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      Early warning system-related challenges in health sector: A qualitative content analysis study in Iran

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          Abstract

          CONTEXT:

          Iran's health system has always faced many challenges in the field of disaster risk management. The establishment of early warning systems in countries has been identified as an important component of preparedness and risk reduction.

          AIMS:

          This study aims to extract the experiences of those involved in the field of risk management in relation to the challenges and problems of early warning system establishment in the Iran's health system.

          SUBJECTS AND METHODS:

          This was a qualitative study, which has been conducted using a content analysis method. Data were collected through semi-structured interviews with 16 individuals who had at least one disaster management experience at the emergency operation centers. Sampling was done purposefully. The data were then analyzed using the Grenheim method.

          RESULTS:

          Nine subcategories of data were analyzed that included legal vacancies, challenges related to protocols and guidelines, weaknesses in the prediction infrastructure, weaknesses in the communication infrastructure, poor coordination, scarcity of resources, inadequate education, information management challenge, and evaluation challenge, and three main categories were extracted that included policy challenges, infrastructure challenges, and management challenges that represented the issues experienced in establishing an early warning system in the Iranian health system.

          CONCLUSION:

          Policy-makers and managers of health system need to pay special attention to improve the legal framework and standard protocol, strengthening infrastructures, increasing management performance in the field of coordination, education, allocation of resources, flow of information, and evaluation system.

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          Most cited references22

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          Gender, age and circumstances analysis of flood and landslide fatalities in Italy.

          Floods and landslides are frequent and destructive geo-hydrological hazards that cause harm to people every year. We analysed data on 1292 landslide and 771 flood fatalities that occurred in Italy in the 50-year period 1965-2014, to determine the dependence of the fatalities on gender and age and the circumstances of death by type of hazard. The multinomial probability mass function of the expected fatalities by gender and age, as reported by national census data, were estimated and compared with the observed landslide and flood fatalities. We identified the age categories over or under represented when the observed fatalities were respectively higher or lower than the modelled expected deaths. We found that in Italy males are more vulnerable to floods and landslides for most of the age categories. Apart from children, males are over-represented up to the age of 89 for floods and up to 79 for landslides, whereas females are under-represented up to the age of 59 for floods and landslides, and over-represented above 70 for floods and between 60 and 79 for landslides. To consider the demographic and socio-cultural changes over time, we performed a temporal analysis splitting the record into two non-overlapping subsets of 25year each. The analysis demonstrated that the over-representation of males compared to the females, both for landslide and flood is statistically significant and does not vary in time, indicating a different propensity towards the risk taking and a different degree of exposure between males and females. Analysis of the data allowed to identify the common circumstances of death. Landslides fatalities occurred frequently indoor, whereas the majority of the flood fatalities occurred outdoor, outlining the different dynamics of the hazards. Floods killed numerous people along roads and drivers or passengers travelling in vehicles. We expect that the results of this work will be helpful to design recommendations for self-protecting actions, and proactive policies that can contribute to reduce the human toll of floods and landslides in Italy, and elsewhere.
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            The Sendai framework: disaster risk reduction through a health lens

