RESHAPE: RESilience in HeAlth Post-Extreme weather events

The frequency and intensity of extreme weather events (EWEs) are increasing and will continue to increase due to Climate change. EWEs impact on health through direct consequences such as injury or heat exhaustion. Wider impacts include impaired delivery of healthcare due to, for example, transport issues preventing access to hospitals and clinics and loss of essential power and water supplies. Further impacts emerge from longer-term effects. Following EWEs, health services may struggle with ongoing repairs and backlogs of elective cases. Such lingering effects are frequently under-recognised. Designing health services that are resilient to EWE is key to reducing impacts. But much research on health service resilience to EWEs has focussed on high-income countries and practical guidance for LMICs is under-researched. It is therefore unsurprising that existing frameworks for building climate resilient health systems in LMICs, including those published by the World Health Organization, would benefit from a stronger evidence base. Therefore, this research aims to enhance the evidence base to design strategies for Healthcare Resilient services in LMICs. We build strongly on the 2012 IPCC Special Report on managing the risks of EWEs by following several key recommendations: a portfolio of actions to reduce risk; a multihazard risk management approach; and the importance of integration of local and scientific knowledge. Our research sits at the interface of several globally-established priorities in international development policy, including health and wellbeing (SDG3), clean water and sanitation (SDG6), infrastructure (SDG9) and climate action (SDG13). Our four-phase research plan was developed at a participatory workshop in Malawi combining public, patient and carer representatives from Malawi, Uganda and Tanzania, with academics from Vietnam, Malawi, Tanzania and Uganda and UK. In the first phase, systematic reviews and fuzzy-set qualitative comparative analysis will collate, synthesise and improve knowledge of the effects of EWEs on healthcare systems globally and of factors affecting healthcare system resilience. We will then apply mixed methods research to generate understandings of healthcare systems and their response to EWEs in our four case study areas within Malawi, Vietnam, Tanzania and Uganda. Building on this baseline analysis, we will deploy a novel integration of business continuity planning, resilience engineering and participatory research methods to develop and deliver a set of tools for EWE mitigation preparedness, response, recovery for Healthcare Resilient Services. In the fourth phase these co-designed tools will be evaluated, targeting individual facilities at primary, secondary and tertiary levels to enhance Healthcare Resilience. This work will create learning and action principles that are useful within these countries and transferable between LMICs. To ensure our work is translated for and delivered to the corresponding areas of international policy, our research will engage continuously with stakeholders throughout and outputs delivered in Phase 4 will be targeted at addressing key gaps in Healthcare System Resilience frameworks. To help enhance research capacity in the global south, as the project progresses co-creation of research activities and project leadership will increasingly transfer to Southern partners.