

Short toMedium- Build the capacity ofengineers and architects
inretrofitting and seismic
risk reduction techniques
for buildings

Mediumto Long- Carry out comprehensive
training on how to abate
falling hazards

Short- Raise awareness andcapacity of policy andplanning personnel andother relevant healthpersonnel on
mainstreaming risk
reduction concerns

Short toMedium- Evaluate and strengthen
emergency communication
systems in place

Short toMedium- Strengthen emergency
transportation
arrangements

Medium- Provide training to targeted Short togroups:paramedics, Health Medium
Help Centre staff, disastermanagement units, healthfacility administrators,
doctors, nurses, focal
persons- Provide standard
equipment/materials forresponse and immediate
recoveryMediumPerformance
Indicators

Responsible
Agencies- Engineers and technicalpersonnel are trained in
the use of vulnerability
assessment tools andprocedures andequipped with capacity
to retrofit/strengthen
existing heathfacilities/buildings

Lead:Healthinfrastructuredevelopment
division, Ministry of
Health- Health personnel are
equipped withknowledge on
emergency
management

Lead: Department ofMedical Services,
Ministry of HealthSupporting Agencies:

1. Department ofMedical Services,
Ministry of Health- Technical personnel are 2. Hospital/healthfacility
able to communicate
management
risk effectively
3. District/ Thromde- Health personnel,
engineers
especially maintenance 4. Ministry of Works
staff,are trained inand Human
carrying out nonSettlement
structural risk reduction 5. Department of
measures
DisasterManagement- Medical teams, focal
persons have enhanced
capacity to carry out
their responsibilities

Supporting Agencies:
1. Hospital/ healthfacility
management
2. Health Help
Centre3. Doctors, nurses
other health staff
4. Department ofDisasterManagement,
Ministry of Homeand Cultural
AffairsNational Action Plan for Earthquake Safety of Health Facilities

Outcome 5.1 - Capacity building for risk reductiona.

Build capacity of engineers and maintenance staff to assess building for vulnerability andsafety of health facilities/buildings

Bhutan has more than 700 health facilities (including basic health units and outreach clinics),many ofwhich were constructed before building codes required earthquake-resistant features. It is therefore
very important to determine the potential earthquake vulnerability of existing health facilities andbuildings. To carry out vulnerability and safety assessment of health facilities and buildings, theMinistry of Health needs to formulate tools to carry out the assessments and train engineers to use
them.
b.

Build the capacity of engineers and architects for retrofitting and carrying out mitigation
measuresEngineers should receive training in mitigation and retrofit techniques so that, after conducting
vulnerability and safety assessments, they are able to provide recommendations on how to strengthenor replace health facility buildings.
c.

Carry out comprehensive training on protecting backup utility systems and abating potential
falling hazards

Maintenance staff and other relevant personnel should receive training as soon as possible on how to
fix and brace potential falling hazards, and on how to address other non-structural hazards such as poor
electric wiring etc. that could lead to fires. Maintenance staff and engineers should be trained on how
to protect and strengthen critical backup utility systems, to ensure that they are not damaged during
earthquakes or other hazardous events.
d.

Raise awareness and capacity on mainstreaming risk reduction concerns

Both the National Disaster Risk Management Framework 2006 and the National Disaster Management
Bill require Ministries and Agencies to mainstream disaster management risks and concerns into theirplans and programs. The 11th Five Year Planning Guidelines identify "mainstreaming disaster
resilience" as one of 16 National Key Result Areas and "disaster risk reduction" as a cross-cutting
theme. Raising awareness and building the capacity of policy and planning and other relevant
personnel of the Ministry of Health will help to enable them to mainstream disaster management
concerns into their plans and programs.
Outcome 5.2 - Capacity building for preparedness and responsea.

Evaluate and strengthen emergency communication systems in place

Bhutan has a networked medical services system that relies on telephone and mobile communication.
The Health Help Centre's entire emergency medical response system is based on mobile23

National Action Plan for Earthquake Safety of Health Facilities

communication. This system is not robust enough to function during a widespread earthquake
emergency. The Ministry of Health should evaluate its existing communication systems both within andbetween health facilities and upgrade them as needed for effective and reliable communication during
emergencies.
b.

