Title page

Contents

Acknowledgements 4

Executive Summary 5

Country application: Belize 6

Acronyms 7

1. Introduction 8

1.1. The expanding frontier of health shocks 8

1.2. Quality of and access to health care: two dimensions of resilience to shocks 9

1.3. Building health systems that are resilient to natural hazards and climate change 9

2. The Frontline Scorecard: a new assessment tool 11

2.1. Two levels of sophistication 12

2.1.1. The rapid assessment 13

2.1.2. The deep dive assessment 13

2.2. Scoring 14

2.2.1. Indicators 14

2.2.2. Indicator categories 15

2.3. Limitations 17

3. Country application: Belize 19

3.1. Country context 19

3.2. Disaster risk exposure in Belize 20

3.2.1. Exposure of public and private buildings 22

3.2.2. Exposure of the health system 22

3.3. Assessment results 23

3.3.1. Rapid assessment 24

3.3.2. Deep dive assessment 26

3.3.3. Analysis by indicator category 28

3.4. Recommended future actions 28

3.5. Discussion 30

4. Outlook 33

Appendix A. Overall results from Belize rapid and deep dive assessments 35

References 43

Table 1. Scoring logic of the Frontline Scorecard 14

Table 2. Number of indicators per pillar of the health system 15

Table 3. Nine indicator categories for CDRM capabilities 16

Table 4. Key findings of the rapid assessment for Belize 25

Table 5. Experts interviewed, by sector 26

Table 6. Summary results of the deep dive assessment 26

Table 7. Overall scores for the Belize health system, by category 28

Table 8. Critical areas for strengthening in the Belize health system 29

Table 9. Potential implementation actions for facilities 29

Figure 1. Overview, inputs, outputs and timeline of the Frontline Scorecard 12

Figure 2. Exemplary output for scored indicators, incorporated feedback, and resulting focus actions 17

Figure 3. Exposure to hurricanes in Belize 22

Figure 4. Exposure of buildings to hurricane and earthquake damage in Belize 22

Figure 5. Overview and timeline of the Belize scorecard 24

Boxes

Box 1. Disaster response and recovery in Belize 21

Box 2. The impact of COVID-19 23

Table A.1. Results for each indicator of the rapid assessment (left) and the deep dive assessment (right) 36

Table A.2. Results for the five focus areas identified through the categorical scoring process 40

Table A.3. Potential future actions 42