Project Report. Submitted to: GOAC

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1 Project Report Enhancing Emergency Health And Rehabilitation Response Readiness Capacity of Health System in the Event of a High Intensity Earthquake in Kathmandu Valley Submitted to: GOAC

2 Summary Project Progress Activities Undertaken of Merlin, in partnership with the National Society for Earthquake Technology (NSET) have conducted structural and non-structural assessments of 3 hospitals and 2 rehabilitation centres in Kathmandu District, they are: Tribhuvan University Teaching Hospital (TUTH), Civil Service Hospital (CSH), Shree Birendra Hospital (SBH), Sainik Punaristhapana Kendra Rehabilitation Centre (SPK) and the National Disabled Fund (NDF)). TUTH was selected for the non-structural retrofitting implemented by NSET. The structural and nonstructural assessments were completed successfully and lesson learnt shared with key hospitals and rehabilitation staffs and representative of the ministry of health and population. The findings of the assessment allowed us to develope a Mass Casualty Management plan (MCM) in line with the main findings. The non-structural retrofitting was achieved with locally available materials and methods to ensure mitigation measures in the event of an Earthquake, in cooperation with the Hospital maintenance team. Removal, Relocation, Anchorage, Chaining and Hooking, Strapping, Flexible Connection, Modification and Support. Non-structural mitigation measures contribute significantly to increase the TUTH functionality following a major earthquake at reasonable cost. The TUTH retrofitting measures were presented as an example in different forums and lessons sharing with public and private hospital management teams in Kathmandu Valley. Structural and non-structural assessments were completed in TUTH, CSH, SBH, SPK and NDF using the methodology developed by NSET, covering all buildings and departments. Several workshops were conducted to orientate staffs about the project and clarify the objectives. The work was conducted in close coordination with maintenance department, whose staff were actively involved in the activities. Operation theatres always busy in the day were assessed after working hours. Qualitative procedures were adopted for assessment of the building based on the review of all available drawings and design details observed. Various seismic vulnerability factors were checked and the expected performance of the building was estimated for different earthquake intensities. The qualitative structural assessment and nonstructural assessment findings and recommendations were disseminated to key hospitals and rehabilitation staff including the management, technical and support staff. Hospital staff showed much interest about what they might do to increase the safety of patients. Mitigation measures for each component of the system were identified and critically evaluated in terms of ease and cost of implementation and of their expected efficiency regarding vulnerability reduction. Non-structural retro-fittings were completed in TUTH based on the findings of the non-structural assessment. Medical equipment and components of critical systems were evaluated and medical and administration departments were assessed to identify vulnerability to an earthquake. All equipments and components were rated in terms of risk for medium size (MMI VI-VII) and severe earthquake (MMI VIII-IX). Risk mitigation options, implementation priority and cost estimates for implementation of mitigation options were identified. Meetings were conducted with the head of departments before the retrofitting. During the implementation of non structural vulnerability measures, appropriate technology available in local markets was used. Locally available gadgets are used for different types of mitigation measures.

3 Some items are fabricated in local market using locally available expertise and knowledge. Progress towards Project Outputs Monitoring and Evaluation Long-term Impact and Sustainability The non-structural retrofitting work of the TUTH was completed by December In the event of a disaster, over 2,000 hospital staff and 600 patients would be safer thanks to non structural mitigation measures implemented in the hospital facilities. According to a nurse at TUTH they are feeling safe inside their working station after retrofitting of non-structural components. Challenges included: It was difficult to find structural and architectural drawings of the TUTH facilities. Structural assessments of the CSH, NDF, SBH (hospital) and SPK (rehabilitation centre) were based on a visual inspection and nondestructive field test in absence of architectural drawings. It was often difficult to conduct the retrofitting work in a health facility functional 24 hours a day, drillers and impact wrenches were used to install the retro-fittings as quickly as possible. The lack of offer of structural mitigation components in the local markets was a challenge faced in countries like Nepal. However, a lesson learnt is that the manufacture of such items using locally available materials is possible. Monitoring was conducted by MERLIN during assessment and retrofitting. Coordination visits were planned at implementation initial stage. Feedback was provided to partners and maintenance section of the hospital. Consultation was also conducted with hospital staff during M&E. Direct observation was applied for monitoring and evaluation before, during and after implementation. Pictures were taken as a means of verification of the activities. The structural and non-structural assessment reports and recommendations, as well as the lessons learnt on retro-fittings, were disseminated among relevant health officials and staff at various hospitals in Kathmandu. Merlin s comprehensive approach: Retrofitting was conducted in the Civil Service Hospital through other funding sources. Influencing planners: Representatives of the Ministry of Health and Population and of the major hospitals of Kathmandu participated in a workshop on assessment findings and non-structural mitigation. Replication: Recommendation for non-structural mitigations was provided to Shree Birendra Hospital, Sainik Punaristhapan Kendra and National Disabled Fund. Shree Birendra Hospital is interested to conducted non structural retrofitting through their own funds following the assessment recommendation. Impact on health staff: Most of the staff of targeted facilities became aware of the benefits of the retrofitting, they are able to help conduct non-structural retrofitting when any new equipment is added, not only realising of the importance of retrofitting in health facilities but also in their homes and neighbourhood.

4 GOAC Budget Budget GBP Total Expenses Structural and Non-Structural Assessments of 5 Facilities 2,149 3,011 Consultative Briefings and Processes for Hospital Retrofitting 1, Non Structural Retrofitting of 1 Hospital 29,963 29,837 Assessment Report Publication and Dissemination 2,189 2,039 Retrofitting Lessons Learned Publication and Dissemination 2,535 1,871 Total 38,104 37,715

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