Background: The small island developing states (SIDS) in the Caribbean are particularly vulnerable to the impacts of climate change. Many SIDS' health facilities are in high-risk areas such as coastal zones and are affected by extreme weather events. It is imperative to develop climate-resilient health systems to ensure health service continuity during and after an extreme weather event. One model to achieve this is the Smart Hospital Initiative. Objective: This case study was designed to strengthen the evidence base for decision-making regarding investing in Smart Hospital Initiative facilities as a climate adaptation strategy. Methods: This case study used secondary data derived from the Smart Hospital Initiative implementation (n = 55) focusing on four domains: country population/population served by the facility; pre-post Smart Hospital Initiative facilities' data; disaster and severe weather events' data; and diabetes mellitus (DM) mortality data. To assess the effectiveness of the initiative, an analysis of these data domains across seven countries is presented. Findings: Examining population size and healthcare service resources, healthcare facilities' readiness, climate-related disasters, and a health condition of concern, represents a viable strategy to assess the impact of climate adaptation on health. The Hospital Safety Index data showed that there were statistically significant pre-post retrofitted smart improvements across all 55 retrofitted facilities. The findings revealed that the effectiveness of any adaptation strategy is influenced by local financial and human resources beyond an initial, often external, investment and the capability to maintain the initial retrofitting of health facilities' impact on DM mortality. Conclusions: Climate-smart hospitals are a promising initiative to support the development of climate-resilient health facilities in SIDS. However, successful implementation depends on local capacity to support implementation and maintenance. We propose a framework to assess the utility of implementing climate-smart facilities as an adaptation strategy.
Lichtveld et al. (Wed,) studied this question.