Warning system for Extreme weather events, Awareness Technology for Healthcare, Equitable delivery, and Resilience (WEATHER).

Extreme Weather Events (EWE s) in KwaZulu-Natal province, South Africa are increasingly common causing water-borne disease outbreaks, loss of homes, property and life.

A Predictive Warning System intervention (PWSi) is needed to alert communities increasing preparedness for floods, improving resilience of health services to predict, detect and respond to disease outbreaks.

Aim: To develop, implement and evaluate the efficiency and impact of PWSi in averting or reducing risk associated with EWE s.

Objectives: (1) Develop a community engagement and co-creation strategy informing Objectives 2-7. (2) Assess the relationship between EWE s, health risk agents and reported disease outbreaks. (3) Map/audit healthcare delivery organisations to establish capacity and training needs. (4) Develop a PWSi and pathogen and contamination management tool. (5) Support and deliver disaster management and intervention implementation training to health professionals (6) Evaluate the impact of the PSWi on EWE preparedness, system resilience and establish cost-effectiveness. (7) Build local research capability, strengthen knowledge transfer with other lower- and middle-income countries.

Methods: This transdisciplinary project will build on prior engagement with communities/health providers (e.g communities, professionals, policy makers) integrating a participatory, co-creation approach.

An over-arching intervention development framework will guide this project with evaluation conducted via a longitudinal, mixed methods approach in 4 Work Packages (WP). WP1: Systematic review of the literature investigating emerging trends in EWE s and infectious disease outbreaks.

Examination of water quality data will identify patterns of emerging pathogens and contaminants impacting on human health due to EWE s.

These data will inform the development of a pathogen and contaminant management tool assisting healthcare providers; adapted and piloted in WP3. WP2: Low-cost sensors will be deployed in 4 selected communities to measure climate indicators and input into the PWSi. An algorithm will combine historic disease data (identified in WP1) and current Department of Health data.

A mobile phone app will be developed to deliver alerts via PWSi to: (n=259,000 mobile phone users, coverage approximately 97%) WhatsApp groups, SMS messages or warning alerts via community sirens or community radio hubs.

A dashboard will be deployed within healthcare and disaster management departments to support decision making and planning resources.

WP3: will focus on strengthening capacity/resilience in healthcare systems and communities via training in disaster management and support for implementation of the PWSi.

WP4: A mixed methods, longitudinal process, outcome and economic evaluation will explore: PWSi effectiveness, local community and healthcare implementation experiences.

A combined Realist Evaluation (RE) and Social Return On Investment (SROI) approach will develop a programme theory, anticipated mechanisms of change and impact and estimate social cost benefit analysis to inform future sustainable and adaptable implementation via a continuous feedback loop established between work packages to inform refinement of the PWSi and intervention delivery.

Impact and Dissemination: Conference presentations and academic publications will be supplemented by stakeholder events with government, professionals and communities.

A communications strategy implemented throughout the study will impact local, national and international media (newspapers, radio, TV).

Training aids, decision tools, the PWSi (with implementation guide) for replication and positive impact on affected populations in the global South.