Quantitative approach to hospital resilience based on system dynamics : case of Sri Lanka

Abstract

Past records depict that both the intensity and frequency of climatic-related hazards are increasing devastatingly. Although the number of deaths caused by these extreme events has been comparatively less recently, the economic losses have increased considerably. The complexity of the world with interconnected infrastructure systems has been the main catalyst of these huge losses. COVID-19 and concurrent hazards have set out a perfect example that shows hazards no longer affect discreet parts of the system but render the failure of the whole system. Out of critical infrastructure sectors, damages on health systems have attracted global concern more as the impacts on the health sector can cascade further to socio-economic aspects as well. Therefore, currently, health is considered an important part of disaster risk reduction. Sri Lanka, as a tropical country, experiences climatic-related hazards more frequently. Although Sri Lanka has a disaster management mechanism and public health system, a limited number of evidence exists on integrated systemic risk management mechanisms in the country. Most of the existing emergency and disaster management mechanisms have a hazard-by-hazard approach and fail to incorporate synergized impacts of compound hazard events. The levels of integration of public health and disaster risk management aspects into each other still needs to be enhanced. In a context where systems thinking approaches are more promoted in disaster resilience, this study aims at providing a framework for assessing the public health system disaster resilience for multi-hazard contexts amidst biological hazards. In this regard, this study has followed multiple steps to evaluate the existing health disaster management approaches in the country. Initially, a desk study was conducted to identify key drivers of effective response mechanisms for pandemics, which can affect the capacities of integrated disaster risk management approaches. It was followed by a stakeholder analysis, which used Social Network Analysis (SNA) to identify the stakeholder behaviour in the country for multi-hazard preparedness planning. Furthermore, field data collection was conducted under three phases, including forty-one key informants representing the sectors that are related to disaster management in the country. Qualitative information from this step was analysed using systems thinking and cascading effects were modelled for early warnings, evacuation, shelter management, and hospital functionality. Since functional continuity of healthcare facilities was identified as a key driver of multi-hazard preparedness and response mechanisms, this study presents a model that captures interdependencies within a hospital during a hybrid hazard scenario. As the final outcome, the study presents a framework for enhancing public health systems resilience for multi-hazard contexts. The developed framework was tested for its applicability at the community level in Sri Lanka, through scenario workshops. Along with these outcomes, the study further presents a set of gaps that needs to be immediately addressed based on lessons from recent multi-hazard scenarios amidst the COVID-19 outbreak in Sri Lanka