Ul-Haq Zia, Shah Basharat Hussain, Ardakani Mohammad, Khan Saeed Akbar, Muhammad Saleem, Farooq Saeed, Khan Sardar Hayat, Huda Qudsia
Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
East Mediterr Health J. 2019 Oct 7;25(8):553-561. doi: 10.26719/emhj.18.072.
The World Health Organization (WHO) has strongly advocated health systems' preparedness for effective management of crisis situations globally for more than two decades. Pakistan is known for its high vulnerability to hazards and lack of coping and adaptive capabilities. Health systems' preparedness for locales with such high-risk profile is essential, yet there is a dearth of studies addressing the status of such preparedness in the country.
This study aimed to assess the status of preparedness of health-system components for crisis management in the most disaster prone districts of Pakistan.
A purposive sample of 12 of the most disaster prone districts in two provinces of Pakistan was evaluated for preparedness using the WHO's toolkit for assessing health-system capacity for crisis management. Six core functions of the Health Systems Framework, with a total of 229 indicators, were evaluated at the district management as well as secondary and tertiary health care facilities level. Proportions of indicators prepared were calculated and preparedness was classified as Acceptable (≥ 66%), Partial (36-65%) or Inadequate (≤ 35%).
Seventy-two percent, 95% Confidence Interval [46.0, 90.0] of indicators in these most vulnerable districts were evaluated as partially or inadequately prepared for appropriate management of crises. Even the highest scoring core function, Leadership and Governance was partially prepared with a score of 53.6% (52.4, 54.9). Process elements were found to be less prepared compared with structure components.
Federal level strategic planning, implementation, management and follow-up aimed at ensuring health-systems' preparedness need to be reviewed and strengthened.
二十多年来，世界卫生组织（WHO）一直大力倡导全球卫生系统做好应对危机局势的有效管理准备。巴基斯坦因极易遭受灾害且缺乏应对和适应能力而闻名。对于具有如此高风险特征的地区，卫生系统的准备工作至关重要，但该国缺乏针对此类准备状况的研究。
本研究旨在评估巴基斯坦最易受灾地区卫生系统各组成部分应对危机管理的准备状况。
使用WHO评估卫生系统危机管理能力的工具包，对巴基斯坦两个省份12个最易受灾地区进行了有目的抽样评估。在地区管理以及二级和三级医疗保健设施层面，对卫生系统框架的六项核心功能（共229项指标）进行了评估。计算已准备好的指标比例，并将准备状况分为可接受（≥66%）、部分（36 - 65%）或不足（≤35%）。
在这些最脆弱地区，72%（95%置信区间[46.0, 90.0]）的指标被评估为对危机的适当管理准备不足或部分准备不足。即使得分最高的核心功能“领导与治理”也只是部分准备好，得分为53.6%（52.4, 54.9）。与结构组成部分相比，流程要素的准备情况较差。
旨在确保卫生系统准备的联邦层面战略规划、实施、管理和后续工作需要重新审视并加强。
