'Crises Highligil and Zambia (REACHht' Building resilience to floods and heat in the maternal and child health system in Braz)

Climate change is affecting health systems around the world, with those in low and middle income countries (LMIC) at particular risk due to limited health resources and greater exposure to climate hazards such as floods and extreme heat. Mothers and children are especially vulnerable to the effects of floods and heat, and they require access to routine and emergency services, which can be compromised by these hazards. Our project is focused on understanding the health system that provides services to mothers and children. This includes the people, resources, and activities that are involved in delivering services. We want to better understand the characteristics that make this system vulnerable to floods and heat, as well as the characteristics that make it resilient - able to absorb, adapt or transform - when faced with these hazards. By doing this, we hope to protect the health of mothers and children over the long term. Existing studies often focus on the effect of individual hazards on individual elements of the maternal and child health (MCH) system (such as health workers, or the number of services delivered) after the hazard occurred. However, health systems evolve over time, and comprise interconnected elements with feedback (where outputs of the system affect inputs). Further, climate hazards can occur together or sequentially, with implications for the MCH system.

We will use system science methods which help us better understand how complex systems work and how we can make them work better. These methods have been used in health systems and environmental research and have great potential to help us understand how health systems function and respond to climate hazards and resilience building interventions over time. We will use causal loop diagrams (CLDs) - visual representations of system elements and their interconnections - and two types of mathematical models: a model of how the MCH system functions in terms of the overall flows of patients and drugs and supplies (a system dynamic model - SDM) and a model of the way community members and facilities interact and behave (an agent-based model- ABM). These models will then be integrated to provide a more holistic picture of the MCH system. The research will be carried out in Zambia and Brazil, two LMIC which are vulnerable to floods and heat, but which differ in terms of MCH care. This will allow us to explore how context affects health system vulnerabilities and responses.

The research comprises a number of stages. First, will examine the relationship between floods and heat and MCH service outcomes and the affordability of health care. Second, we will define the MCH system and how flood and heat interact with it and affect service delivery, identifying vulnerabilities, and points of intervention to reduce these using CLDs. Then, we will identify potential interventions to build climate resilience, their feasibility acceptability and cost, and a plan for their financing. Next, we will build an SDM and ABM and an integrated model to quantify the effects of flood and heat scenarios on MCH service delivery and demand and the impact of resilience building interventions. Scenarios describing flood and heat events and their interactions with the MCH system, the CLDs and the models will be produced through repeat engagement with stakeholders at community, health facility and district levels, using surveys, in-depth interviews and participatory workshops. We will also use evidence from literature and existing household and facility data in each country. The model will be designed so that it can be used by decision makers at the local level to guide intervention selection and indicators to monitor the MCH system in relation to floods and heat. The project builds on a strong existing partnership and comprises a unique interdisciplinary team.