Disaster risk assessment of primary healthcare facilities in South East of Iran: a study with approach of disaster risk reduction

InTrodUcTIon: Disaster risk management requires a systematic process, including executive, organizational decisions, other capacities to perform policies, strategies, and social capacity to reduce the negative effects and consequences of risks. The purpose of this study is to investigate the risk assessment process in all healthcare facilities of South East of Iran. MATerIAL And MeTHods: This cross-sectional study was conducted at the Kerman University of Medical Sciences in 2021 and the population participating in this study was all healthcare facilities, n = 2835 in the cities of South East of Iran that were selected with a census method. The risk assessment of healthcare facilities was performed with two qualitative and quantitative methods. resULTs: The results of the current study showed that 26 main hazards threaten healthcare facilities in South East of Iran and high priorities of healthcare hazards were earthquake, dust, drought, flood, and traffic incidents. Also, the results indicated that the vulnerability total mean score (733.26) of healthcare facilities was at a high level and the total mean score of response capacity (418.13) in healthcare facilities was at a moderate level. The results based on the assessment of three dimensions of hazard, vulnerability, and response capacity showed the risk total mean scores of healthcare facilities (117.39) was at a high level. concLUsIons: Current research showed that the risk level of disasters was very high in the majority of healthcare facilities of South East of Iran. Therefore, national and provincial decision-makers or policymakers should make the right decisions to decrease disaster risks level through special attention to structural, non-structural, functional, managerial vulnerabilities and improvement of response capacity of healthcare facilities. KeY Words: risk assessment; hazard; vulnerability; capacity; healthcare facilities; disaster Disaster Emerg Med J 2022; 7(1): 11–20 InTrodUcTIon Iran with a population of about 75 million is prone to a variety of natural and man-made disasters [1]. Providing resiliency for the society, health care facilities attempted to deliver essential services, improve the health condition, and deal with emergencies, efficiently [2]. Healthcare facilities should remain stable and deliver services when disasters occur [3, 4]. The goal of disaster risk management in health care systems is to reduce the adverse effects and consequences of natural and unnatural disasters [5]. The first step in the disaster risk management process Disaster anD emergency meDicine Journal 2022, Vol. 7, No. 1 12 www.journals.viamedica.pl to prevent and reduce damage is to perform a risk assessment [6]. Disaster risk assessments analyze potential hazards and evaluate vulnerability to identify the nature and extent of risk, which may harm exposed people, property, services, livelihoods, and the environment [7, 8]. Components of risk assessment are hazard identification and monitoring, vulnerability assessment, and capacity assessment [9]. By analyzing and studying the probability of hazards occurrence, we can determine and address the health-related risks. Thus, in addition to hazards, which threaten and change organizational performance and processes, hazard analysis improves risk management in health organizations [6, 10]. Vulnerability is a component of the risk assessment and it is defined as the conditions affected by physical, social, economic, and environmental factors or processes, which increase the vulnerability of a community to the hazards [7, 11]. With the disaster capacity program of the health system, healthcare centers can provide continued healthcare in emergency and non-emergency situations during disasters. Literature review A study estimated hospital safety from disasters in Iran in 2015 and showed that the total disaster safety of Iran’s hospitals was 43%. About 20% of the hospitals had low safety and the rest had moderate safety [12]. Researchers found that many healthcare facilities were influenced by climatic hazards [13]. A study was conducted in Roburnia Plantation, Mpumalanga, South Africa, and indicated that Roburnia Plantation was highly vulnerable to hazards, including fires, harsh weather conditions, tree diseases, pests, and pathogens [8]. According to a study of the vulnerability of public hospitals affiliated with Tehran University of Medical Sciences to earthquakes, researchers reported functional safety to be 77.16% in six hospitals [14]. One study investigated the safety of selected hospitals affiliated with Shahid Beheshti University using the WHO/Pan American Health Organization Checklist and concluded that most of the studied hospitals had moderate safety [15]. research aim and question Although disaster risk assessment is very important in reducing adverse effects and consequences of disasters, it has not yet been taken into account