Assessing District Hospital Preparedness During a Public Health Emergency of International Concern (PHEIC): Development of a Comprehensive Checklist in the Indian Context

Abstract

Background: The COVID-19 pandemic exposed critical weaknesses in healthcare systems, particularly in low- and middle-income countries such as India. In Delhi, district hospitals faced severe challenges during successive waves, including inadequate infrastructure, staffing, and poor emergency coordination. These shortcomings underscore the need for a standardized, context-specific tool to assess and improve hospital preparedness for future Public Health Emergencies. Material & Methods: A preparedness checklist was developed using a mixed-methods approach. The initial draft was developed through a literature review of global and national frameworks, followed by expert consultations with public health specialists, physicians, administrators, and infectious disease experts. Feedback was incorporated through structured consensus-building exercises, ensuring contextual relevance and technical rigor. Results: The resulting checklist encompasses six core domains: (1) Infrastructure, Equipment and Supplies, (2) Health Worker Safety, (3) Patient Care, (4) Biomedical Waste Management and Disinfection, (5) Health Information, Outreach and Communication, and (6) Monitoring and Reporting. Each domain includes actionable items with standardized response formats for scoring and gap identification. Conclusion: This checklist provides a comprehensive, adaptable framework aligned with WHO health emergency standards. It supports institutional learning, staff preparedness, and policy planning. Field validation is needed, but it presents a practical solution for enhancing hospital readiness in future health emergencies.