As part of the "Bangladesh Resilience Advancement in City Ecosystems" (BRACE) Program initiated in in June 2023, with support from the USAID Bureau for Humanitarian Assistance, Simulation Drills to test Emergency Response Plans (ERPs) of three Urban Primary Healthcare Centers (UPHCCs)in Dhaka South City Corporation (DSCC) were carried out in November 2024. The simulation aimed to evaluate the plan's functionality and enhance participants' readiness for real-life emergencies. The exercise consisted of multiple sessions, including a review of the draft ERPs, scenario-based tabletop exercises, and practical simulations focusing on Infection Prevention and Control (IPC), triaging, evacuation, and referral coordination. Comprehensive ERPs were facilitated by the BRACE program, focusing on enhancing the facility's preparedness and resilience against emergencies and disasters. The process drew from WHO and the Pan American Health Organization’s (PAHO) Hospital Safety Index (HSI) and existing emergency response tools relevant to hospital safety and emergency management. The ERP development comprised of five key phases: initial briefing, capacity-building and training, data collection, stakeholder engagement, and assessment of disaster safety. The ERP process was introduced to the UPHCCs management team during an initial briefing session, emphasizing the significance of adopting contextualized HSI tools to assess hazards and vulnerabilities. A two-day training, facilitated by ADPC under the USAID BHA-funded BRACE Program, equipped participants with knowledge and skills to understand local hazard profiles, vulnerabilities, and ERP tools.

Data collection involved the use of customized checklists and tools tailored for emergency preparedness. Collaborative engagement with DSCC engineers, power and water supply authorities, Ward Disaster Management Committee (WDMC), and other health sector actors ensured the accuracy of structural, non-structural, and architectural safety data. This inclusive approach aimed to align UPHCCs’ ERP with city and national response frameworks.

The simulation exercises utilized a participatory approach to evaluate the functionality of the ERPs and enhance the readiness of UPHCCs during emergencies. Key stakeholders, including representatives from DSCC, WDMC, emergency response agencies, Fire Service & Civil Defense, law enforcement agencies Police and community volunteers, collaborated to refine the ERPs into a practical and actionable model tailored to local contexts. The exercises, aligned with the ERP validation guidelines developed under the BRACE program, engaged participants, with a core team representing the Disaster Management Committees (DMC) leading activities such as tabletop discussions and live-action role-playing simulations conducted at the centers’ waiting area and entrance. The remaining facility staff, community volunteers and support staff, guard acted as hazard victims, rescuers, and observers, ensuring a realistic simulation. The facilitator briefed the team on the hazard scenario, structured into four sequential phases: Alert, Stand-by, Mobilization, and Stand-down (Demobilization), guided by the Simple Triage and Rapid Treatment (START) protocol, "Triage Plan and Procedure", ensuring rapid patient assessment and categorization. Realistic simulations featured five mock victims—two affected by earthquake and two injured due to fire hazard including one pregnant woman and child patient—brought in by community volunteers. These victims underwent diagnosis and were provided recommendations for necessary treatment, simulating real-life emergency responses. Tools included Triage tags, First Aid, PPE kits, IPC equipment and referral forms.

Post-exercise evaluations were conducted to assess the strengths, challenges, and areas for improvement. Feedback collected through evaluation forms informed the refinement of the ERPs. Participants also contributed to an action plan, underscoring the commitment to continuous improvement in emergency readiness. This exercise demonstrated the practical application of the ERPs and strengthened the centers’ capacity to respond effectively to future emergencies.