The Caribbean region is disproportionately affected by the occurrence and impact of disasters due to its geography. Its vulnerabilities are exacerbated by the impacts of climate change, which include rising sea levels, coastal erosion and the general escalation in the intensity of tropical storms and hurricanes and varying rainfall patterns. Weather-related disasters impact the capacity of health-care facilities, both functionally and structurally, to provide critical services, including emergency care and ongoing health care for communities. According to the Sendai Framework and the Pan American Health Organization (PAHO) Plan of Action for Disaster Risk Reduction 2016–2021, 141 77% (13 566 out of 17 618) of the hospitals in the region are in areas of risk and require urgent remedial measures to protect personnel and patients’ lives during and after a disaster. Knowledge of the condition of the facilities, level of exposure and their role within the health service network is indispensable (for example, if the facilities are in areas prone to flooding, or along the hurricane path and so forth). Information on this was collected from health facilities’ personnel, Ministries of Health and National Disaster Management Offices. Health-care facilities are also intensive energy users due to the services provided and their hours of operation, thus making significant environmental footprints. With energy prices in the Caribbean among the highest in the world, cost savings could be better used on improving health services.

The Smart Health Care Facilities in the Caribbean project, funded by the UK Foreign, Commonwealth and Development Office (FCDO), was implemented by PAHO and WHO in partnership with seven Ministries of Health in Belize, Dominica, Grenada, Guyana, Jamaica, Saint Lucia and Saint Vincent and the Grenadines. A regional building code annex, guideline and toolkit for retrofitting existing or new facilities was developed. The toolkit provided a step-by-step guide and included the Hospital Safety Index (HSI), the Baseline Assessment Tool (BAT) and the Green Hospitals Checklist, utilizing cost-benefit analysis to support investment decision-making. PAHO has been providing technical assistance to Caribbean countries for the implementation of the Smart Hospitals initiative in two phases (2012–2014 and 2015–2022). During the project planning process, consultations were made with agencies and entities, such as ministries of environment and the Caribbean Community Climate Change Centre based in Belize. Entities were invited to participate in the implementation of the project (for example Town Hall meetings, ad hoc meetings and so forth). In addition to FCDO, the European Union funded five health-care facilities in Belize and four shelters in British Virgin Islands. The International Development Bank funded the La Paix Smart Hospital in Haiti.

The Smart Hospitals initiative focuses on improving hospitals’ resilience, strengthening structural and operational aspects and providing green technologies. Energy improvements include solar panel installation, electric storage batteries and low-consumption electrical systems, which, in addition to reducing energy consumption, reduce the health sector carbon footprint and provide the hospital with energy autonomy, allowing it to continue running during emergencies and disasters. An additional benefit is the fact of not increasing the carbon footprint associated with new construction, because the project improves existing facilities. Health-care facilities are Smart (Gold Standard of A70) when they link their structural and operational safety with green interventions at a reasonable cost-to-benefit ratio. The Hospital Safety Index and the Green Hospitals Checklist as part of the Smart Toolkit are used the calculate the score. Belize suffered significant damage to infrastructure following the passage of Hurricane Lisa in November 2022. The National Emergency Management Organization reported that the initial damage estimate to the housing sector was approximately USD 10 million. Although the health sector was slightly impacted by Hurricane Lisa, the five health facilities retrofitted as “smart” hospitals remained functional during the hurricane and after it made landfall. They were able to serve their catchment population, especially those who were affected by the hurricane. Critical services such as immunization, sexual, maternal and child health care, medical services for chronic conditions, and others were readily accessible to communities. The required infrastructure and critical systems such as electricity through solar power, water supply via rainwater harvesting and the drainage system, among others, provided the backup system to enable the health facilities to remain operational during the COVID-19 pandemic, and also after the volcano eruption in St. Vincent and the Grenadines, when the Chateaubellair Smart Hospital was able to provide water from its tanks to the affected community.

The Smart Hospital initiative is focused on improving hospitals’ resilience, strengthening structural and operational aspects and providing green technologies.