Factors Influencing Disaster Preparedness And Response In Public Health Institutions ( A Case Study Of Nyamira Level 4 Hospital)

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1.1 Background information


The issues of disaster management dates back to more than 20 years ago, with difficulties in undertaking disaster management assessments leading to calls for continued development of standardized tools (Brandt et al., 2009). The continued occurrence and magnitude of disasters have prompted World Health Organization (WHO) and other organizations to come up with best practice models for hospitals and disaster management (Traub, et al., 2007; Adams, 2009; De Lorenzo, 2007). Over the years there have been efforts by WHO and other technical bodies in promoting hospital preparedness, examples being the 2008-9 world disaster reduction campaign of “hospitals safe from disasters” and more recently the 2010-11 “one million safe schools and hospitals” initiative. This is because of the need to continue strengthening the healthcare system’s preparedness and response for mass casualties with a view of saving as many lives as possible when disasters occur.


World events, such as the Singapore Airline crash in Taiwan in 2000, the attack on the World Trade Centre of 11 September 2001, severe acute respiratory distress syndrome (SARS) of 2003, Pakistan earthquake of 2005, Hurricanes Katrina and Rita of 2005 and the more recent Japanese earthquake and Tsunami of 2011, reaffirmed the need for disaster research to understand how people coped and survived when faced with such calamities. Those events also reaffirmed the limited understanding of hazard management, reinforcing the need for research (Ressler, 2007). Because of disasters that occurred throughout the world, various organizations in the USA made efforts aimed at improving emergency preparedness and response. For example the Joint Commission on Accreditation of Healthcare Organizations

(JCAHO, 2003) made  it mandatory for  healthcare  institutions

to  have  emergency


based on hazard vulnerability analysis; the U.S.  Department  of

Health  and  Human



DHHS),  the  Agency  for Healthcare  Research  and  Quality  (AHRQ)  and the  Centre


Disease  Control  and Prevention (CDC) placed emphasis on emergency preparedness in



their research agendas; the Department of Homeland Security (DHS) began funding initiatives designed to improve emergency preparedness (Adams, 2009).

Emergency preparedness can be achieved through a process of planning and formulating policies training and exercise; acquisition of important equipment and infrastructure needed for emergency response; and the acquisition and improvement of the knowledge and capabilities of staff (Adini et al., 2006; Perry & Lindell, 2003). One of the major components of the hospital emergency preparedness process is that of planning. It is, however, important to note that the written plan does not guarantee preparedness (Perry & Lindell, 2003), but should be viewed as one of the elements of preparedness activities aimed at improving emergency response (Adini et al., 2006). Following the September 11 attacks on the World Trade Centre and Pentagon in the USA, there has been a worldwide emphasis on the rapid development of emergency plans to combat or cope with consequences of disasters, especially in the US, United Kingdom and Europe (Perry & Lindell, 2003).

It is necessary for hospitals to be well prepared to manage disasters. In a survey conducted in 2003 in the US, most health care practitioners believed they and their local health care systems were not well prepared to respond to bioterrorism and natural epidemics (Alexander et al. 2006:). In another survey, Hsu et al. (2005) discovered that most health care practitioners participating in the survey reported that they were not confident in their ability to diagnose or treat cases related to chemical, biologic, radiologic, nuclear and explosives (CBRNE) as they had never seen or treated such cases. Various studies investigating the willingness and ability of health care workers to report for duty during disaster, had been conducted in the US (Barnett et al., 2009; Rokach et al., 2010), Australia (Smith, 2007), Singapore (Cheong et al., 2007; Koh et al., 2005), Israel (Shapira, et al., 1991), and Canada (Singer et al., 2003). These studies have all shown that it may not be realistic to expect all staff to report for duty during a catastrophic event (Smith, 2007), hence the need for planning for such cases.


Like other continents, Africa has had its fair share of disasters and emergencies examples being the famine in Somalia; US Embassy bombings in Kenya and Tanzania in 1998; suicide bombings in Mombasa, Kenya in 2002; suicide bombings in Taba, Egypt in 2004; soccer stadium stampede in Zimbabwe, 2000; and the 2009, 2010, 2011 floods in Northern Namibia. In addition to these emergencies, Africa had the honor of hosting the Rugby World Cup in 1995, and the soccer World Cup in 2010, which could have led to mass causalities. Despite these emergencies and important events, few reports on the healthcare system preparedness and response have been published or made available on electronic databases. On 07 August 1998 the US Embassies in Nairobi, Kenya and Tanzania were bombed almost simultaneously (approximately nine minutes apart), killing over 200 people and injuring over 5000 people (Chandler et al., 2002). The medical response to those bombings was uncoordinated and inadequate, showing the need for healthcare disaster preparedness and the need for improved emergency management capabilities of both countries (Clack et al., 2002). In Nyamira district, disasters occurrence though not common but cases of violent theft, road accidents and fires and malaria outbreaks are a common phenomenon. However, knowledge on how prepared Nyamira level 4 hospital to respond and manage disasters is unknown. The knowledge on factors influencing disaster management and preparedness in the same hospital is also lacking. Therefore, this creates the need for a study in Nyamira level 4 hospital, to determine the factors that influence the preparedness of the medical facility.


