Community: Khalilabad Country: Islamic Republic of Iran Population: 48686 Starting the safe community movement: 1996 Institution: Primary Health Care Network of Khalilabad Address: Primary Health Care Network, Imam Khomeini Street, Khalilabad, Khorasan Razavi Province, Islamic Republic of Iran. Zip Code: 9677115565 Tel: (+98) 5327727310-2 Fax :( +98) 5327727315 E-mail: [email protected] Mohammad Ali Mahdinejad: Governor& Head of Safe Community committee in Khalilabad Dr. Seyed Mehdi Hashemi: Head of Primary Health Care Network and Secretary of the Safe Community committee of Khalilabad Dr. Hassan Makarem: Senior Injury Expert & Technical Consultant of Safe Community movement in Khalilabad Engineer Javad Torkaman Nejad Sabzevari: Head of Secretariat of Safe Community committee of Khalilabad Introduction: Despite the fact that injuries consume a large number of health care resources, at least 5 million people worldwide die from injuries each year. (A mortality rate of 83 per 100,000 populations) Injuries account for 9% of world’s death and 12% of world’s burden. More than 90% of deaths occurred in low and middle income countries. In Islamic Republic of Iran as a middle income country (Gross National; income per capita =$ 3470), injuries are the first cause of burden (DALY=1962.9) and second cause of death (YLL=1259.4). On the other hand, the safe community is known as a community based solution oriented model in which community creates the capacity to address its disaster and injury challenges in a thoughtful and practical way. In this model there is a shift from individual to community based, to ensure everyone in the society is involved. This movement has been started in Khalilabad from 1996. We believe that Khalilabad can achieve the standards of an international safe community model regarding putting people and processes in place to ensure that a blend of strategic activities and community involvement will have a significant impact on the rate of its injuries wherever and however they occur. So that, the whole community, government and non government organizations that have a vested interest in community safety have become the main stakeholders. A summary of the Community: Khalilabad has been separated from Kashmar in 29th June 2002. This city is located on the southern part of Khorasan Razavi province and its antiquity as an urban spot traces back to 40 years ago. On the average, its about 1767.5 square kilometers, 975 meters above the sea level. The population of Khalilabad has been reported 48686 by the Statistical Center of Iran in 2009. Khalilabad is about 1000 kilometers far from Tehran and 240 kilometer far from Mashad. This city leads to Kashmar(115th international safe community) from the east and the north, to Bardaskan(136th international safe community ) from the west and to Gonabad and Mahvelat from the south and it contains two districts. 1. Khalilabad is the center of the main district that consists of two rural regions (Rastagh County with Ebrahimabad as its center and Dehestan County with Nasrabad as its center). 2. Sheshtaraz district with Kondor as its center consists of two districts (Sheshtaraz County with Kondor as its center and Kavir county Sa'dodin village as its center). This city benefits from the proximity of the mountains, valley, and desert having very cold winters, pleasant springs, mild summers, and beautiful autumns. Economically, it relies on agriculture, animal husbandry, and handicrafts. Population: Based on the latest census (2009), the population is about 48686 out of which 33130 (68.5%) in rural areas and 15556 (31.95%) in urban area. 23.37% are under 14 years old, 25.5% between 15 and 24 years old, 41.28% between 25 and 59 years old and 9.85% are above 60 years old. Male to female ratio is about 104.5, the average number of people per family is 2.4, 16.15 percent of the whole population are students, and the percentage of literacy is 93.53. The reasons for running a committee to promote safety& prevent injuries are: • Injuries are the second cause of death after cardiovascular disease in khalilabad. • Injuries (especially road traffic injuries) are the leading cause of burden. • Road traffic injuries cause high amount of years life lost and financial damages because high occurrence in the young age groups and breadwinners. • Most of Injuries are predictable and preventable with a simple intervention. • Islamic Republic of Iran is a disaster prone country, though it is almost impossible to fully recoup the damage caused by the disasters, we need to be prepared in order to minimize the potential risks. A summary about beginning of the movement: A Safe Community is one which reflects the passion and commitment of people who dream of a community that is free of injury