Emergency preparedness of licensed health facilities in Greater Accra, Ghana: an analysis of regulatory data.

Flooding kills more people than any other natural event apart from storms and affects hundreds of millions worldwide each year (Menne et al., 2013). In Ghana, flooding is ranked as the country’s second most frequent natural hazard after epidemics, affecting over three million people and causing major economic losses annually (Girardet, 2020). The Greater Accra Region Area (GAR) is particularly vulnerable due to unregulated settlement growth, inadequate drainage systems, and poor waste management (Amoako and Frimpong Boamah, 2015, Okyere et al.,2024). Given these impacts, strengthening resilience to floods is central to global and national development agendas. The Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 11 (Sustainable Cities and Communities), and SDG 13 (Climate Action), emphasize reducing vulnerability to climate-related hazards and ensuring access to essential services during disasters (United Nation, 2015) . Ghana’s national development frameworks and health sector policies align with these goals by prioritizing disaster risk reduction, climate resilience, and continuous access to quality health care, especially in urban and flood-prone regions such as Greater Accra (Commission, 2021). In practice, these commitments are reflected in national strategies that call for climate-resilient health systems, integration of disaster risk reduction into health planning, and the protection of critical health infrastructure in high risk urban areas such as Greater Accra. Emergency preparedness within health systems is therefore a critical pathway through which these SDG commitments and national priorities can be operationalised. Emergency preparedness has become a global public health priority as the frequency and intensity of disasters escalate under the pressures of climate change, urbanization, and population growth (World Health Organization, 2020) . Health facilities form the cornerstone of national resilience systems; yet they are also among the most affected when disasters occur. The World Health Organization (WHO), through its Health Emergency and Disaster Risk Management Framework, emphasizes that the capacity of health facilities to anticipate, respond to, and recover from emergencies determines the overall resilience of a country’s health system(Organization, 2019). In flood-prone settings, this means that the extent to which facilities can continue to function during and after flooding is central to protecting health and achieving SDG and national resilience targets. For Ghana, ensuring that health facilities in Greater Accra remain functional during floods is therefore not only a clinical or operational concern, but also a key requirement for delivering on national development plans and SDG commitments related to health, urban resilience, and climate adaptation. Health facilities in flood-prone regions like Greater Accra are at the frontline of response efforts during emergencies such as floods and outbreaks. However, their ability to maintain services during crises depends on their level of preparedness. The dimension of this preparedness concerns facility-level readiness for flooding and disease outbreaks, including the existence of contingency plans, communication systems, essential supplies, and trained staff (Amoako and Frimpong Boamah, 2015). While WHO’s Health EDRM Framework and the UN Sendai Framework for Disaster Risk Reduction (UNISDR, 2015) urge countries to safeguard critical health infrastructure (UNDRR, 2015), evidence shows that many hospitals in sub-Saharan Africa continue to operate without emergency plans or training (Farah et al., 2023). Health facilities in flood-prone regions like Greater Accra are at the frontline of response efforts during emergencies such as floods and outbreaks, yet their ability to maintain services depends on their level of preparedness. Ghana’s Health Institutions and Facilities Act, 2011 (Act 829) mandates the Health Facilities Regulatory Agency (HeFRA) to license and regulate all public and private facilities, but the current framework does not include explicit disaster preparedness standards (HeFRA, 2011). As a result, even licensed facilities may lack trained personnel, functional equipment, emergency supplies, and designated response areas required to operate effectively during crises (Afrifa-Yamoah et al., 2024). Despite recurrent flooding and the high concentration of health facilities in the Greater Accra Region, there is limited empirical evidence on how prepared these facilities are to manage flood- related and disease emergencies, and how legal and regulatory expectations translate into actual readiness on the ground (Boateng-Osei et al., 2023). This proposed cross-sectional, ecological study is to assess the emergency preparedness of licensed public and private health facilities in the Greater Accra Region of Ghana from both regulatory and public health perspectives. The study will address the current level of emergency readiness for floods and disease outbreaks among health facilities. The authorship team includes a researcher practitioner (JD). Through her role, there will be the opportunity to translate her findings into targeted health systems strengthening support for emergency preparedness within the most flood-prone facilities, and so it will enable providing targeted health systems strengthening. Using the existing regulatory governing structures and Health Facilities Regulatory Agency to do so.