As the world battles the ongoing COVID-19 pandemic, it has become very clear that societies depend on functioning healthcare facilities. The sufficient availability of hospital beds, healthcare staff, protective gear or ventilators can make all the difference between a situation that is still manageable and a severe crisis. UNU-EHS Senior Scientist Dr. Simone Sandholz explains five important lessons on health infrastructure.
1. Health infrastructures are considered to be “critical” infrastructures in many countries. Critical infrastructures are understood as facilities and services vital to the basic operations of a society. Although the sectors considered critical vary from country to county, they usually include sectors such as energy, water, food or banking. In order to function properly, societies depend on these infrastructures to work. Health infrastructures are typically included in this list as well. Therefore, many countries have plans how to safely plan, operate and protect their health infrastructures, so that they can sustain natural and man-made risks.
2. Functioning health infrastructures depend on other infrastructures. Hospitals and other healthcare facilities depend critically on power supply, among others. Without power, for example, ventilators on which human lives depend, cannot continue to operate, and digital patient files can no longer be viewed. This is why countries such as Germany, for instance, have legal regulations for emergency power supply in hospitals, so that the most essential areas, such as intensive care units, can continue to function for a certain period of time even during blackouts. But even here there are gaps, for example in homes for the elderly or in respiratory care facilities, for which there are no such regulations. In an aging society, this needs to be reconsidered.
3. A functioning water supply is necessary to maintain hygiene standards, without which a hospital would soon reach the limits of its functional capacity. In the event of a grid-based supply failure, there are theoretically other ways of supplying water, but only to a limited extent. Dialysis patients are just one of many groups that depend on the availability of high-quality water. In past disaster events, such as Hurricane Sandy, water supply failures proved to be a bottleneck. Functioning supplies are even more important during the ongoing pandemic where hygiene measures such as frequent hand washing can save lives. In contrast to power failures, there are almost no provisions for emergencies in the event of water supply failures. However, in an emergency, a hospital without water supply will no longer be fully operational.
4. Health infrastructures depend on many other factors in society, as the ongoing pandemic has made very clear. It is obvious that they cannot function without their staff, even if all other supplies are in place. But when borders are closed and foreign medical and nursing staff cannot enter the country, health infrastructures can quickly become understaffed. Closed borders also affect international supply chains for medical supplies. The pandemic has also shown how dependent health infrastructure is on childcare for staff. When daycare centers and schools close, hospital staff may not be able to work as needed, which in some countries has inspired gender debates on responsibilities for childcare of predominantly female nursing staff. This underscores the need for adequate and forward-looking crisis management, especially for health care infrastructures, as capacity deficits and competition for available resources can quickly arise.
5. Planning guidelines for health infrastructure need to be reconsidered. In the past, hospitals were usually built in central locations in order to be accessible as easily and quickly as possible. In the future, this planning principle will have to be partially reconsidered. As sensitive facilities, hospitals should not be built in locations that are particularly affected by summer heatwaves, for example, which are likely to become more severe in the future. Access routes must be usable for as long as possible, even during flood events or other natural hazards, which can also become more severe due to climate change impacts. Such factors must be incorporated into future urban and regional planning, without compromising the proximity of life-saving health facilities.
The COVID-19 pandemic has shown that health infrastructures are critical in many ways, and that there is a need for plans to protect them and ensure their operations during times of crisis. One project at UNU-EHS that addresses some of these challenges is the NOWATER project. It focuses on developing technical and organizational solutions and strategies for water supply and sanitation in hospitals. To find out more about the NOWATER project, please click here .