"Emergency preparedness is an afterthought for many hospitals," said Jonathan Abrahams, coordinator of the World Health Organization (WHO) Safe Hospitals initiative [http://www.safehospitals.info/], which helps countries reinforce medical centres to withstand disasters.
The Philippines and Indonesia are two of nine countries working with the Bangkok-based Asian Disaster Preparedness Center (ADPC) that have emergency preparedness plans in place for their health sectors. The others are Nepal, India, Bangladesh, Laos, Vietnam, Cambodia and Pakistan.
"Even poor countries can strap their equipment to a wall to decrease the risk of expensive equipment tumbling over and being destroyed in an earthquake," said Frederick John Abo, deputy head of a US-funded programme at ADPC helping to design the programmes.
"Where are the hospital records stored? The water lines and electricity generator? These are questions that can save lives and money," said Abo. "So many countries do not see the importance of those plans and try to use other hospital emergency plans, taking them from the internet, not realizing that the risks and needs are different for each hospital. I have seen plans where the original hospital name was not removed after it was downloaded."
Experts calculate that from the design stage, it costs an additional 4 percent to make a building resilient against disasters.
Countries in Asia are most at risk for natural disasters. [http://www.irinnews.org/Report.aspx?ReportId=89305] Since January this year - excluding the Pakistan floods [http://www.irinnews.org/Asia-Country.aspx?Country=PK] - one million people have been affected and an estimated 321 have died in natural disasters in Bangladesh, Indonesia, Myanmar, Nepal, Philippines and Sri Lanka, according to the Belgium-based emergency events database [http://www.emdat.be/] run by the Centre for Research on the Epidemiology of Disasters. In Pakistan, flooding has destroyed 1.2 million homes, killed at least 1,600 people and affected another 17 million, based on UN estimates. Almost 400 health facilities have been damaged or destroyed, according to WHO.
Even for governments that want to prepare their health sectors for the worst, budget traditions steer their focus from preparation to response, said Margareta Wahlström, UN Assistant Secretary-General for Disaster Risk Reduction.
"Indonesia has come a very long way since the tsunami, but [the government] still [has not] yet really decided . how to move some of these [budget] resources from a fund for responses to prevention," Wahlström told IRIN in June.
After hearing an interview with a local official from the Indonesian city of Padang [http://www.irinnews.org/report.aspx?ReportID=86480], rocked by a 7.6 magnitude earthquake in 2009, describing how he had repeatedly asked for help from the central government to reinforce the city against earthquakes, Wahlström put the question to the chairman of the national budgetary and planning committee.
"He said it [was] true. [He told me:] 'We have no allocation in our national budget for prevention. We have not yet decided how to handle prevention investments.' But they are working on it now,'" Wahlström said.
The WHO's Abrahams told IRIN that monies coming in after a disaster tended to go to international agencies, doing little to help improve local capacity for the next one. "Mechanisms are well established to respond to a disaster, but we are not sorted out yet on how to reduce risk. Resources go to the international response community - UN organizations, international NGOs. We need to also build community and national capacities [to face disasters]."
Donors are often bound by systems that authorize releasing emergency funds only once disaster hits, said Wahlström. "Part of the challenge is a lot of the resources donors have given to risk reduction [are] from humanitarian budget lines, but really where they need to get the resources from is the developmental side."
As disasters become more frequent and deadly, donors will be forced to find new ways to help countries prepare, Wahlström said.
According to a doctor and health researcher from India, Shisir Ranjan Dash, relief is short-lived. "Usually the donors support the short-term relief and rehabilitation interventions in post-emergency situations, but [the] already over-burdened healthcare system of poor developing countries needs long-term support. in improving its human resources and infrastructure to deal with the disaster recovery process."