Heatwaves and floods are already killing people in the slums of Freetown, Dhaka, and Karachi, and local health clinics are not ready for them. This project addresses a critical gap: the World Health Organization’s framework for climate-resilient health systems has never been adapted for the informal urban settlements where hundreds of millions of people live in low- and middle-income countries. Existing health services in these areas are often inaccessible and collapse during extreme weather, yet no one has systematically tested how to strengthen them from the ground up. The researchers will work directly with slum communities, health workers, and city officials to co-design and test practical interventions—such as early warning systems linked to clinics, mobile health teams, or stockpiles of emergency supplies. If successful, the approach could reshape how urban health systems prepare for climate shocks, not just in these three cities but across the global South. The project is applied and participatory, not fundamental science: its success will be measured by whether clinics stay open and people survive the next storm.
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Research Title: Strengthening responsiveness of health services provision to extreme weather events for urban marginalised people Summary: Research question: How can participatory action research (PAR) facilitate improvements in the preparedness, responsiveness of health service delivery to address adverse health impacts of extreme weather events among urban marginalised communities in Low- and Middle-income countries (LMICs)? Background: The Intergovernmental Panel on Climate Change identifies that the greatest gains in well-being will be achieved through reducing the risks faced by marginalised people in urban contexts. Existing health services in these contexts are often inaccessible, unprepared for and unable to cope during extreme weather events. The WHO framework on climate resilient health systems has not been operationalised in informal urban settings in LMICs, and it is currently unclear how health services in informal urban settings may be strengthened to enable preparedness and adaptation. Aim: To collaboratively design, implement and evaluate context sensitive interventions to improve the preparedness and responsiveness of health service delivery in the context of extreme weather events through equitable partnerships with urban marginalised people, health system and relevant governance actors. Objectives: To retrospectively assess the health and social vulnerabilities and health service impacts of specific recent extreme weather events for urban marginalised people. To assess the preparedness and capacities of health systems for health service delivery during and following extreme weather events based on existing frameworks, policies, tools, and mechanisms. To work with communities, health system and governance actors to co-produce and implement a package of research-informed interventions to strengthen health service preparedness and delivery for urban marginalised people during and following extreme weather events. To assess and strengthen the capacities of researchers, community groups, health system and governance actors, and their relationships and processes for working together equitably to improve responsiveness of health services to the health consequences of extreme weather events. To collaboratively monitor and evaluate implementation of the intervention package (see 3) within and across city and country contexts for feasibility, fidelity, costs, and enabling/constraining factors across diverse contexts. To promote uptake of project learning by health system actors, communities, other stakeholders, and global health researchers. Study design & methods: We will use a Participatory Action Research (PAR) methodology and a mixed methods research design. The design corresponds to dimensions of the WHO operational framework for climate resilience across the health systems building blocks and will be actualised in five phases. Timelines for delivery: Phase Year 1 Year 2 Year 3 Phase 1: Participatory research design Phase 2: Formative research Phase 3: Participatory intervention development Phase 4: Intervention implementation Phase 5: Final dissemination
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