In line with the Hyogo Framework for Action (HFA) Priority Action 2, Iran’s health system has developed and institutionalized a metrics system for disaster risk management that provides policymakers with annual qualitative information on indicators. This system has expanded throughout Iran and includes indicators, measurement tools, and protocols for data collection, analysis, reporting, and feedback targeting hospitals, primary healthcare facilities, and households.
As the result of this initiative, today, Iran’s health system has an established disaster risk management metrics system integrated into the national health information system. This model can potentially be extended to other sectors beyond health, and to other countries, and be adapted to their specific situations.
Case Study
Develop and institutionalize a metrics system for disaster risk management in Iran’s health system.
Location
Iran: Ministry of Health and Medical Education in collaboration with the Health Emergency Working Group at the National Disaster Management Organization, and the National Platform for Disaster Risk Reduction.
Hyogo Framework for Action Priority
Priority Action 2: Identify, assess and monitor disaster risks and enhance early warning
Context
Iran is a disaster prone country. While the national health system has always been on the frontline of disaster responses, it has also been seriously affected by disasters. The road map for Iran’s health system’s disaster risk management (DRM) has required this health system to enhance its resilience to disasters. In addition, it has emphasized the proactive role of primary health care (PHC) in community preparedness, which is crucial for reducing the health consequences of disasters.
To make these strategies operational, the health system started with some key questions:
Iran’s health system was not able to answer any of the questions. It was not surprising as the health information system lacked DRM indicators. This reminds us of the saying, “If you cannot measure it, you cannot manage it”.
Addressing the Problem
In 2011, a team of experts was assembled to develop and institutionalize a DRM metrics system to address both health facilities and Iranian citizens. The team started with the development of indicators, and testing measurement tools and protocols for data collection, analysis, reporting, and feedback targeting hospitals, PHC facilities, as well as households.
The metrics tools and corresponding calculators included a hospital safety index (HSI); a primary health safety index (PHSI); and a household disaster preparedness index (HDPI). The first tool, translated into Farsi and called FHSI, was an adopted version of the tool introduced by the World Health Organisation (WHO). The programme team, however, developed the other two tools. FHSI and PHSI assess the functional capacity, structural and non-structural safety of hospitals and PHC facilities, respectively. All three tools have an all-hazard approach, but with a special focus on Iran’s most important hazards, especially earthquakes.
The FHSI was tested in four hospitals first and applied after in 224 hospitals (25% of Iran’s hospitals). The PHSI was piloted in 644 PHC facilities, and then extended to 2,715 facilities, (12% of total PHC facilities). HDPI was tested in three districts, and then extended to 10 districts in 10 out of 31 provinces.
Results
The aforementioned activities led to a 2012-2013 estimation of the indicators of interest as baseline values:
To promote the programme at the highest levels of authority both provincially and nationally, several meetings were held to emphasise the application of metrics for policymaking, planning, and resource allocation. It was hoped that this process would lead to endorsement of the programme and allocation of a budget by the Ministry of Health and Medical Education (MoHME), and to a change through quantifying disaster preparedness of the health system which was previously uncertain.
These efforts resulted in financial resources being harnessed in a sustainable way for this programme within the health system; budget allocation and in kind support from MoHME through the assigning of three national officers and allocation of provincial staff; the establishment of a regular monetary flow; mainstreaming provincial budgets; and stimulating cross-sectoral and cross-disciplinary solutions for improving the preparedness of households.
Today, all health facilities should assess and report their safety indices annually; FHSI is used for annual accreditation of hospitals; and district health systems are required to conduct annual surveys for HDP. The HDP estimation has also attracted media attention, while the MoHME has used the baseline estimations for its 2015 budget allocation.
As the result of this initiative, Iran’s health system has an established DRM metrics system that is integrated into the national health information system.
Measuring Success
Along with other health indicators, the 2013 values of DRM indicators are now posted in the rooms of the Deputy Minister for Public Health and provincial public health authorities. Iran, however, is a vast country, so full coverage of the programme will take time. To ensure this, MoHME monitors implementation of the metrics system. By September 2014, about 30% of hospitals and 40% of PHC facilities had performed and reported their disaster safety assessment, while HDP surveys had been conducted in 24% of districts. The quantitative estimation of DRM indicators has helped the provincial health authorities to use this information for advocacy of DRM programmes and mobilization of provincial financial resources.
Relevance to the HFA
This initiative is in line with the HFA Priority Action 2. It has both developed an institutionalized model of DRM measurement in the country, and helped the Iranian health system to be equipped with quantitative information for the purpose of policymaking, planning and resource allocation. The model has been presented to the National Disaster Management Organization and Tehran Disaster Management Organization. Fortunately, the model has been well received by the authorities and they have expressed their willingness and support to use and expand it to other sectors.
Having an integrated DRM metrics system is a key component of risk reduction initiatives. It provides policy makers and planners with timely and quantitative information. This needs to be emphasised in HFA2.
Replication Potential
The model has the potential to be extended to other sectors beyond health, and to other countries. Sector/organization specific mandates and situations, however, need to be considered in the adoption process.
So far, Iran’s National Disaster Management Organization, and Tehran Disaster Management Organization have expressed their willingness to support and expand the model to other sectors.
Contributors
Ali Ardalan MD, PhD
Adviser to Deputy Minister
Director of Disaster Risk Management Office/Adviser to Emergency Management Center
Ministry of Health and Medical Education, Iran
Email: aardalan@gmail.com
In collaboration with:
Ms. Homa Yusefi
Ms. Narges Roohi
Dr. Amin Saberinia