Strengthening the health workforce to respond to health impacts of climate crisis in Nepal and Zimbabwe

Background: Climate crisis is a global health threat. Heatwaves, droughts, floods and landslides cause substantial morbidity and mortality either directly or indirectly through infectious diseases, respiratory illnesses and food insecurity. The health workforce (HWF) is critical for supporting response to climate crisis through providing care and treatment and fostering development of climate-resilient communities.

However, there is evidence that the HWF has suboptimal resilience to climate crisis, particularly in low- and middle-income countries.

Aim: To strengthen the responsiveness of the health workforce against health impacts of climate crisis in Nepal and Zimbabwe. The specific objectives are: 1. To assess preparedness and capacities of health system actors to respond to climate crisis related health impacts

2. To co-create context sensitive and gender equitable interventions to improve HWF and community resilience to climate crisis related health impacts

3.To pilot the co-created interventions and evaluate them for equity, feasibility, effectiveness, costs, sustainability and scalability 4.To promote uptake of learning on climate crisis and health among health systems actors and researchers Methods: The study has six work packages.

Work package 1 (Months 1-6): Setting up. We will refine our consortium values and consolidate our partnerships with communities, health system actors and expert advisory committee. With partners we will refine our theory of change and co-develop our research protocols before obtaining ethical approval.

Work package 2 (Months 7-18): Formative research. We will conduct a scoping review on climate crisis impact on health and determinants of HWF responsiveness. We will conduct a policy analysis on content, actors, context and processes that influence HWF resilience to climate crisis.

We will conduct qualitative studies to explore perceptions on climate crisis and HWF resilience. Finally, we will survey i) health facilities, ii) health workers, and iii) communities, to determine knowledge and practices about climate crisis. The surveys will form the baseline of our intervention evaluation.

Work package 3 (Months 19-25): Intervention development. We will use findings from work package 2 to co-create interventions for improving HWF and community resilience to climate crisis. Possible interventions include training, performance management, establishing safe working environments, and strengthening links between communities and health workers.

Work package 4 (Months 26-48): We will pilot and refine the interventions through participatory action research. Qualitative studies will inform intervention refinement. We will conduct detailed costing of intervention development and implementation and an endline survey to determine impact of the intervention on health worker and community knowledge on climate crisis and health.

Work package 5: Throughout the study we will share findings with policy makers, managers, heath workers, community representatives and researchers.

Work package 6: Throughout the study we will conduct training and capacity strengthening at different levels: individual – supporting 4 PhDs and 4 MScs; organisational - strengthening CeSHHAR and HERD capacity for financial and project management, and governance; community - through our citizen science approach, training community members to conduct research.

Anticipated impact is improved HWF and community resilience to climate related health threats.