Disaster preparedness and service continuity in primary healthcare centers: a systematic review and structured contextual evidence synthesis

Abstract

Background Primary healthcare centers (PHCs) are a key health-system contact for disaster-affected populations, yet direct PHC evidence remains thin and is frequently conflated with hospital, workforce, policy, and secondary-review literature. Objective To identify factors, barriers, facilitators, capacities, and operational gaps shaping PHC disaster preparedness; contrast component profiles against a structured contextual synthesis; characterize what is operationally distinctive about PHCs; and propose a PHC-derived layered model. Methods A systematic review, supplemented by a structured contextual evidence synthesis, was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and Synthesis Without Meta-analysis (SWiM) principles. The primary Scopus search plus preserved supplementary retrieval from PubMed, ProQuest, and OpenAlex, followed by a pre-submission full-text update, duplicate reconciliation, and independent confirmation by two reviewers, yielded 74 unique publications: 15 primary empirical PHC studies and 59 contextual publications. Evidence was mapped descriptively to the 10 World Health Organization Health Emergency and Disaster Risk Management (Health EDRM) components; all 15 primary PHC studies were independently appraised by two reviewers using design-specific Joanna Briggs Institute (JBI) tools or the Mixed Methods Appraisal Tool (MMAT) 2018. Results All 10 Health EDRM components were assessed across the 15 primary PHC studies. The most frequently identified were human resources (14/15, 93.3%), planning and coordination (13/15, 86.7%), information and knowledge management (11/15, 73.3%), followed by health infrastructure and logistics and monitoring and evaluation (each 10/15, 66.7%). Distinctive PHC characteristics included small generalist teams, staff and family-readiness barriers, executable plans, referral dependence, continuity of basic utilities and water, sanitation, and hygiene (WASH) services, limited local stocks, community outreach, and regular facility-level monitoring. Conclusion PHC preparedness emerges as an interdependent capacity, with several distinctive PHC characteristics arising from specific Health EDRM components. Community capacities for Health EDRM were reported in only 40% of primary PHC studies, highlighting an under-reported area warranting further exploration. A layered model is proposed for center-level assessment and future instrument development, organizing system support, core preparedness capacity, service and community response, and cross-cutting information, communication, and monitoring as interacting domains linked to continuity of essential services. Systematic review registration Open Science Framework, https://doi.org/10.17605/OSF.IO/H8JU7 , Identifier: 10.17605/OSF.IO/H8JU7 .

The authors' abstract, as published at the source. Frontiers in Public Health, 2026 · DOI ↗