Strengthen emergency transportation arrangements

Bhutan depends heavily on its fragile road networks for all transportation. In the past, minor
earthquakes or even heavy monsoon rains have produced landslides that blocked roads for days. Major
earthquake events could affect the whole of Bhutan and render the road network impassable. For thisreason, it is crucial to consider alternative arrangements for transporting critically ill patients from one
health facility to another (to district and referral hospitals) within Bhutan, as well as arrangements fortransporting people outside Bhutan to receive specialized medical care.
c.

Provide training to targeted groups in the health sector

The Ministry of Health should assess the capacity needs for the various health personnel at different
levels. These include paramedics, Health Help Centre staff, disaster management units, health facility
administrators, doctors, nurses, focal persons, etc. Based on the assessment, a capacity building
programme should be developed and implemented. Training topics should include conduct of
preparedness and evacuation drills, mass casualty management, search and rescue, first aid,
emergency logistics, psychosocial and trauma care, fire safety and other emergency management
skills.
d.

Provide standard equipment/materials for response and immediate recovery

All health facilities should have the standard equipment and materials that the staff will need torespond to an earthquake or other emergency, and to continue providing medical care in its immediate
aftermath. A set of standard, essential equipment and materials for each facility would include items
for mass casualty management, fire suppression, basic search and rescue, and emergency
communications, as well as emergency food and water and extra medical supplies needed to treat thetypes of injuries earthquakes and other hazard events will cause. Similarly, emergency medical
response teams and ambulances should be equipped with standard emergency medical response
equipment and communication facilities.

24National Action Plan for Earthquake Safety of Health Facilities

Table 13 - Priority V - Outcomes, Activities and Sub-activities
Outcome
5.1 Capacity
building for risk
reduction

5.2 Capacity
building for
preparedness
and response

Activitya. Build capacity ofengineers andmaintenance staff toassess buildings forvulnerability and safety
b. Build the capacity ofengineers and architects
in retrofitting and carryingout mitigation measuresc. Conduct comprehensive
training on fixing andabating of falling hazards
d. Raise awareness andcapacity of policy andplanning and otherrelevant personnel
regarding mainstreaming
disaster risk reduction
a. Evaluate and strengthen
emergency
communication systems inplace

Sub-Activity
1. Formulate tools and train engineers and assessors
2. Plan and provide resources for actual assessment
3. Conduct related skill enhancement and mentoring andtraining programs and activities

b. Strengthen emergency
transportation
arrangements

1. Review needs and explore alternative transportation
requirements
2. Put alternative transportation systems and arrangements
into placec. Provide training totargeted groups in thehealth sector

1. Assess capacity and training needs at various levels
2. Prioritize capacity requirements—emergency drills, masscasualty management, search and rescue, first aid,
emergency logistics, psychosocial and trauma care, fire
safety and other capacity requirements
3. Formulate plan and strategy for capacity building
4. Implement prioritized plan
1. Review needs for standard equipment and materials forresponse and immediate recovery at various levels
2. Develop lists of essential standard equipment and materials
facilities at each level should have on-site
3. Procure and disseminate standard equipment andmaterials

d. Provide standard
equipment and materials
required for response
andimmediaterecovery

1. Assess capacity needs and gaps
2. Conduct training and mentoring programs
3. Conduct pilot projects for skill development
1. Develop guidelines, manuals and provide training
2. Fix falling hazards in pilot health facilities as ademonstration and skill development project
1. Carry out awareness and sensitization activities
2. Integrate disaster risk reduction policies and practices into
Ministry of Health’s plans and programs

1. Evaluate existing emergency communication systems andfacilities
2. Upgrade and enhance emergency communication systems
and facilities
3. Formulate emergency communication procedures andsensitize health personnel

25National Action Plan for Earthquake Safety of Health Facilities

IV.

