Building back better health facilities after the earthquake in Nepal

In April and May 2015, two devastating earthquakes hit Nepal, claiming the lives of more than 9,000 people and leaving more than 21,000 injured. Fourteen districts were severely affected, covering a population of more than 5.6m. Over 900 health facilities were damaged or destroyed, with the majority in the most affected districts. As a result, health facilities have been unable to respond effectively to healthcare needs. Vulnerable populations, including disaster victims, have limited access to health services in remote areas.

Restoring health services after the devastating earthquake has been a challenge for the Government of Nepal. Temporary shelters were set up by relief aid agencies and the government as an immediate response to the crisis. Our programme, NHSSP, has been supporting the government to build longer term strategic infrastructure solutions for sustainable service delivery. We have helped develop standardised guidance for reconstruction and undertaken detailed engineering assessments which will ensure that plans for reconstruction are strategic, evidence based and meet required standards to improve access to health services for people in the 14 most affected districts.

Part of these guidelines has been for standardisation of health facilities constructed using pre-fabricated technology. The guidelines ensure standardisation of pre-fabricated constructions and provide recommendations on technologies, specifications and list of supplies and equipment for different levels of health facility. A sub-committee was set up to evaluate proposals for the reconstruction of health facilities against these guidelines.

To inform the reconstruction planning process NHSSP supported the government to undertake detailed engineering assessments to provide the technical details required to design and cost a reconstruction/rehabilitation plan. Prior to this, NHSSP had supported the Department of Health Services (DoHS), to develop an information system to manage health infrastructure in Nepal. The system is designed to collect, update and present infrastructure information (location, accessibility, land and building details) about every health facility. This system uses Geographical Information System (GIS) and data collected by mobile phones from health sub posts to provide the individual locations of facilities (GPS coordinates) and information on road accessibility.

The Health Infrastructure Information system (HIIS) informed the detailed engineering assessment by providing crucial information for planning the movement of the enumerator teams in the 14 districts. Trained technical experts visited 784 facilities to gather information using standardised damage assessment guidelines and tools. As well as assessing damage to health facility buildings, accessibility, availability of lifelines (water, electricity, sewerage etc), land ownership, and medical equipment status were also considered to inform future health facility reconstruction planning.

A major problem foreseen for construction was the lack of land owned by the facilities. The updated data from the assessment showed that many of the facilities had already acquired land, or at least were in possession of usage rights for public land. This information was used to prioritise building and for assigning the reconstruction of facilities to different organisations: facilities with confirmed land ownership were given highest priority, followed by facilities with usage rights on public land.

This evidence base has been critical in understanding the extent of damage caused by the earthquake and in developing a strategic approach to ‘build back better’. With this information, the Government of Nepal subcommittee has been fully equipped to evaluate proposals to ensure proper selection of facilities and designs that meet the standard guidelines for Post Disaster Recovery and Reconstruction.

Currently, NHSSP is looking at how to support the Ministry of Health in monitoring the progress of agreements made with relief and aid agencies for the reconstruction of health facilities as well as the rehabilitation of services.

The collected data, along with recommendations and associated costs for further actions, are available as a searchable online tool at www.nhsp.org.np.

The map shows the intensity scale of the earthquake of April 25.