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 . 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 . The occurrence of disasters in societies causes serious damage and influences them severely. It was estimated that from the approval of Hyogo Framework for Action to 2015 thousands of people had lost their lives and millions of people had become homeless throughout the world because of disasters . 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 .
Disaster risk management prevents or reduces deaths, accidents, diseases, disabilities and mental problems . Therefore, policies and strategies should focus on equipping and preparing PHC facilities because they can reduce the vulnerability of families, societies, and public health systems which is caused by disasters and emergencies . Continuous training and exercises as strategies for improving functional safety can improve preparedness and resiliency of health staff and people against disasters and emergencies. WHO introduced lack of training to prepare for disasters in state level and ordinary people as one of the main reasons for high damage from disasters .
Additionally, availability and continuity of public health services to all populations are one of the principal actions of public health in order to reduce disaster risks [1, 5]. 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 .
The United Nations post-2015 framework for disaster risk reduction announced the aims of negotiations on disaster risk reduction as follows: increase in health system flexibility, incorporation of disaster risk reduction into healthcare programs, and capacity building especially at local level . 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 . Some studies indicates that the main reason for most of the damages in the health facilities is related to inappropriate site selection for the building, lack of proper design or insufficient maintenance . In the earthquake of the Iranian city of Bam in 2003, more than 90% of health facilities were demolished . Further, after the 2004 Indian Ocean tsunami, in Sri Lanka at least 92 % of the health physical infrastructure were partially or fully damaged . Indeed, a combination of the structural and non-structural safety and a high level of functional safety is required to ensure that PHC facilities are resilient enough to disasters and emergencies. If the safety in the mentioned domains increases, the flexibility of PHC facilities also increases .
Since Iran is a disaster-prone country, one of the public health concerns in the country is related to the harmful consequences of disasters . Notably, these PHC facilities are the first level of contact between families and the health system in the governmental sector of Iranian health system .
The structure of PHC system was established in Iran in 1985. In this structure up to 1200 inhabitants of each village or a collection of villages has a health house, staffed by a trained health care worker named Behvarz who provides public health care. In the bigger villages in addition to health houses, there are rural PHC facilities which staffed by a physician and a team of up to 10 health workers that provide health care for more complex health services such as child and mother care, reproductive health, environmental health and mental health. Each rural PHC center covers almost 7000 inhabitants. In urban areas, PHC facilities provide similar health services as health houses and rural PHC facilities. This network is managed by district PHC facilities, under the supervision of Medical Sciences Universities. Due to economic situation, village or city location and road damages, the majority of population only access to these PHC facilities and afford the cost for receiving the health care services in rural and urban areas, particularly after disasters occurrence [12, 13].
Totally, these 24000 PHC centers across the country have been accounted as a good potential to deliver multi-health services in four phases (prevention and mitigation, preparedness, response, and recovery) of disasters to the population . Therefore, the stability and safety of PHC facilities as well as trained staff is necessary for continuing the health care service delivery to affected people at time of disasters and emergencies . 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 . In regarding to topographical, diversity of geographical and ethnicity. 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 . Regards to disaster-proneness of this province and the low socio-economic indices, the stability of PHC centers and continuity in delivering health services has the high importance for affected people, particularly after the disaster occurrence. Additionally, the comprehensive safety assessment has not been conducted in all of the PHC facilities across the province until now. Therefore, it is crucial to collect data and provide precise information for health officials and decision makers for recognizing the weak points and improve the preparedness of PHC facilities against disasters and emergencies. The aim of this study was assessing the structural, non-structural, functional and total safety and relevant risks for disasters in 805 primary PHC facilities at provincial, regional and local levels in Kurdistan province, Iran.