Implementation, Review and Monitoring Arrangements

Mainstreaming disaster risk reduction is an important theme in the 11th Five Year Plan. As is true forother cross-cutting themes, the Gross National Happiness Commission and the Ministries andAgencies would be required to monitor their progress and achievements in mainstreaming theseconcerns.
Through the National Action Planning Process, the working groups have succeeded in incorporating
their immediate priorities into the upcoming 11th Five Year Plan. However the plan takes a long-termview (over more than 10 years) and identifies priorities and activities that would extend beyond the11th Five Year Plan. In addition, as needs and priorities change over time, the plan requires continual
review and monitoring.
The Department of Medical Services should ensure, as the key agency, that the national action plan isreviewed in conjunction with the annual and five yearly plan reviews. A Review Committee, which
would be co-chaired by the Department of Medical Services and the Department of Disaster
Management and would involve the working group members, would carry out annual reviews of theaction plan. The annual review meeting would evaluate the progress made in implementing the action
plan, gaps, support and resource requirements and also plan for current priorities to be included in
upcoming annual and five yearly plans.
V.
Annexure
Annexure I - Health Earthquake Safety Working Group Members
Annexure II - Terms of Reference for the Working GroupAnnexure III - Guidance Note on Development of Action Plan
Annexure IV - Health Facilities Earthquake Safety Action Plan Matrix

26

National Action Plan for Earthquake Safety of Health Facilities

Annexure I
Hospital Earthquake Safety Working Group Members
Name

Designation

Organisation

1

Dr. Drupthop Sonam

Medical Superintendent

Jigme Dorji Wangchuck National Referral Hospital

2

Wangdi Gyeltshen

Project Director

Health Infrastructure Development Division

3

Pelden Zangmo

Chief Program Officer

Department of Disaster Management

4

Lhachey Dema

Program Officer

Department of Disaster Management

5

Yangchen Wangmo

Civil Engineer

Health Infrastructure Development Division

6

Sonam Letho

Architect

Health Infrastructure Development Division7

Pema Tshewang

Administrative Officer

Bumthang District Hospital

8

Pema Dorji

Administrative Officer

Gelephu Regional Referral Hospital

9

Tashi Duba (Coordinator)

Program Officer

Ministry of Health

10 Phuntsho Norbu

Administrative Officer

Mongar Regional Referral Hospital

11 Tek Nath Kararai

Engineer

Thimphu Thromdey

12 Kinley Dorji

National Program Officer

World Health Organization, Bhutan

13 Anne Erica Larsen

Program Analyst

United Nations Development Program, Bhutan

14 Karma Doma Tshering

National Coordinator

GeoHazards International, Bhutan

15 Sonam Tenzin

Project Officer

GeoHazards International, Bhutan

27

National Action Plan for Earthquake Safety of Health Facilities

Annexure II
Terms of Reference for School and Hospital Earthquake Safety Working Groups
The Department of Disaster Management (DDM) and GeoHazards International (GHI) will becollaborating in the area of disaster risk reduction and preparedness capacity in the country. Towards
this end, the development of National Action Plans for School and Hospital Earthquake Safety in Bhutan
is an important activity. The goal of the action planning process is to support the key Ministries - theMinistry of Health and the Ministry of Education to develop a comprehensive consensus plan on how to
do away with the current situation of seismically unsafe schools and hospitals, to acceptable levels ofseismic safety and preparedness.
Hospital and School Earthquake Safety Working Groups have been formed respectively, withrepresentation from relevant Agencies and Departments, to come out with the draft National Action
Plans for school and earthquake safety. This document describes the roles and activities of the Working
Group and outlines the support and assistance to be provided by the DDM and the GHI in facilitating theplanning process.
A.

Working Group Members

Representative from key Ministries, Departments, the DDM and relevant UN and other Donor Agencies
have been identified as members of the two Working Groups. The same Working Group members are
expected to participate through out the action planning process for continuity and coordinatedoutcome of the process. In the absence of a designated Working Group member, a replacement fromthe same Agency/Department should represent with prior information to the DDM focal person.
B.

