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Integration of Hospital Safety Index into Health System of Iran

In line with the 2008-2009 UNISDR-WHO Global Campaign on Hospitals Safe from Disaster, WHO developed the Hospital Safety Index (HSI). Accordingly, Iran’s Ministry of Health and Medical Education (MoHME) in collaboration with Tehran University of Medical Sciences initiated a national program to integrate HSI into the health system. As a first step, the HSI was translated into Farsi and adapted to Iran’s situation as Farsi HSI (FHSI).

In 2012, MoHME endorsed the FHSI and required all to apply it. By September 2013, 224 hospitals conducted their assessments. The results were used to advocate the importance of hospital safety to authorities, and finally led to the 2014 Hospitals Accreditation Protocol, ratified by MoHME, which included the FHSI conduct and reporting as annual accreditation criteria.

Title of case study

Integration of Hospital Safety Index in Health System of Iran: A National Initiative following the UNISDR-WHO Global Campaign

Which priority of action does the practice/case contribute to

HFA Priority Action 2 – identify, assess and monitor disaster risks and enhance early warning

Context

Iran is a disaster prone country with over 900 hospitals. Hospitals are potentially vulnerable to disasters because of their complexity in terms of structural, non-structural, and functional components; high level of occupancy; and expensive equipment. Hospital safety from disasters is a challenge in both developing and developed countries. Nevertheless, during disasters, hospitals must be able to continue their functions in a safe environment and save the lives of injured victims.

The adverse impacts of disasters on Iranian hospitals have been enormous. For example, in the Bam earthquake (2003), almost all public and private hospitals collapsed. The Zarand earthquake (2005) led to non-functionality of the district hospital for about six hours due to non-structural damages and absence of staff. In the East Azarbaijan earthquake (2012), the district hospitals almost collapsed including one hospital that had opened one year before the earthquake. A fire in Tehran’s Arg Mosque in 2006 led to more than 100 burn injuries and challenged Tehran’s hospitals surge capacity and their ability to manage burn victims. A similar problem was observed following a bomb explosion in Shiraz (2009) that left 202 injuries.

Location

Iran (Islamic Republic of): The Ministry of Health and Medical Education in collaboration with Health Emergency Working Group in the National Disaster Management Organization, and National Platform of Disaster Risk Reduction.

How was the problem addressed?

 

 

In 2011, Iran’s MoHME in collaboration with Tehran University of Medical Sciences assembled a multidisciplinary group of experts, including doctors, nurses, disaster managers and engineers to help develop an adapted version of HSI for Iran. The HSI was translated to Farsi and tested in pilot hospitals. The content validity of the tool was assessed based on opinions of subject experts, and face validity was assessed using views of the hospital personnel. The adopted tool was called Farsi Hospital Safety Index (FHSI). To be comparable with the assessments in other countries, in FHSI, Iran kept the structure of the tool and number of items similar to the original HSI version. Modifications, however, were made to the section on guides to evaluators whenever appropriate, and, the calculation method was modified. Three national training workshops were carried out to train the provincial assessors.

Results

In 2012, MoHME endorsed the FHSI and required all the Iran’s hospitals to assess their safety using FHSI and report back to MoHME. By September 2013, 224 hospitals conducted their assessment. The results were as follow: functional capacity (27.3%), structural safety (36.0%), non-structural safety (36.0%), overall safety (32.4%), and safety level (4 out of 10). 

The assessment results were used to advocate the importance of hospital safety to the relevant authorities. Advocacy finally led to: the 2014 edition of Hospitals Accreditation Protocol, ratified by MoHME, which included FHSI conduct and reporting as annual accreditation criteria. Today, all Iranian hospitals are mandated to assess their disaster safety using FHSI to renew their annual license.

Measuring success

The two main indicators to measure the success of this initiative are the number of hospitals that conduct safety assessment using FHSI; and whether the programme has been integrated into the health system. By the middle of the current Iranian year, 315 hospitals (1/3 of total hospitals) have conducted their assessment. Furthermore, hospital safety assessment using FHSI has been included among the criteria of hospitals accreditation, endorsed by Iran’s MoHME.

The annual safety assessment using FHSI is the first step to provide updated information that can be potentially leveraged for policymaking, and evidence-based resources allocation. However, it is important to plan and conduct appropriate measures accordingly to enhance the hospital’s safety and reduce disaster risks. MoHME is working with provincial health authorities and hospitals to ensure that the information from FHSI is being used in planning and risk reduction measures.

Relevance to HFA

This initiative was started following the 2008-2009 UNISDR-WHO Global Campaign on Hospitals Safe from Disasters, and is in line with the HFA Priority Action 2 – identify, assess and monitor disaster risks and enhance early warning.

Potential for replication

The model has a potential to be extended to other countries. Of course, the specific situations need to be considered for adoption.

Contribution by

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:

Dr. Amin Saberinia

Dr. Davoud Khorasani

Dr. Hamidreza Khankeh

Dr. Reza Masoumi

Ms. Samaneh Maleknia

Ms. Maryam Kandi