Building resilience to floods and heat in the maternal and child health system in Brazil and Zambia (REACH)

Impacts of heat and flood on maternal and child health service use and the affordability of care

We are examining the evidence for the effect of floods and heat on maternal and child health care use and the affordability of care. The realist informed systematic review will explore the health system pathways by which flood and heat events undermine service use. We are undertaking analyses of secondary health data to quantify the impacts of flooding and heat on maternal health service use and financial protection in Zambia and Brazil. 

Understanding health system resilience to floods and heat

We will identify and map drivers of maternal and child health (MCH) system vulnerability and resilience to floods and heat in four health centres in two districts in each country. First, we will develop locally relevant climate scenarios for flood and heat and their compound effects, drawing on the results of Objective 1 together with a review of policy documents; in-depth interviews and focus group discussions (FGD) with stakeholders at community, facility and district/municipality levels. Second, we will conduct a household survey to determine the effects of floods and heat on community-level dynamics influencing demand for MCH services. Third, we will conduct group model building workshops with stakeholders from district, facility and community levels to produce causal loop diagrams (CLDs) that identify the most vulnerable MCH system elements.

Identifying and costing interventions to build resilience to floods and heat

We will review current evidence on adaptation strategies that will reduce the impacts of heatwaves and floods on maternal and child health services. We will work with stakeholders and use MCDA (multi-criteria decision analyses) to prioritise the interventions using information on impact, acceptabiltiy and feasibility. We will explore the acceptability, feasibility and trade-offs for top ranking interventions, and measure their incremental financial and economic costs and options for funding them.

Modelling to evaluate the effects of floods, heat and resilience building interventions on health service delivery

Quantitative simulation models will be developed from the CLDs (causal loop diagrams) in objective 2, with system dynamics modelling, focussing on processes that drive supply of services. Agent based modelling (ABM) will explore the community dynamics related to care seeking and health system dynamics surrounding referrals.  Model parameters and equations will be derived from objectives 1-3, supplemented with  local data and literature. Iterative consultation with stakeholders will take place throughout model development to inform and validate model assumptions and to identify relevant scenarios supporting decision making. 

Development of user-friendly decision-support tool for subnational stakeholders

We will develop user-friendly interfaces for decision makers to interact with the models and explore how changes in climate risk scenarios, context and resilience building interventions affect outcomes, and to identify priority interventions for their setting. We will also identify monitoring indicators that can be integrated into National Vulnerability and Adaptation Assessment tools.