Working Group Activities

The Working Group will conduct the following activities:•
Hold in-person meetings as per agreed schedule to carry out the action plan development
process;•
Participate in a National Consultation Workshop to help advance the plan development process;•
Review and provide advice on the draft Action Plan Document, as needed;•
Provide information and data needed for the description of current conditions and gap analysis;•
Produce the draft National Action Plan as a consensus document, with support from DDM and
GHI.
C.

Expected Outcomes

Expected Outcomes of the Working Group meetings are:•
The development of a draft National Action Plan for Hospital Earthquake Safety and School
Earthquake Safety;28

National Action Plan for Earthquake Safety of Health Facilities

•
•

D.

Increased awareness, understanding and urgency among members and stakeholders on the needfor seismic safety and to reduce risks and enhance preparedness levels;
The use of the Action Plan as a mainstreaming and prioritization tool for the Ministry of Healthand the Ministry of Education in the 11th FYP.
Responsibilities of the Department of Disaster Management

As the National Coordinating Agency for disaster management, the DDM will be responsible for:•
Assigning a National focal person•
Providing the space for meetings•
Identifying and facilitating the participation of relevant stakeholders•
Facilitating technical experts/consultants, as required, during the process•
Ensuring awareness and advocacy on the formulation and implementation of the Plan•
Supporting the Ministry of Education and the Ministry of Health in taking ownership and inmainstreaming the Plan during the 11th FYP and consecutive FYP periods, as required.
E.

Responsibilities of GeoHazards International

Support from GeoHazards International will consist of the following:•
GHI's Local Project Officer will organize and facilitate meetings of the Working Group, assist theWorking Group members in obtaining background information and data and document for theWorking Group meetings and decisions made;•Develop drafts of the Plan document and compile and edit the draft Plan as per the comments
and advice of the Working Group members.
•
GHI will provide Mr. Thomas Tobin, who has many years of experience in mitigation planning, as aresource for the Working Groups. Mr. Tobin will co-chair the National Consultative Workshop for
the Working Groups and other stakeholders.

29National Action Plan for Earthquake Safety of Health Facilities

Annexure III
Developing a National Action Plan (School Earthquake Safety and Hospital Earthquake Safety) - A
Guidance for the Bhutan Working Groups
A.

Background

In any earthquake disaster event, hospitals and schools have proven most vulnerable, be it in terms ofloss of lives or damage to infrastructure. Bhutan lies in one of the most seismically active regions andeven in the most recent earthquake events in Bhutan (21st September, 2009 Earthquake that impacted
Eastern Bhutan and 18th September, 2010 that affected mostly Western Bhutan), both health andeducation sectors suffered heavy losses. More than 250 numbers of school infrastructure and over 100
hospital infrastructures were recorded as damaged in the two earthquake events. These figures alone
call for schools and hospitals to enhance their seismic safety and preparedness.
In any community hospitals and schools are critical public service nodes and have a key role to playduring all phases of disaster management. Above all, hospital and school management have theresponsibility of ensuring a safe environment for children and the public.
Therefore, developing and implementing National Action Plans for Earthquake Safety for Schools andHospitals is an initiative that needs to be urgently realized. This initiative also fits very well into theoverall National Disaster Risk Management Framework, which calls for proactive risk reduction andmainstreaming of disaster concerns into national programs and policies and upcoming National
Disaster Management Act, which requires each notified department/agency to preparecontingency/action plans for disaster management. The formulation of such actions plans could also
be used as a disaster mainstreaming tool and help the concerned sectors in prioritizing andincorporating important risk reduction and preparedness initiatives/actions into their own five year
and annual plans.
B.

What is an Action Plan?

An Action Plan is a written document that describes the tasks or actions to be performed to achieve astrategy or certain objectives/goals successfully. The purpose is to organize and develop solutions toaddress specific issues and challenge.
An action plan usually outlines - strategy/objectives (what is the strategy and what needs to beachieved), issues (challenges, problems, needs), specific tasks (what will be done and by whom), a timeline (when will it be done), resources (available and required), likely constraints (existing or expected)
and outcomes (expected changes that need to happen to move closer to the goal).
C.

