NIHR RIGHT 5: Improving primary healthcare for patients with non-communicable diseases during flooding in India A UK and low-and-middle-income-country (LMIC) research partnership between University of Birmingham and Sree Chitra Tirunal Institute for Medical Sciences and Technology, India that aims to co-develop primary care interventions with communities and stakeholders, to improve preparedness and response for non-communicable diseases (NCDs) during flood-disasters in India.

India has the second highest rates of diabetes and heart disease globally. During flood-emergencies, patients may not receive their usual medicines or care from their doctor or hospital, interrupting the on-going care that is needed. Lack of medicines and stress or other illnesses due to floods cause conditions to get worse. The health system prepares for infectious diseases or injuries caused by disasters but has limited plans in place for dealing with these common diseases. This results in worsening health and increased complications, hospital admissions, and death. Floods have become more frequent, unpredictable, and severe, and current warning systems are inadequate to prepare the population or services adequately.

The research will involve surveys, discussions, and interviews with patients and health-workers, and observe how services work in Kerala districts during annual monsoon floods. Key stakeholders will be consulted to develop and test a practical, community-focused intervention to ensure that community members and primary healthcare services are better prepared for and can respond to the needs of patients with common long-term conditions during floods.

The ‘prepare-and-response’ intervention system will adapt existing, and develop new processes with communities and health-workers. Climate specialists will provide methods for future advanced flood forecasting. The development of the intervention will be tested across 20 flood-prone Kerala communities over two years. How well the community and health system are using the new ‘prepare-and-response’ system will be measured before comparing results with data gathered in the same district before the intervention, and with another district without the intervention. An assessment of the economic costs and benefits to patients and health systems with and without the system will be undertaken. Subsequent investigation involving Bihar state will take place to understand the context and prospective adaptation of the Kerala-based intervention.

Community members and stakeholders will be involved in the decision-making process in a culturally appropriate and inclusive way in all aspects of research and intervention development. Additionally, the project aims to influence policy-makers in other Indian states and share findings with other flood-risk countries through a targeted communication plan and engagement with expert partners, the United Nations, and other global agencies. The project has ten objectives: 

1. To conduct a situation analysis in Kerala to investigate the major flood-related non-communicable disease management challenges, including mapping healthcare service and patient needs.

2. Co-develop health system and community preparedness intervention components to manage non-communicable diseases 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 modelling 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.

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.