HOSPITAL SAFETY INDEX

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BUDI SAMPURNA
(KAKP)
Potensi Risiko Bencana
• Indonesia, negara dengan lebih dari 17.000 pulau,
menghadapi jumlah bahaya yang luar biasa tinggi.
• Terletak di 'Cincin Api' Pasifik di mana 90% gempa bumi
dunia terjadi, Indonesia mengalami aktivitas seismik tingkat
tinggi. Garis patahan ada di seluruh negeri dan 15% dari
gunung berapi aktif di dunia berada di Indonesia, membuat
gempa bumi, letusan gunung berapi dan tsunami menjadi
bahaya rutin di negara ini.

Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Potensi Risiko Bencana 2
• Indonesia juga memiliki kurang lebih 5000 sungai yang 30%-
nya melewati perkotaan, termasuk ibu kota Jakarta.
• Ditambah dengan curah hujan yang tinggi, saluran yang
tersumbat sampah dan sistem pengelolaan air yang sudah
ketinggalan zaman, banjir merupakan bahaya yang cukup
besar di Indonesia.
• Selain itu, penggundulan hutan, aktivitas seismik, dan
hujan deras berkontribusi pada seringnya tanah longsor

Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Ketahanan Fasyankes pada Bencana
• Gempa bumi tahun 2009 merusak 85 rumah sakit dan fasilitas
kesehatan di Padang, Sumatera Barat (United Nations Office for
Disaster Risk Reduction, 2010).
• Demikian pula, setelah gempa bumi melanda Yogyakarta pada
tahun 2006, 17 rumah sakit, termasuk yang terbaik di
Indonesia, ditutup di Kota Yogyakarta. Dari total 117
Puskesmas di Provinsi Yogyakarta, 45 rusak berat, 22 rusak
sedang dan 16 rusak ringan. Sekitar 65% dari total kerusakan
dan kerugian di sektor kesehatan dialami oleh praktik swasta
dan rumah sakit
Available from:
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 BANGUNAN DAN PERALATAN RUSAK

PELAYANAN TERGANGGU TENDA BANTUAN PELAYANAN

Mengapa fokus ke Keselamatan Fasyankes?
Secara Politis dan Sosial:
• Rumah sakit / Fasyankes yang aman memiliki nilai sosial
simbolis; kehilangan fasilitas kesehatan menimbulkan rasa
tidak aman dan ketidak-stabilan sosial/politik.
• Fasyankes ditempati sepanjang waktu oleh populasi yang
paling rentan.
• Rumah sakit / Fasyankes tahan bencana harus mampu
melindungi nyawa pasien dan staf serta tetap terus berfungsi
ISU KESEHATAN
• BENCANA MENIMBULKAN KEBUTUHAN PELAYANAN
KESEHATAN YANG TINGGI
• Meskipun pada bencana, Fasyankes harus tetap mampu
melanjutkan pelayanan Kesehatan rutin sehari-hari
disamping melayani masyarakat dalam kedaruratan
• Diperlukan jejaring Fasyankes yang terpadu dalam system
Kesehatan masyarakat nasional
• Terhentinya pelayanan Kesehatan dalam waktu lama dapat
berdampak besar dan sukar diperkirakan
Di dunia dikenal Hospital Safety Index,
Apakah itu?
• Hospital Safety Index (HSI) merupakan salah satu instrumen yang
digunakan untuk menilai suatu Rumah Sakit atau fasilitas pelayanan
kesehatan dapat tetap beroperasi, berfungsi dan memberikan
pelayanan dalam kondisi darurat dan/atau bencana.

• Rapid, reliable, low cost diagnostic tool

• Easy to apply by trained team of engineer, architects, and health professionals
• 4 components: location, structural, Non-Structural, Functional
• Values are calculated through scoring module (calculator)
• 145 items or areas are assessed
• 3 categories of safety: high, average, and low
Hospital Safety Index (WHO, 2015)
Terdapat 4 modul penilaian:
 Bahaya yang berdampak pada keamanan Rumah Sakit dan
peran Rumah Sakit dalam pengelolaan kondisi darurat
dan/atau bencana (Hazards and the Role of Hospital)
 Keamanan Struktur Bangunan (Structural safety)
 Keamanan Non-structural (Non Structural safety)
 Pengelolaan kondisi darurat dan atau bencana (emergency
and disaster management)
WHO/PAHO Guidelines: Evaluation of Small & Medium-Sized Health
Facilities, Fourth edition (2015)
Membership and responsibilities of the
evaluation team
• engineers with training in structural engineering;
• architects with training in hospital design;
• specialists in hospital critical systems, biomedical engineering
and equipment, and/or electrical and mechanical maintenance;
• health-care professionals (doctors, nurses etc.);
• specialists in emergency and disaster management, including
planning and/or administration and logistics; and
• others (security specialists, municipal inspectors etc.).
Role of the Evaluators