Likely Components of an Action Plan for School and Hospital Earthquake Safety

An action plan can be presented in many different ways - it can be a 50-page report, a five page list of key
plan elements, or a simple one-page table. The working group should determine how best to present
30National Action Plan for Earthquake Safety of Health Facilities

the plan and the level of detail the plan should try to achieve. Too much detail may obscure the major
elements of the plan.
Some of the main elements of an Action Plan would be:1.

Background - A brief description of current conditions physically (hazards, risks, vulnerabilities)
and policy-wise (the NDRMF, Bill, relevant policies/guidelines). The plan document might also
include a summary of the planning process and the work that was put in to come up with the Plan.

2.

Goals - What are the objectives of the Action plan? - What does the Action Plan seek to achieve
over a period of time? Goals and Objectives can be divided into short term, long term andintermediate or medium term goals. Clear and measurable Objectives would lead to identifying
proper needs and interventions.

3.

Identified Gaps - What are the issues to be tackled? A description of the shortcomings, gaps andneeds which should be filled before the fundamental objectives can be met.

4.

Strategic Areas of Intervention - What are the strategies that need to be adopted to overcome
the identified gaps and meet the set goals and objectives? Areas of intervention may be identified
in terms of - Awareness Raising, Mitigation/Risk Reduction, Response/Preparedness,
Mainstreaming etc.

5.

Specific Activities - The Plan then needs to specify priorities and actions under each identified
strategy to fill the gaps and reach the objectives.

6.

Expected Outcomes - What are the expected results/changes due to implementation of thestrategy/ activities? - In quantitative as well as qualitative terms.

7.

Time Frame - Timeline for actions should be realistic and could be aligned with the annual andfive year planning process.

8.

Lead Agencies - A listing of the organizations (and possibly individuals / positions) and agencies
that would take the lead or be responsible for each action.

9.

Resources - A summary of required and available resources, both fiscal (funding to implement
elements of the action plan, cost estimates, sources of funding) and technical (technicaldocuments, standards, training materials, manuals, etc.).

10. Mechanisms/Additional Notes - Implementation/ Coordination/ Reporting mechanisms andarrangements for carrying out activities and other requirements to be noted could also be
included in the Plan.
An Action Plan Matrix to summarize all the key elements and for easy reference would be an importantannexure to the Plan document.

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National Action Plan for Earthquake Safety of Health Facilities

D.

Action Plan Development Process

For the development of an Action Plan, the working groups would adopt the following steps/process:1.
Set the Goals (Clarify objectives, scope, priority areas, etc.);
2.
Based on the objectives, analyze needs and gaps;
3.
Discuss steps or actions to be taken;
4.
Identify - responsibilities and resources (both available and required), opportunities forcooperative implementation, barriers to implementation;
5.
Discuss and estimate duration/ time required to carry out actions;6.
Establish priorities and a sequence or schedule for implementation.
Working group members shall meet once a month to review the plan drafting process until its
finalization and adoption. An Action Plan is a work in progress. With time, as organizations grow andnew developments take place, the Plan should be reviewed on a timely basis to reflect current realities
and changing needs and priorities.

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National Action Plan for Earthquake Safety of Health Facilities

Annexure IV
National Action Plan for Earthquake Safety of Health Facilities
Priority
Area

Outcomes

Baseline

Interventions

Timeline* Performance
Short
Indicators

Responsible
Agencies(1-5 yrs.)
Medium (510 yrs.)
Long (Morethan 10yrs.)
1.
Strengthening
earthquake
safety anddisastermanagement
institutional
and policy
framework in
the Health
Sector

1.1 Policies,
guidelines,
Ministerial
Directives
supporting
disastermanagement
in hospitals/
basic health
units in place

1.2 Disaster
Management
institutions
within thehealth sector
strengthened- National
Health Policy
2011- Review and endorse healthsector disaster management
and contingency plan

Short

-Health Sector
Contingency
Plandeveloped in2011- Formulate standard
guidelines for emergency
planning in all healthfacilities

