Flood season in India forces thousands of people with diabetes, heart disease, and lung conditions to go without medication or medical care for days or weeks at a time. This research tackles the gap between disaster response and chronic disease management—a problem that grows worse as climate change intensifies monsoon floods in states like Kerala and Bihar. The team will work directly with patients, health workers, and local authorities to design practical interventions that keep primary care running during floods. They will map where services break down, test a coordinated care model across 20 flood-prone health centres in Kerala, and build a flood-forecasting system tailored to health system needs. A parallel study in Bihar will test whether the same approach can adapt to a poorer, less resourced region. If successful, the project could produce a replicable blueprint for flood-resilient primary care in low- and middle-income countries. Patients would no longer face preventable hospitalisations or deaths simply because a flood cut off their insulin or asthma medication. The research also includes a health economic analysis to show whether investing in flood-preparedness for chronic disease care saves money overall—a calculation that could influence national health policy in India and beyond.
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Non-communicable diseases (NCD) pose a major challenge to sustainable development and high-risks of annual floods worsen their management in India. During flood-disasters medication access and ongoing care for patients with diabetes, chronic cardiac and respiratory diseases are interrupted, leading to exacerbations, hospital admissions, and death. We aim to co-develop with communities and stakeholders, primary care interventions to improve preparedness and response for NCDs during flood-disasters in India. Specific research objectives: 1__Mixed-methods situation analysis in Kerala to investigate the major flood-related NCD management challenges, including mapping healthcare service and patient needs. 2__Co-develop health system and community preparedness intervention components to manage NCDs during floods. 3__Implement and evaluate the complex-intervention model in Kerala. 4__Investigate co-adaptation of the complex-intervention model in Bihar through situation analysis, and community and stakeholder engagement activities. 5__Co-develop an integrated meteorological-hydrological modeling system to provide timely flood forecasts, integrated with the needs of the health system. 6__Estimate the potential costs and benefits of the complex-intervention with the health system, community, and meteorological-hydrological forecasting, including a societal perspective and the effect of flood-forecasting on this estimate. Cross-cutting, overarching objectives: 7__Engage stakeholders, patients, and communities in two-way exchanges of experiences and information that support their meaningful involvement. 8__Ensure capacity building across the range of research disciplines in our consortium. 9__Ensure comprehensive dissemination of the findings to key stakeholders and academics across states, national and global levels. 10__Ensure equitable partnership in governance and project management. A mixed-method situation analysis will be conducted in Kerala (household survey, camp clinic observations, focus group discussions and semi-structured interviews) to understand current practices and issues faced by the patients and health-workers/system in preparedness and management of NCDs during flood-disasters, the rate of exacerbations, inpatient and outpatient visits. After initial separate analysis, we will use Normalisation Process Theory (NPT) to triangulate qualitative and quantitative findings to establish barriers and facilitators to system improvement. Subsequently, working with communities, stakeholders and Theory of Change workshops, we will co-develop a multi-level complex-intervention with health system and patient/community components. We will then assess the intervention effectiveness during two consecutive flood seasons in a cluster randomised control trial design involving 20 flood-prone Primary Healthcare Centres in Kerala with cross-sectional surveys at baseline and follow-up. Furthermore, ongoing qualitative evaluation of the process outcomes, and barriers and facilitators of the intervention uptake will be conducted, consolidating the mixed-method findings through the application of the NPT. To examine the application of our intervention to geographically and socioeconomically different settings (less resources), we will conduct similar mixed-methods studies and NPT situation analysis in Bihar. We will work with patients and stakeholders to investigate adaptations needed for our complex-intervention to be implemented in Bihar. We will use past data to model an early geographically focused hydro-mereological flood forecasting system in Kerela (and adapt for Bihar), and conduct health economic evaluation of the benefits of our intervention with or without the flood-forecasting. We will include strong community and stakeholder involvement and engagement, national and international dissemination, and impact plans in all stages.
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