The Smart Hospitals Program was implemented in seven Caribbean countries to enhance disaster resilience and environmental sustainability in small- to medium-sized healthcare facilities. The initiative focused on improving energy efficiency, water conservation, and overall environmental performance while ensuring uninterrupted healthcare service delivery in disaster-prone regions.

Facility assessments were conducted using the Green Checklist, a tool tailored for Caribbean healthcare facilities based on LEED standards. Pre- and post-retrofit evaluations targeted water and energy conservation, air quality, and waste management. Interventions included infrastructure upgrades—such as photovoltaic systems, energy-efficient equipment, and rainwater harvesting systems—and staff training on resource conservation.

Energy consumption at the Vieux Fort Healthcare Facility decreased by 47.7 %, with a mean monthly reduction of -5773 kWh (95 % CI:6175 to -5371; p < 0.0001; t = 31.61, df = 11). Comfort Bay showed a median reduction of 26.6 % (-1919 kWh; p = 0.0005; W = -78.00). Water consumption reductions included 58.5 % at Saltibus (-40,456 gallons per month; p = 0.0005; W = -78.00), 18.1 % at Vieux Fort (-6924 gallons per month; p = 0.0005; W = -78.00), and 7.2 % at Mongouge (-1269 gallons per month; p = 0.0005; W = -78.00). These reductions highlight significant improvements in resource efficiency and operational sustainability across facilities.

The Smart Hospitals Program achieved significant reductions in water and energy consumption, demonstrating the potential of targeted retrofitting interventions to enhance sustainability and resilience in healthcare facilities. While the results highlight the program's effectiveness, maintenance challenges and variability in usage patterns underscore the need for ongoing monitoring and tailored strategies to sustain these gains. This model provides valuable insights for similar initiatives in resource-constrained and disaster-prone regions.