World Health Organization (WHO) considers public health as a set of organized actions which attempt to prevent disease, improve health, and increase the longevity of populations [1]. The focus of Primary Health Care (PHC) is on delivering essential services to improve the health condition, and by providing resiliency for the society, emergencies can be dealt with efficiently [2]. The occurrence of disasters in societies causes serious damage and influences them severely. Since the approval of Hyogo Framework for Action by 2015, thousands of people have lost their lives and millions of people have become homeless because of disasters [3]. Natural disasters, emergencies, and other crises have a direct effect on people and society’s health and influence it through causing trouble for health systems, equipment, and services [2].Due to the vital role of primary healthcare facilities in emergencies, in order to save people’s lives, it is essential that they remain stable and deliver services when disasters occur [4, 5].
Disaster risk management prevents or reduces deaths, accidents, diseases, disabilities and mental problems [2]. Therefore, policies and strategies should focus on equipping and preparing PHC because they can reduce the vulnerability of families, societies, and public health systems which is caused by disasters and emergencies [2]. According to WHO, certainty about the availability of appropriate and affordable care such as improving the health and disease prevention services to all populations is one of the principal actions of public health in order to reduce disaster risks [1]. On the other hand, when disasters occur, continuity of public health services depends on reducing disaster risks from prevention to recovery [6]. Countries are encouraged to improve health systems in line with international commitments in order to improve preparedness for disasters. In this regard, the World Health Assembly of WHO approved a resolution on strengthening national health emergency and disaster management capacities and resiliency of health systems in May 2011 [7].Some examples of the aims of negotiations on disaster risk reduction in January 2015 have been as follows: increase in health system flexibility, incorporation of disaster risk reduction into healthcare programs, and capacity building especially at a local level [6]. One of the expected outcomes from Sendai framework in addition to reducing casualties due to disasters is to lessen the damage to basic infrastructures and service-delivery facilities [3]. Therefore, evaluating disaster risks is essential in the public health area in order to mitigate disaster risks and manage disasters effectively [6]. Indeed, in order to ensure that PHC facilities are resistant enough to disasters and emergencies, evaluating the safety and risk of centers in terms of functional preparedness as well as structural and non-structural safety is essential [5].
Since Iran is a disaster-prone country, one of the public health concerns in the country is related to the consequences of disasters [8]. This country with 24000 PHC centers across all urban and rural areas has the ability to deliver health services in four phases (prevention and mitigation, preparedness, response, and recovery) of disasters to the population. Notably, it can be claimed that the first respondents to disaster are PHC centers in the Iranian health system [8]. However, in the earthquake of Bam in 2003, more than 90% of health facilities were demolished [9]. The focus of this study, Kurdistan Province, has an area of 28235 square kilometers accounting for about 1.7% of the country’s area. This province is located in the west of Iran and neighbors Iraq [10]. Due to topographical, geographical, and political conditions, it is one of the provinces prone to various disasters such as earthquake, floods, fires (especially on forests), terrorist attacks, war, avalanche, blizzard, drought, and other risks. Further, the Zagros fold-thrust belt crosses over this province and large earthquakes are expected to occur due to this fault in the province. Kurdistan Province is divisible into eastern and western areas in terms of seismicity, with more than 60% of the western area in this province including the towns of Kamyaran, Sanandaj, Marivan, and Baneh located in the high-risk zone [10]. Therefore, due to the disaster-proneness of this province and the importance of PHC centers in delivering health services after the occurrence of disasters, it is crucial to evaluate the safety of PHC facilities in line with precautionary measures, the promotion of preparedness, and continuity of services. The aim of this study is assessing the safety and relevant risks for disasters in 805 primary healthcare facilities of Kurdistan province in Iran. The healthcare facilities under assessment were from all existing types across the province including health house, urban health posts, urban-rural, rural and urban health centers, district health centers and the deputy of health. All mentioned healthcare facilities deliver the governmental health services to population in different levels of health system in Iran.