 Advocating to obtain approval/commitment

from senior management.
 Applying the Safety Index to health
facilities.
 Interpreting the results of the assessment and
advising on priorities.
Role of the Evaluators

Advocacy
 Preliminary meetings with senior managers
to explain the rationale and purpose of the
“Safe Hospitals Initiative” and the
assessment.
 Assurances of confidentiality of the results.
Role of the Evaluators

Applying the Safety Index

 Able to explain the purpose and rationale of the
instrument to facility staff and others.
 Able to work as a member of a team to apply
the assessment instrument.
Role of the Evaluators

Interpretation of the results

 Able to explain the basic methodology of
scoring the instrument.
 Able to analyze the results, identify and justify
priorities based on these.
The good news…
 Well-built or retrofitted hospitals have remained
functioning following disasters.
 The health sector has excellent examples of and
substantial accumulated experience contributing to
safe health facilities.
 The knowledge exists to assess vulnerability and
reduce risk in health facilities.
Safe Hospitals?
Hasil Penelitian Riza Yosia Sunindijo, Fatma
Lestari, Oktomi Wijaya (2019)

• West Java and Yogyakarta

• The average level of Hospital Safety Index for the hospitals under
investigation is B, indicating that their ability to function during and
after emergencies and disasters are potentially at risk, thus
intervention measures are needed in the short term.
• Hospitals in Yogyakarta scored lowly in terms of their emergency and
disaster management, even though they have previously experienced
major disasters in 2006 and 2010.

Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Rekomendasi Penelitian tsb
It is recommended that they (Government)
• (1) identify disaster-prone areas so that their hospital readiness and
resiliency can be assessed;
• (2) assess the readiness and resiliency of hospitals in the prioritised areas;
• (3) implement intervention measures;
• (4) re- assess the readiness and resiliency of hospitals in the prioritised
areas after implementing intervention measures; and
• (5) develop a framework to ensure that the hospitals can maintain their
level of readiness and resiliency over time

Available from:
https://www.emerald.com/insight/content/doi/10.1108/F-12-2018-0149/full/html.
Bagaimana Puskesmas / Fasyankes kecil?
WHO/PAHO Guidelines: Evaluation of Small & Medium-Sized Health
Facilities, Fourth edition (2015)

• geographical (22 items), structural (14 item), nonstructural (47 items),

and functional (33 items) modules, with a total of 166 items

• Module 1: Potential Hazards and Disaster Risks

• Module 2: Structural Aspects
• Module 3: Nonstructural Aspects
• Module 4: Functional Aspects
 Penelitian Fatma Lestari dkk
• score of HSI for PHCs in Jakarta (0.674) and North
Sumatera (0.752) fell into the “A” category, meaning that
these PHCs would likely remain operational in the case of
disasters.
• HSI scores for PHCs in West Java (0.601) and Yogyakarta
(0.602) were between 0.36 and 0.65, or in “B” category,
meaning that these PHCs would be able to recover
during disasters but several services would be exposed to
danger.
Fatma Lestari et al. The Application of Hospital Safety Index for Analyzing Primary Healthcare Center (PHC) Disaster
and Emergency Preparedness . Sustainability 2022, 14, 1488. https://doi.org/10.3390/su14031488
Pembelajaran bagi Kita
• Ketahanan Fasyankes dalam menghadapi Bencana atau
Kedaruratan Kesehatan Masyarakat sangatlah penting,
terutama bagi Indonesia yang Rawan Bencana
• Hospital Safety Index mampu menilai ketahanan RS
dan Puskesmas menghadapi bencana, dan dapat
merekomendasikan PemPus dan Pemda untuk
mengantisipasi dan menyiapkan ketahanan RS dan
Fasyankes lain