Hospital Safety Index Implementation in Indonesia: A Systematic Review of Evidence and Gaps in Disaster Preparedness

Abstract

Hospitals play a critical role in maintaining healthcare services during disasters. Indonesia is highly vulnerable to disasters, including earthquakes, tsunamis, volcanic eruptions, floods and other hazards due to its geographical characteristics. The World Health Organization's Hospital Safety Index (HIS) provides a standardized framework for assessing hospital preparedness and resilience. This systematic review aimed to analyze HIS implementation in Indonesia and identify persistent gaps in hospital disaster preparedness. We conducted the systematic review following the PRISMA 2020 guideline. Literature searches were performed in PubMed, Scopus, Web of Science, Science Direct and Google Scholar. We included studies published from 2021 to 2026 that evaluated hospital disaster preparedness using HIS or related frameworks. We synthesized data narratively across structural safety, non-structural safety, emergency management and organizational preparedness domains. Findings indicated that most hospitals demonstrated moderate to high preparedness, particularly in structural and non-structural safety. However, challenges remained in disaster simulation, communication systems, emergency management capacity, intersectoral coordination and workforce preparedness. Urban hospitals generally showed better preparedness than resource-limited facilities. HIS has supported disaster preparedness assessment in Indonesia; however, strengthening operation readiness, training, organizational resilience and integrating HIS findings into hospital management systems remain essential for sustainable healthcare resilience.