Evaluation of flood preparedness in public health facilities in Eastern Province, Sri Lanka

Thesis (Master's)--University of Washington, 2016-06

Background Sri Lanka, a lower-middle income country with universal healthcare, is vulnerable to floods and other hydro-meteorological disasters. Climate change is projected to increase the intensity of these events. This study aimed to assess the functional flood preparedness in Trincomalee District, Eastern Province, within a health system framework, to understand how government guidelines on disaster preparedness and management are translated and disseminated within rural health facilities, and to assess climate change awareness among physicians in the study area. Methods This was a cross-sectional, descriptive, mixed methods study conducted in Trincomalee District in Eastern Province. Face-to-face surveys were conducted in 31 of the district’s 34 public healthcare facilities, using a pre-tested, structured questionnaire. Among these 31 facilities, 7 were selected using a simple random sample for an additional in-depth interview, and 3 interviews were also conducted with Medical Offices of Health, which provide public health support during floods. Respondents were Medical Officers in Charge or their equivalent. Descriptive statistics from the survey results were generated using Stata13, and interviews were analyzed in Atlas.ti. Results Two Ministry of Health hospitals, three base hospitals, 11 divisional hospitals, and 15 primary care units (PMCUs) were included in this study. Six respondents (19.4%) reported flooding in their facility in the last five years, and 19 (61.3%) reported flooding in their catchment area in the same time period. For health workforce, 77.4% of respondents reported not enough staff to perform normal service delivery during disasters, and 25.5% reported staff absenteeism due to flooding in the last five years. Several respondents expressed a desire for more disaster-specific and general clinical training opportunities for themselves and their staff. Most respondents (80.7%) reported no delays in supply procurement during weather emergencies, but 61.3% reported they did not have enough supplies to maintain normal service delivery during disasters. Four facilities (12.9%) had disaster preparedness plans, and 4 (12.9%) had any staff trained on disaster preparedness or management within the last year. One quarter (25.8%) of respondents had received any written guidance on disaster preparedness from the regional, provincial, or national level in the last year. Discussion While there is a strong universal health system operating in Sri Lanka, improvements are needed in localized and appropriate disaster-related training, resources for continuing clinical education, and investments in workforce to strengthen flood and other disaster resilience within the public healthcare system in Trincomalee District.