In 2011, Thailand’s health sector has experienced its worst floods in decades. Around 600 public sector health facilities, provincial health offices, and district health offices were interrupted or damaged by the floods. Even higher numbers of private health facilities, including private hospitals, medical and dental clinics, were damaged, as key urban areas in Central Thailand and the Greater Bangkok area were inundated by the floods. Damage was mainly caused by floodwater, water currents, high humidity, and mud. The extent of damage to health facilities tends to be more severe in neighborhoods where the floods came rapidly due to broken water dams, e.g. Patum Thani, Ayutthaya, and Nakorn Sawan.
The total damage is estimated at THB 1.68 billion with an approximate 57-43 split between the private and public sectors. The government identified 26 provinces in Central, Eastern, and Northeastern Thailand as those most affected by the floods. However, the cost of damage to health facilities varies greatly from one region to the next. All of the highly affected health facilities are located in the low lying, flood-prone plains of Central Thailand. The estimated cost of damage to health facilities in five key provinces in Central Thailand alone – Ayutthaya, Bangkok, Nakorn Sawan, Nontaburi, and Patum Thani – accounts for around 90 percent of total cost of damage. On the contrary, the cost of damage of health facilities in the Northeastern provinces is estimated at THB 10.7 million, which is only 0.64 percent of total cost of damage.
In the public sector, regional and provincial hospitals bear the highest cost of damage. Sixteen regional and provincial hospitals were reportedly damaged, and the extent of damage is greatest at Ayutthaya Regional Hospital. Health centers/health promotion hospitals is the health facility category that bears the second highest cost of damage, with as many as 468 facilities were reportedly damaged. Many health centers/health promotion hospitals are located below the roads and streets in front of the facilities, and thus flood water inundated these health facilities even before the flood reached street level. In addition, 77 district hospitals were reportedly damaged. Apart from health service delivery facilities, three Provincial Health Office (PHO) and 29 District Health Office (DHO), which perform administrative and supervision roles at the provincial and district level, were also reportedly damaged.In addition to MOPH facilities, a university hospital in Patum Thani – Thammasat Chalermprakiat Hospital – was severely damaged. At the time of the mission, the flood water had not fully receded. Many areas on the ground floor and all basement areas were still flooded at the time of writing, making it difficult to calculate accurate estimates of damage. An initial estimate of the cost of damage by hospital management team is at THB 139 million, but the hospital management team believes that the cost could be higher once the full extent of damage is shown after waters have fully receded.
Private sector health facilities, which are mainly located in urban areas, were considerably affected by the floods this year. Although floods are relatively common in the central plains of Thailand, major urban areas had largely been well protected from flood destruction in recent years, due to a number of flood prevention measures organized by local authorities and the central government. However, the extent of the flooding this year is significantly more severe, and existing flood prevention mechanisms were overwhelmed, resulting in broken water dams and severe flooding in the majority of urban areas in Central Thailand. Over 73% of Ayutthaya’s and Patum Thani’s urban areas have been severely flooded for over two months. Nearly 40% of Nontaburi’s urban areas have been flooded for over two months, while another 30% have been flooded for one month. In Bangkok, over 35% of its urban areas have been flooded for one month, while an additional 10% have been flooded for two months.
The extent of the flooding in urban areas in Central Thailand, particularly in the Greater Bangkok area (which include Patum Thani and Nontaburi), which have the highest concentration of private health facilities, have severely affected many private hospitals and a great number of large and small private medical and dental clinics, causing a large amount of damage. The cost of damage to private health facilities is estimated at THB 954 million based on the satellite data on flooded areas, but the real cost of damage will not be known until the flood water level has fully receded.
Table 2 summarizes the cost of damage by 4 categories – structural, furniture, medical equipment and medical supplies. The value of damage is estimated based on the cost to rebuild or repair health facilities that were totally or partially destroyed, as well as the replacement value for the furniture, medical equipment, and medical supplies that were destroyed, assuming that they are being replaced with the same capacity and quality prior to the flood.
Most of the damage to public sector health facilities is structural, as many public health facilities straddle across large, spread-out areas and received full exposure to flood water currents, though no health facilities were fully destroyed by the floods. The structural damage caused by flood water currents tend to be more severe in district hospitals and health centers/ health promotion hospitals which are located in semi-urban and rural areas, where the water currents were stronger as they were not obstructed by buildings.
The fact that most of private sector health facilities are located in urban areas, where floodwater currents were weaker, help reduce the structural damage. However, the total cost of damage to their furniture is significant, due to the high number of large and small private medical and dental clinics sprawling across the flooded urban areas. The flood not only ruined the furniture which was directly exposed to water. Most of the furniture which was kept above the water level in nearby areas was damaged by exposure to high humidity brought by the floodwater, as well as by fungi which grow rapidly in the high humidity environment. Molded furniture is commonplace in flooded hospitals and clinics.
A number of expensive medical equipment, including MRI and CT scanners, X-ray machines, and laboratory equipment in public and private hospitals was also damaged. The damaged equipment was located on the first floor and basement of the hospitals, and was directly exposed to floodwater. The fact that the cost of damage to medical equipment in private health facilities is higher than those in public health facilities does not mean that medical equipment in public hospitals was less damaged than those in private hospitals. However, a number of public hospitals, which were flooded, have outsourced the operations of expensive medical equipment to private companies. These sets of medical equipment are owned by private companies, and those public hospitals give the companies the rights to operate
these sets of equipment in public hospital compounds, as part of an integrated hospital service. Thus, the cost of damage to these sets of medical equipment in public hospitals is not borne by the public hospitals, but by private companies.
Apart from private hospitals, large and small private dental clinics are believed to incur high cost of damage to dental equipment. Unlike private medical clinics which do not need expensive medical equipment, large and small dental clinics need to be equipped with expensive dental equipment. One set of dental equipment costs around THB 200,000 per unit. Each unit is heavy and immobile. Given the high number of dental clinics in the flooded areas of Greater Bangkok (including Patum Thani and Nontaburi), the damage to dental equipment in the private sector is expected to be high.
The damage to drugs and other medical supplies is minimal, as floodwater in affected areas rose gradually and hospital/clinic staff had sufficient time to move medical supplies to upper floors. However, some medical supplies were still damaged by floods. In a District Hospital that the team visited in Nakorn Sawan, most of the hospital buildings are one-storey high, except for a small second floor for administrative area. During the floods, which lasted for 3 months, the hospital used the small space on the second floor to store expensive equipment, but there was not enough space to store all medical supplies. Part of the medical supplies was left on high shelves in a one-storey drug storage building. Even as the high shelves helped keep the medical supplies above the water level, all medical supplies stored there were damaged due to high humidity.