A Novel Tool to Assess the Preparedness of Disease Surveillance Systems in Disaster Settings: Lessons from Iran

Advance preparedness of a disease surveillance system (DSS) is crucial in its performance in emergency and disaster settings. The objective of this study was to assess the preparedness of DSS in a developing country setting (capital city of Tehran, Iran), using a systematic framework and a novel functional tool based on a review of the existing literature and WHO recommendations. Preparedness was defined in five major domains: disease surveillance process, communications, training, control, and resource allocation. Specific variables were defined for domains and a model was developed for quantification of the findings, assigning a score of 4 (least prepared) to 20 (most prepared) to each domain. To test the tool, a scenario was written describing conditions in the aftermath of a hypothetical earthquake, when Tehran West Health Center (country's largest public health organization), would be responsible for disease surveillance in its catchment area. Two distinctive questionnaires were designed to assess preparedness at headquarters and operational levels. They were completed at separate sessions with individuals in charge of DSS at various levels. Results were analyzed using the aforementioned model, showing very low overall system preparedness across the board (scoring 39.44/100). Inadequate DSS preparedness in Iran may be attributed to lack of a national policy for public health disaster preparedness and absence of statutory requirements for "disaster plans" at district and provincial health centers. Developing national and local preparedness policies and plans and training programs and drills are recommended in this setting to ensure appropriate DSS response by the health system.