Nationwide Survey on Preparedness for the Health, Medical Care, and Welfare Coordination Headquarters of Local Governments in Japan

Introduction: Establishing an effective management system is crucial for preparedness against large-scale disasters. This study aims to assess the preparedness of the Health, Medical Care, and Welfare Coordination Headquarters (HQs) across local governments in Japan. Methods: In 2023, an email-based survey on disaster preparedness was conducted among 157 local governments in Japan, including 47 prefectures and 110 cities (including special wards) with health centers. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for government categories. The independent variable in the analyses was prior disaster experience, defined as events requiring the activation of disaster response headquarters after July 2017, when the Ministry of Health, Labour, and Welfare requested local governments to establish HQs. Results: Responses were received from 149 local governments (95%, including 46 prefectures and 103 cities). All prefectures (100%) and 77% of cities reported being prepared to establish HQs. However, only 54% of prefectures and 32% of cities conducted exercises for establishing or operating HQs. Additionally, 48% of prefectures and 47% of cities had established formats for assessing evacuation centers. The adjusted ORs (95% CIs) for conducting HQ exercises and for deciding assessment formats, with prior disaster experience as the independent variable, were 0.51 (0.24–1.13) and 1.61 (0.75–3.45), respectively. Conclusion: While most local governments have prepared to establish HQs for large-scale disaster response, the proportion conducting exercises remains low. Governments with prior disaster experience were less likely to conduct exercises, possibly because they were preoccupied with recovery efforts and found it challenging to design exercise programs that could surpass the effectiveness of real disaster experiences. Conversely, these governments were more likely to have predefined assessment formats, possibly due to their use during past disasters.