Short,
Medium- Formulate guidelines to
identify and abate threats tofunctionality and hazards
caused by damage tobuilding contents, backup
utilities and equipment

Medium- Adopt higher safety
standards for the design andconstruction of healthfacilities

Medium- Issue ministerial directives
for implementation ofearthquake safety anddisaster management plans,
policies guidelines,
including incorporation into
curricula of RIHS andmedical university

Medium,Long- Disastermanagement
focal person
identified intheDepartmentof Medical
Services- Health help
Centreestablished in2010- Appoint/ identify emergency Shortmanagement focal persons
and establish emergency
management unitsin all
health facilities- Strengthen emergency
management services
division in the Ministry of
Health- Strengthen Health Help
Center and emergency
health response services

Short &
MediumMedium- All health facilities
with functional
disaster management
andcontingency/evacuati
on plans

Lead: Department ofMedical Services,
MoH- All health facilities
with disastermanagement focal
persons andfunctional disastermanagement units

Lead: Department ofMedical Services,
MoH

Supporting Agencies:- Policy andPlanning Division,
MoH- Guidelines to identify
and abate hazards fro - Royal Institute of
Health Sciencesbuilding contents,/Medicalequipments andUniversity
furnishings adopted
management
and implemented in- Department of
all health facilities
DisasterManagement ,MoHCA- Health Help Centre
fully functional andequipped to fulfill its
mandates

Supporting Agencies:- Human Resources
Division , MoH- Hospital/ HealthFacility Mgtm.
- Department ofDisasterManagement,
MoHCA

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National Action Plan for Earthquake Safety of Health Facilities

2. Education
andAwareness

2.1 Enhanced
knowledge andinformation
sharingmanagement- Establish knowledge sharing
networkMedium- Share information with
communities

Ongoing- Mechanism for
information sharing
developed- No. of knowledge
sharing activities- No. of community
campaigns etc.

2.2
Awareness andEducation- International
Day forDisaster
Reductionobservedsince 2008
- Existing IEC
materials
related todisastermanagement
and healthemergency
services- Conduct awarenessactivities and programs

Ongoing- Observe International Day
for Disaster Reduction (orcommemoration of pastearthquake events) andconduct preparedness drills
in all health facilities as a
National event

Ongoing- Develop information andeducation materials

Ongoing- No. of awarenessactivities carried out- Incorporate safety
information on earthquakes
and other hazardsand
emergency management
materialsinto Royal Instituteof Health Sciences andMedical University
curriculum

Medium,Long- Information andeducation materials
formulated anddisseminated in all
Health facilities- Raise awareness on family
preparedness

Short- Increased awarenesson disastermanagement among
health staff

Lead: Department ofMedical Services,
MoH- Developmentof acomprehensive
awareness strategy
for health sector- Health Institutes/
Universities- Management of
Hospitals/ HealthFacilities- Department ofDisasterManagement- Disaster risk
reduction andemergency
management
materials
incorporated in royal
Institute of Health
Sciences/ Medical
University curriculum- All health staff withfamily disastermanagement plans

34

Lead: Department ofMedical Services,
MoH
Supporting Agencies:- Health Institutes/
Universities- Management of
Hospitals/ HealthFacilities- Department ofDisasterManagement

Supporting Agencies:National Action Plan for Earthquake Safety of Health Facilities

3.
Risk
Reduction
andMitigation

3.1 Structural
measures

New Constructions:- Prepare standard
earthquake-resilient designs
for health facilities

Short
Medium- Review existing guidelines
for health facility
construction

Short
Medium- Institute construction
quality control andinspection mechanism

Short
Medium- All new healthfacilities constructed
as per earthquake
resilient design- Health facilities
constructed as per
guidelines outside ofhazard zones

Lead:Health
Infrastructure
Development
Division, MoH
Supporting Agencies:-- Quality andstandards of all new
constructions
ensured-Existing Buildings:

3.2 Falling
hazards areabated andinsurancecoverage inplace- Conduct vulnerability /safety assessment ofexisting health facilities/buildings