and prepared for disasters, and who dare to commit to do something tangible to realize that dream. The safe community movement was started in Islamic Republic of Iran in the level of province in 1996. This pattern was piloted from 1997-1999 in Kashmar(khorasane Razavi), lahijan (Gilan), Booshehr (Booshehr), Shazand (Markazi) and Eslamshahr (Tehran). At that time khalilabad was a part of kashmar. This movement was followed till now and will be continued. Based on the Statistics: • Based on the injury registry and Statistics in 1998: Population based: 46473 (urban areas: 8277, rural areas: 38196) Number of injuries: 2109 A) The most common cause of injury was fall from same and different level(28.12%), followed by penetrating trauma (16.36%) and Road traffic injuries (12.85%). B) the most common type of injury was Cut, tear and scratch (43.48%), followed by Burning (15.12%). C) The most common field of injury was home (60.56%), followed by Street and road (10.38%). D) 61.02% injuries occurred in rural areas. E) Males were the most vulnerable group. (70.14%) F) 81.60% of the victims were recovered. G) the most vulnerable age groups were 0-9 years old (26.69%), followed by 10-19(25.98%) and 20-29 years old (15.98%). According to this data, the priorities were set as followings: 1. Home safety. 2. Road safety. 3. Child & young hood safety. 4. Prevent intentional injuries (emphasizing on violence & suicide). Goals of the program: A) Main purpose: Prevent injuries and promote safety and well being of all the citizens. B) Objective goals: 1. Reduce number of the injuries about 25% during the first three years after the beginning of the movement. 2. Reducing the mortality rate of injuries. (YLL: Year’s life lost) 3. Reducing the disabilities due to injury. (YLD: year’s life disability) Strategies: 1. Advocacy: sensitizing the policymakers around the communities for injury prevention & safety promotion. 2. Community engagement: a comprehensive and thoughtful plan to inform the community as the key stakeholders. 3. Capacity building: increasing public awareness. 4. Injury surveillance: ongoing, systematic data collection, interpretation and dissemination of data for public health actions to reduce the occurrence and severity (morbidity and mortality) of injuries 5. Epidemiologic investigation in order to determine the risk and protective factors. 6. Highlighting the vulnerable groups & risky behaviors in order to implement evidence based and solution oriented interventions. 7. Priority setting in the field of injury prevention & safety promotion. 8. Determining the responsibilities of each stakeholder. 9. Prepare disaster and injury prevention guidelines. 10. Providing appropriate and on time emergency service and medical care. 11. Ongoing participation the Safe Communities networks. The international indicators of the safe community: 1. An infrastructure based on partnership and collaborations, governed by a cross- sectional group that is responsible for safety promotion in their community; 2. Long-term, sustainable programs covering both genders and all ages, environments, and situations; 3. Programs that target high-risk groups and environments, and programs that promote safety for vulnerable groups; 4. Programs that document the frequency and causes of injuries; 5. Evaluation measures to assess their programs, processes and the effects of change; 6. Ongoing participation in national and international Safe Communities networks. The six Indicator s of safe community: 1. An infrastructure based on partnership and collaborations, governed by a cross- sectional group that is responsible for safety promotion in their community Regarding the national action plan, a safe community committee was formed. The governor (Mohammad Ali Mahdinejad) as the head of the committee, the manager of primary health care network (Dr. Seyed Mehdi Hashemi) as the secretary of the committee, and other stakeholders as the members of the committee are running their responsibilities. The secretariat is located in Center of disease control (CDC) of the Medical University. The junior injury expert of the medical university in the province level is responsible as the coordinator of the meetings. Health and medical and social welfare commission of city Safe community ... … committee of the city Training & Research subcommittee School Safety Subcommittee Work safety Subcommittee Home Safety Subcommittee Social Safety Subcommittee Road Traffic Subcommittee Information & Statistical Data Analysis Subcommittee Monitoring & Evaluation Subcommittee Members of Safe community steering committee of khalilabad are: The governor, head of primary care network, head of education department, religious leader (Imam Jome), Injury experts of medical university, The