Title: NIHR Global Health Research Group on Building Partnerships for Resilience: strengthening responses to health shocks from the grassroots
Funder: Department of Health and Social Care

Abstract: BACKGROUND_x000D_ Recent decades have seen increasingly unpredictable outbreaks of zoonotic and emerging infectious diseases and an increased unpredictability of temperatures, rainfall patterns and extreme weather events. There is growing evidence that these are connected. A rise in frequency of zoonotic infections appears to be associated with the degradation of biodiversity through human action. Local level temporal climatic changes may have a significant effect on infection risks. Climate change is leading to altered patterns of vector-borne diseases and is affecting arable land and food systems, often accelerating environmental degradation and affecting food and water security. All of these issues combine to negatively impact health. The uncertainty of these crises makes it difficult to plan and meet the needs of populations facing them. Local action is key to establishing early crisis-response but there is little robust evidence on “what works” or “why it works” or on how formal structures can support and sustain local action. _x000D_ Through partnership, our multidisciplinary Group will gather evidence from Ethiopia, Madagascar, Sierra Leone and Uganda, where our partners have highlighted the importance of community responses to infectious disease outbreaks. We will analyse the relative effectiveness of different approaches to test our hypothesis: “the most effective crisis-responses are those where robust mechanisms and processes are in place to enable health systems actors and communities to co-produce and co-deliver their response”._x000D_ AIMS AND OBJECTIVES_x000D_ Our overarching strategic aim is to:_x000D_ • Develop and strengthen a newly expanded international partnership to conduct research to inform policy and practice that improves effective community-led responses to public-health crises._x000D_ Our five objectives, are to:_x000D_ 1) Synthesise evidence on how communities, local health systems and other formal and informal entities have responded to health crises, and with what effect._x000D_ 2) Develop effective approaches for public health crisis-response at grassroots._x000D_ 3) Evaluate models for effective community-led responses to public-health crises. _x000D_ 4) Formulate guidance and create dialogue with stakeholders on how to strengthen local resilience for effective responses to public health crises._x000D_ 5) Strengthen and consolidate sustainable partner research and management capacities to strengthen policy and practice in crisis-response._x000D_ METHODS_x000D_ Y1: Narrative synthesis of literature from databases and websites of Government, UN, donor and third sector agencies. Meta-Synthesis of existing qualitative and epidemiological datasets (COVID-19; Ebola; environmental disasters and stresses) held by partners._x000D_ Y2: Develop evaluation indicators measuring effectiveness of community-led responses and evidence-based prototype response models for testing._x000D_ Y2-3: Case studies of models identified as effective during evidence synthesis: in-depth interviews and focus groups; ethnographic work in district health offices and village communities. _x000D_ If outbreaks/health crises occur during project implementation we will prospectively implement and evaluate prototype approaches: same methods as for case studies._x000D_ IMPACT_x000D_ Partners are well connected to wide ranging stakeholders from health, environment and crisis-response whom we will engage in dialogue on our evidence. Our cross-country lessons, indicators and guidance will inform improved resilience of responses to public health crises

Lay abstract: AIM_x000D_ To develop and strengthen an international partnership to conduct research to inform policy and practice that improves effective community-led responses to environment-related public-health crises. _x000D_ _x000D_ BACKGROUND_x000D_ Human health and wellbeing face threats from increasingly frequent and disruptive shocks, including outbreaks (some pandemic) of zoonotic infections (Ebola, Covid19) and severe environmental change, heightened by climate change, that lead to changes in food security, disease patterns and disasters. These challenges are interconnected, yet policy and governance systems have failed to achieve holistic, cross-sector responses. Unpredictability of crises makes it hard to plan for them. Social science work has shown that resilience for responding to shocks is most effectively built at community level. However, no robust data exist on the mechanisms by which formal health and other sectors can engage with, learn from and support resilience-building at the grassroots, to develop effective health responses. Our Group will gather evidence from Ethiopia, Madagascar, Sierra Leone, Uganda, which have experienced a range of public health crises._x000D_ _x000D_ DESIGN AND METHODS_x000D_ Our multi-disciplinary, comparative case-study approach will apply cutting edge combinations of social science methods, across five objectives over three years:_x000D_ _x000D_ 1) Synthesise evidence on how communities, local health systems and other formal and informal entities have responded to health crises, and with what effect:_x000D_ Narrative synthesis of literature from databases and websites of Government, UN, donor and third sector agencies. Synthesis of existing qualitative and epidemiological datasets (COVID-19; Ebola; environmental disasters and stresses) held by partners._x000D_ _x000D_ 2) Design effective approaches for public health crisis-response at grassroots:_x000D_ Identify common principles of effective responses; develop evaluation indicators measuring effectiveness; design prototype response models (i.e. ideal evidence-based approaches that are likely to effectively establish and sustain community-led public health responses)._x000D_ _x000D_ 3) Evaluate models for effective community-led responses to public-health crises. _x000D_ Case studies of models identified as effective during evidence synthesis: in-depth interviews and focus groups; ethnographic work in district health offices and village communities. _x000D_ If outbreaks/health crises occur during project implementation we will prospectively implement and evaluate prototype approaches: same methods as for case studies._x000D_ _x000D_ 4) Formulate guidance and create dialogue with stakeholders on how to strengthen local resilience for effective responses to public health crises._x000D_ _x000D_ 5) Strengthen and consolidate sustainable partner research and management capacities to strengthen policy and practice in crisis-response._x000D_ _x000D_ COMMUNITY ENGAGEMENT_x000D_ Community engagement is central to our research questions, process and results: e.g. “citizen science” approaches, grassroots innovation, and identifying common drivers of success. Community members will be involved and trained as volunteers/researchers._x000D_ _x000D_ DISSEMINATION_x000D_ Multiple pathways include: National (Ministries of Health, Agriculture, Environment, other sector Ministries; Population-Health-Environment (PHE) networks); Global/Regional (academic networks; emergency response organisations; funding agencies; WHO).

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: GENERIC HEALTH RELEVANCE