1.2 Statement of Problem

Kenya’s disaster profile is dominated by droughts, fire, floods, terrorism, technological accidents, diseases and epidemics that disrupt people’s livelihoods, destroy the infrastructure, divert planned use of resources, interrupt economic activities and retard development (National disaster policy 2009). Each year people die or seriously injured as a result of fires at their workplaces. Recent disasters in Kenya include fire that razed down a dormitory (2001) at Kyanguli boys (Machakos) where 68 students lost their lives. Fire at the Nakumatt Downtown supermarket on January 28, 2009, gutted down the building and many lives were lost as well. In Nyamira however, cases of poisoning, injuries sustained from violent robberies and injuries sustained from emergencies dominate the list of disaster/emergencies within hospitals (DHIS report 2012). Nyamira district has also experienced malaria epidemics in the early 1994 to 2007. In their annual report of 2011 the Nyamira divisional police had recorded eight fire incidents and 27 fatal accidents. However, during cases of accidents, many victims lose their lives at the hospital while others are referred to Kenyatta national hospital for emergency treatment. Therefore one wonders how well Nyamira level 4 hospital is prepared in handling emergency cases and what factors are affecting disaster preparedness and management at the hospital. Hence the researcher interest in examining the factors influencing disaster preparedness and management at Nyamira level 4 hospitals, Nyamira county Kenya.

1.3 Broad Objective of the study

The broad objective of the study is to examine the factors influencing disaster preparedness and response in Nyamira level 4 Hospital.


1.3.1 Specific objectives

  1. To assess the influence of knowledge and practices of medical personnel on disaster preparedness and response in Nyamira level 4 hospital
  1. To examine the influence of government funding on disaster preparedness and response in hospitals in Nyamira level 4 hospital
  1. To determine the influence of government policy on disaster preparedness and response in Nyamira level 4 hospital
  1. To determine if there are linkages between the community and Nyamira level 4 hospital that are available in disaster preparedness and response

1.4 Research questions

  1. How do knowledge and practices of the medical staff influence disaster preparedness and response in Nyamira level 4 hospital?
  1. What is the influence of government funding on disaster preparedness and response in Nyamira level 4 hospital?
  1. In what ways do the government policies influence disaster preparedness and response in Nyamira level 4 hospital?
  1. Which linkages are available that may enhance disaster preparedness and response in Nyamira level 4 hospital?
1.5 Significance of the Study

The findings of this study is of importance not only for Nyamira hospital but to other medical facilities in the county and the whole country in general experiencing similar challenges with the recommendations that will provide probable approach to minimizing the impacts of natural and human induced disasters. The hospital personnel may also benefit as based on their level of knowledge, attitude and practices, the hospital may decide to provide them with in-service training or allow them to pursue further education on disaster preparedness and management. The hospital may also benefit from increased funding from the County government and other bilateral donors who may help in upgrading emergency preparedness and response systems and hence make it efficient in preparing for and managing disasters. Given the importance of community and hospital linkage during disaster situation, this study may help improve the relationship between the two groups and also with other relevant stakeholders. This study will add to an already existing body of knowledge as well as act as a baseline for further studies.


1.6 Limitations of the Study

Various limitations are envisaged for this study, one limitation may be the fact that some respondents may fail to fill their instruments or return partially filled instruments which may place the accuracy and reliability of collected data in question. Some respondents may refuse participation in fear of victimization by the hospital management; this may affect the sample size and the generalization of the study findings. To limit this, the respondents will be assured of anonymity as their names will not be mentioned anywhere and also the researcher will make it clear to them that the main intention of the study is to seek the improvement of the hospitals emergency preparedness and response systems. The findings of this study may also not be applied to other level 4 hospitals due to the smaller population and sample size.


1.7 Conceptual Framework

Disaster preparedness aspect of a hospital deals with a lot of issues, the number of available surgical  personnel,  facilities  in  place,  their  condition,  knowledge  of  personnel  on  disaster preparedness and management, their attitude, practices, level of funding, level of involvement in planning for disaster, level and nature of linkages between the hospital and other stakeholders, government policies and corruption. The researcher conceptualizes that these variables are very influential and are capable of affecting disaster preparedness and management within hospitals.

The relationship between variables under study is diagrammatically presented below.

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