Medium- Cary out recommended
strengthening, replacement
and relocation measures

Long- Carry out fixing, bracing andother non-structural
measures in all healthfacilities

MediumShort ,- Explore and institute risk
Mediuminsurance for health facilities- All health facilities
assessed andstrengthened
accordingly- Insurance scheme forhealthfacilities/buildings
developed- Falling hazards inhealth facilities
identified and abatedLead:Health
Infrastructure
Development
Division, MoH
Supporting Agencies:
-

-

-

-

4.
Preparedness
and Response

4.1
Preparedness
planning
strengthened-Health Sector
DisasterManagement
andcontingencyPlanformulated in2011- Number ofsimulation/
table top
exercises
conducted atvarious levels- Review and adopt healthsector disaster management
and contingency plan

Short

- Formulate and adopt
emergency management
plans in health facilities

Short,
Medium- Conduct evacuation drills inall health facilities

Short- Conduct table top exercises
to test plan and sensitize
participants on plan andtheir responsibilities

Short,
MediumConduct preparedness andevacuation drills in all healthfacilities

Short
Medium

Department ofMedical Services,
MoH
Management of
Hospitals/ HealthFacilities
Department ofDisasterManagement- Functional healthsector contingency
plan in place

Department ofMedical Services,
MoH
Management of
Hospitals/ HealthFacilities
Department ofDisasterManagement
RICB and otherinsurance
agencies

Lead:Department ofMedical Services,
MoH
Supporting Agencies:- Functional
DM/Contingency
plan for all healthfacilities in place- All health facilities,
dzongkhags, healthsector agencies
aware of thecontingency plan

- Management of
Hospitals/ HealthFacilities- Department ofDisasterManagement,
MoHCA

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National Action Plan for Earthquake Safety of Health Facilities

4.2 Response
capacities
strengthened- Establish clear chain ofcommand andcommunication flow

Short

Medium
- Maintain stockpile ofmaterials required for
emergency response andimmediate recovery- Establish/institute prearrangements for
emergency requirements

Short,
MediumShort,
Medium- Standardize equipment/materials requirements at alllevelsMedium- Strengthen emergency
medical response capacities- An effective
communication andcommand system inplace foremergencies- Stockpile ofemergency materials
and prearrangements inplace and prepositioned for
effective response
and recovery- Health facilities
equipped with basic
DM equipment andmaterials- Health Help Centre
equipped withmanpower andcapacities to deliver
effective emergency
medical response

5. Capacity
Building

5.1 Capacity
building for
Risk Reduction- Build capacity of engineers
and maintenance staff toassess buildings forvulnerability and safety

Short,
Medium- Build capacity for engineers
and architects for
retrofitting and carrying out
mitigation measures

Medium,Long- Carry out comprehensive
training on protecting
backup utilities and abating
potential falling hazards

Short- Raise awareness andcapacity on mainstreamingrisk reduction concerns
5.2 Capacity
building for
preparedness
and Response

36- Evaluate and strengthen
emergency communication
systems in place

Short,
Medium- Strengthen emergency
transportation
arrangements

Ongoing- Provide training to targetedgroups in the health sector

Short- Provide standard
equipment/materials forresponse and immediate
recovery

Short,
Medium- Engineers/ technicalpersonnel trained in
the use ofvulnerability
assessment tools andprocedures andequipped withcapacity toretrofit/strengthen
existing healthfacilities/ buildings

Lead:Health
Infrastructure
Development
Division, MoH- Health personnel,
especiallymaintenance staff
trained in carryingout fixing of falling
hazards etc.

-

- Health personnel
equipped withknowledge on
emergency
management

Lead:Department ofMedical Services,
MoH- Health personnel
with enhanced
capacity in carryingout their
responsibilities

Supporting Agencies:--

Department ofMedical Services,
MoH
Management of
Hospitals/ HealthFacilities
Department ofDisasterManagement

Supporting Agencies:- Management of
Hospitals/ HealthFacilities- Department ofDisasterManagement,
MoHCA

Formulated and printed under the National Action Plan Development Project for Schools and Hospitals (2012-2013)