Adaptations to strengthen healthcare delivery and resilience to extreme weather events in Southern Africa (ASTRA)

Background: Climate change is projected to further increase the number and severity of heat waves, floods and droughts, causing a disproportionate increase in injury, illness and death in resource-limited settings already burdened with wide-ranging health conditions.

While much is understood about the direct impact of extreme weather events (EWEs) on ill-health, less is known about indirect routes, such as population displacements and damage to infrastructure which could equally impact the health of vulnerable populations through interrupting access to or hindering health service provision.

Aim: ASTRA aims to engage and involve stakeholders, including the community, to co-design and deliver research that prioritises and evaluates interventions to strengthen community and health system resilience to the impacts of EWEs on vulnerable populations living with HIV and/or tuberculosis in Mozambique, South Africa and Zambia.

Our objectives are to: i) undertake community and health service vulnerability and adaptive capacity assessments; ii) design a Community Resilience Map, a software tool for coordinating community and health system response during EWEs; iii) strengthen the capacity of the health workforce to respond to EWEs; iv) develop a system dynamics model to evaluate the impact of co-created interventions to strengthen health service delivery; vi) quantify the value for money of identified interventions; vii) facilitate South-South and North-South sharing of best practice in research and advocacy in climate change and health.

Methods: We will use frameworks recommended by the WHO to investigate community and health system vulnerabilities to EWEs.

These frameworks will be augmented with the Driving Forces-Pressures-State-Impact-Response framework and Broad-Brush Surveys, both of which can be used to collect and integrate information on social, cultural, and economic aspects of environmental and human health into a single framework.

Data will be collected using a range of methods, including individual and key informant interviews, group discussions and analysis of policy documents.

System dynamics modelling will be used to evaluate impact of interventions, whilst multi-criterion decision analysis will be used to quantify value for money of identified interventions to strengthen health service delivery.

Timelines for delivery: Contracts and collaboration agreements, recruitment of administrative and research staff, registration of PhD students, and obtaining regulatory approvals will take place in Year 1.

Community and health system vulnerability assessments including evaluation of interventions and their value for money will take place in Years 1 to 4. Face-2-Face meetings of team ASTRA and the Scientific Advisory Board will occur in Years 1, 2 and 4.

Anticipated impact and dissemination: Our research is intended to generate long-term benefits at individual, community and policy levels by co-producing evidence that will strengthen the resilience of healthcare facilities to provide safe and quality care during EWEs.

Our Impact, Communications and Engagement strategy will identify important global, regional and national routes through which our research findings may be disseminated.

These will include hosting national and international meetings and conferences and attending and presenting symposia and papers at existing. academic and policy fora.

We will publish our results as peer-reviewed articles and look for opportunities to maximise their impact through public communication activities.