Strengthening public health system resilience to disasters in Türkiye: Insights from a scorecard methodology

Abstract

BackgroundTürkiye is a country that faces many disasters, especially earthquakes and floods, which have serious short- and long-term consequences for public health. The importance of disaster risk reduction activities in building resilience before a disaster strikes is increasingly recognized. Furthermore, resilience assessment is considered to be the starting point for these activities. However, there is a substantial gap in the scientific evidence on systematic assessments of the resilience of the public health system and also a serious lack of activities to strengthen the system against disasters in Türkiye. AimUsing a Scorecard methodology, the study aimed to systematically assess the resilience of the public health system in Türkiye by examining key indicators related to disaster risk management and preparedness, and subsequently to recommend priority actions. A systematic assessment of resilience can provide the scientific evidence needed to identify weaknesses in the system. Furthermore, identifying priority actions based on this evidence allows progress to be made towards strengthening the system. MethodsThis mixed-methods study was conducted in two separate regions of Türkiye with the highest earthquake (Esenler/Istanbul) and flood risk (Ortahisar/Trabzon). Based on the Scorecard methodology, two-stage workshops (online and face-to-face) were held. During the online stage, qualitative data were collected by interviewing participants about their evaluation of the situation in the counties regarding the Scorecard indicators, and quantitative data were collected through scoring. In the face-to-face stage, strategies were developed to improve the resilience of the public health system. Quantitative data were expressed with numbers and percentages, and thematic analysis was utilized for qualitative data analysis. ResultsThe lowest scoring indicators were as follows (Esenler and Ortahisar, respectively): addressing mental health needs associated with disasters (2.17 ± 1.29; 2.27 ± 1.16), resilience of key healthcare facilities (2.22 ± 0.55; 2.91 ± 1.08), and protection and identification of ecosystem services (2.39 ± 1.04; 2.13 ± 1.49). In this study, participants recommended increasing the resilience of the public health infrastructure and improving human resources and ecosystem services to ensure the resilience of the public health system. ConclusionsThe study found that the weakest areas in terms of public health system resilience were the seismic safety and infrastructure of health facilities, the capacity of disaster-related mental health services, and disaster-related ecosystem services. To improve the resilience of public health systems, it is essential to strengthen these areas of weakness and ensure collaboration between all stakeholders in the system. The identification of weaknesses in the study has guided the determination of priority actions to build a baseline of resilience. In addition, the results of the study have highlighted priority areas for investment to improve disaster response and the overall health of the population in the context of disasters.