NIHR Global Health Research Group on Building Partnerships for Resilience: strengthening responses to health shocks from the grassroots

BACKGROUND

Recent decades have seen increasingly unpredictable outbreaks of zoonotic and emerging infectious diseases and an increased unpredictability of temperatures, rainfall patterns and extreme weather events. There is growing evidence that these are connected. A rise in frequency of zoonotic infections appears to be associated with the degradation of biodiversity through human action.

Local level temporal climatic changes may have a significant effect on infection risks. Climate change is leading to altered patterns of vector-borne diseases and is affecting arable land and food systems, often accelerating environmental degradation and affecting food and water security. All of these issues combine to negatively impact health.

The uncertainty of these crises makes it difficult to plan and meet the needs of populations facing them. Local action is key to establishing early crisis-response but there is little robust evidence on “what works” or “why it works” or on how formal structures can support and sustain local action.

Through partnership, our multidisciplinary Group will gather evidence from Ethiopia, Madagascar, Sierra Leone and Uganda, where our partners have highlighted the importance of community responses to infectious disease outbreaks. We will analyse the relative effectiveness of different approaches to test our hypothesis: “the most effective crisis-responses are those where robust mechanisms and processes are in place to enable health systems actors and communities to co-produce and co-deliver their response”.

AIMS AND OBJECTIVES Our overarching strategic aim is to:

• Develop and strengthen a newly expanded international partnership to conduct research to inform policy and practice that improves effective community-led responses to public-health crises. Our five objectives, are to:

1) Synthesise evidence on how communities, local health systems and other formal and informal entities have responded to health crises, and with what effect. 2) Develop effective approaches for public health crisis-response at grassroots. 3) Evaluate models for effective community-led responses to public-health crises.

4) Formulate guidance and create dialogue with stakeholders on how to strengthen local resilience for effective responses to public health crises.

5) Strengthen and consolidate sustainable partner research and management capacities to strengthen policy and practice in crisis-response. METHODS

Y1: Narrative synthesis of literature from databases and websites of Government, UN, donor and third sector agencies. Meta-Synthesis of existing qualitative and epidemiological datasets (COVID-19; Ebola; environmental disasters and stresses) held by partners.

Y2: Develop evaluation indicators measuring effectiveness of community-led responses and evidence-based prototype response models for testing.

Y2-3: Case studies of models identified as effective during evidence synthesis: in-depth interviews and focus groups; ethnographic work in district health offices and village communities.

If outbreaks/health crises occur during project implementation we will prospectively implement and evaluate prototype approaches: same methods as for case studies. IMPACT

Partners are well connected to wide ranging stakeholders from health, environment and crisis-response whom we will engage in dialogue on our evidence. Our cross-country lessons, indicators and guidance will inform improved resilience of responses to public health crises