Achieving Health Service Delivery Resilience During Climate-Induced Disasters among the Most Vulnerable Communities in Mozambique

Background: Climate-induced disasters disproportionately impact the most vulnerable. Health service delivery disruption results in increased morbidity and mortality of those with underlying chronic conditions and those not able to withstand severe water and vector-borne illnesses. There is an urgent need for interventions to improve strengthen resilience, specifically improving access to health services, in the setting of climate-induced disasters in vulnerable communities. Mozambique is a country that is ranked highest on the global climate risk index report due in part to its repeated exposure to climate-induced disasters; there is an urgency to develop approaches to reduce morbidity and mortality due to health service delivery disruption. Aims and Objectives: Our aim is to actively engage community members and key stakeholders to develop an intervention that can reduce health service delivery disruption at the community, health facility, and district level in the most vulnerable communities in the setting of extreme weather events Mozambique. We achieve this with the following objectives: 1. Engage community members in participatory systems dynamic modeling to map out causes and consequences of health service delivery disruption in the setting of disasters; 2. Design a multi-component intervention to address the challenge; 3. Build a robust data surveillance system to provide the data needed to inform adequate preparedness and response; 4. Implement and evaluate a multi-component intervention to strengthen resilience of health system delivery; and 5. Build a cadre of faculty and staff in public health that can move the field of disaster preparedness and response as well as climate and health forward. Methods: We use robust systems science methods to develop intervention components for disaster preparedness and response, and then use an implementation science framework to guide our comprehensive evaluation. We have engaged community and stakeholders in development of this proposal and engage them throughout the research process. Timelines for delivery: By the end of year 1, we will deliver the causal loop diagram depicting the causes and consequences of health service delivery disruption in the setting of a disaster. This coupled with a description of the multi-component intervention to address the challenge. By the end of year 2 we will have implemented the novel intervention and built a data surveillance system to track communicable and non-communicable diseases in the setting of a disaster. By the end of year 3 we will have trained a cadre of faculty-staff in implementation and systems science who can help disseminate findings from our evaluation. Anticipated Impact and Dissemination: this project will provide a community-based approach to strengthening resilience of health service delivery in the setting climate-induced disasters. We will have provided Mozambique with information on an intervention that can be optimized for effectiveness, scale-up and scale out. In addition, we will have built a data surveillance system that integrates communicable and non-communicable conditions to optimize efficiency and provide much needed information to inform disaster response. Results will be disseminated through a report and meetings with stakeholders and community members, presentation at regional and international conferences, and peer-reviewed publications.