            After negotiations at the World Conference on Disaster Risk Reduction in March 2015, a new framework was adopted by 187 Member States. 1 The Sendai framework for disaster risk reduction 2015–2030 highlights concerns on human health and well-being that are common to disaster risk reduction, climate change and sustainable development. 2 A substantial emphasis on health is a welcome development, given the relative lack of attention to health issues in its predecessor, the Hyogo framework for action 2005–2015. 3 The Hyogo framework did succeed in galvanizing many stakeholders including governments, scientists, the commercial sector and nongovernmental organizations to make progress on disaster risk reduction. 1 , 4 However, more progress is needed in addressing underlying vulnerability from poverty, inequity or poor urban planning and land use. 5 Disaster impacts are strongly influenced by physical, social, economic and environmental factors. 6 Reducing disaster risk, therefore, requires concerted action across a wide range of sectors, institutions and disciplines. The Sendai framework is relevant within and beyond the health sector. There are more than 30 explicit references to health, referring to the implementation of an all-hazards approach to managing disaster risk, including links to epidemics and pandemics, several references to the International health regulations (2005) 7 and to rehabilitation as part of disaster recovery. Via the framework, Member States have called for enhanced scientific and technical work on disaster risk reduction and its mobilization through the coordination of existing networks and scientific research institutions at all levels and all regions, with the support of the United Nations International Strategy for Disaster Reduction’s Scientific and Technical Advisory Group, in order to strengthen the evidence base in support of the implementation of this framework; promote scientific research of disaster risk patterns, causes and effects; disseminate risk information with the best use of geospatial information technology; provide guidance on methodologies and standards for risk assessments, disaster risk modelling and the use of data; identify research and technology gaps and set recommendations for research priority areas in disaster risk reduction; promote and support the availability and application of science and technology to decision-making; contribute to the update of the terminology on disaster risk reduction; use post-disaster reviews as opportunities to enhance learning and public policy and disseminate studies. 1 , 4 Over the next 15 years, the framework aims to achieve the substantial reduction of disaster risk and losses in lives, livelihoods and health and in the economic, physical, social, cultural and environmental assets of persons, businesses, communities and countries. Voluntary commitments with a specific public health focus that have been agreed include: enhancing the resilience of national health systems through training and capacity development; strengthening the design and implementation of inclusive policies and social safety-net mechanisms, including access to basic health care services towards the eradication of poverty; finding durable solutions in the post-disaster phase to empower and assist people disproportionately affected by disasters, including those with life threatening and chronic disease; enhancing cooperation between health authorities and other relevant stakeholders to strengthen country capacity for disaster risk management for health; the implementation of the International health regulations (2005) 7 and the building of resilient health systems; improving the resilience of new and existing critical infrastructure, including hospitals, to ensure that they remain safe, effective and operational during and after disasters, to provide live-saving and essential services; establishing a mechanism of case registry and a database of mortality caused by disaster to improve the prevention of morbidity and mortality and enhancing recovery schemes to provide psychosocial support and mental health services for all people in need. The framework requires coordinated action across local, national, regional and international levels. Synergies across disaster risk reduction, the sustainable development goals and climate change policy need to be better recognized. This could considerably enhance management of disaster risks through capacity development and joint policy initiatives between the health sector and other sectors. 8
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              Disaster health-related challenges and requirements: a grounded theory study in Iran.

              Despite frequent disasters caused by natural hazards, concern has been raised regarding the effectiveness of disaster health services in disaster-prone countries such as Iran. The purpose of this study was to explore, in relation to health disaster management, the experiences and perceptions of individuals who responded or were affected by a recent Iranian earthquake disaster.
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                Author and article information

                Journal
                J Educ Health Promot
                J Educ Health Promot
                JEHP
                Journal of Education and Health Promotion
                Wolters Kluwer - Medknow (India )
                2277-9531
                2319-6440
                2020
                28 February 2020
                : 9
                : 38
                Affiliations
                [1 ] Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
                [2 ] Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
                [3 ] Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
                [4 ] Resource Development of Shafa' (Healing) Neuroscience Research Center, Tehran, Iran
                [5 ] Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
                [6 ] Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran
                Author notes
                Address for correspondence: Prof. Hamid Reza Khankeh, Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Kodakyar Ave, Daneshjo Blvd, Evin, Post Code: 1985713834, Tehran, Iran. E-mail: hamid.khankeh@ 123456ki.se
                Article
                JEHP-9-38
                10.4103/jehp.jehp_510_19
                7161681
                965d5a0e-5743-4c94-a6ec-0055330e030b
                Copyright: © 2020 Journal of Education and Health Promotion

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 04 September 2019
                : 08 October 2019
                Categories
                Original Article

                challenge,content analysis,early warning system,health sector

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