seriously in the Iranian healthcare system. Therefore, the purpose of this study is to investigate the risk assessment process (hazard analysis, response capacity, and vulnerability) in all healthcare facilities of South East of Iran. In other words, the present research attempts to answer the following questions: a) what are the hazards threatening healthcare facilities in South East of Iran? b) Which hazards are in higher priorities? c) What is the level and condition of vulnerability (structural, non-structural, and functional) of healthcare facilities? d) What is the response capacity of healthcare facilities to disasters? e) What is the level of risk (quantity and quality) in healthcare facilities? Decision-makers can use the results of this study to prioritize the resources and apply information obtained from the disaster risk assessments in the design and construction of new healthcare facilities to reduce vulnerability or increase the capacity of the existing healthcare facilities. MATerIAL And MeTHods The Kerman University of Medical Science approved this study prior to the collection of data. A cross-sectional design was employed in 2021. Kerman is the largest province of Iran located in southeastern Iran. According to the statistics center of Iran in 2016, its population was 3 164 717 people. Kerman is one of the largest cities of Iran in terms of area, which is about more than 11% with about 183 193 square kilometers. Twenty-seven percent of Kerman province is exposed to drought and strong winds in different seasons, especially in the southern and eastern regions, which severely restricted the life of people in these regions. There are 13 active faults in Kerman province with more than 84% of the population exposed to seismic hazards. samples and settings The population participating in this study was all healthcare facilities, n = 2835 included (the deputy of health, district health centers, comprehensive urban health centers, comprehensive rural health centers, comprehensive urban-rural health centers, urban health posts, health house in the cities of Kerman province (Kerman, Baft, Kouhbanan, Shahrbabak, Ravar, Bardsir, Orzueyeh, Rabor, Rafsanjan, Anar, Jiroft, Kahnooj, Anbrabad, Roodbar, Ghalehganj, Manoujan, Fareyab, Bam, Fahraj, Rigan, Rostamabad, Sirjan), which were selected with a census method, Gholamreza Khademipour, Hojjat Sheikhbardsiri, Disaster risk assessment of primary healthcare facilities in South East of Iran 13 www.journals.viamedica.pl therefore a total of healthcare facilities have participated in this study. The risk assessment of healthcare facilities was performed qualitatively (identification and prioritization of hazards) and quantitatively (assessment of capacity and vulnerability). Inclusion and exclusion criteria Inclusion criterion includes all healthcare facilities in Kerman province, which provide all healthcare services, and exclusion criterion includes dissatisfaction with sharing organizational information as well as dissatisfaction of experts with participation in Interactive Group discussion (IGD) sessions. data collection Qualitative method (identification and prioritization of hazards) First, all the hazards threatening the healthcare facilities of Kerman province, including geological, climatic, social, biological, technological, and man-made hazards were identified and extracted with the cooperation of relevant organizations and based on joint meetings through IGD discussion and brainstorming, previous maps and researches of organizations and historical evidence of the occurrence of disasters. Three 8-hour sessions of IGD consisting of eight people (one geologist, one expert in provincial crisis management, two experts of disaster risk management in health system, one meteorologist of the province, one regional water expert, one firefighter, and one Red Crescent expert) were held in the medical emergencies and incidences management center of Kerman University of Medical Sciences. In the first two sessions, two experts experienced in disaster conducted sessions and one individual wrote down the information. After the acquisition of informed consent from the participants, a tape recorder was also used to record information. In the third session, the probability, frequency severity, and impact of hazards were determined separately for each city based on the opinions of the IGD members and using the national tools of health assessment in disasters [16], Shows in (Tab. 1 and 2). Table 2 shows how to prioritize hazards based on scores obtained from Table 1 and the coefficients of frequency [7], probability [2], severity [6] and impact [5] are the constant base of national tools of health assessment in disasters. In this study the scores between 20–40 show low-level hazards, 41–60 show moderate-level hazards, 61–80 show high-level hazards and 81–100 show very high-level hazards. Based on the above tool, all-hazards extracted at this stage were prioritized based on hazard characteristics. Quantitative method (assessment of vulnera