NIHR RIGHT 5: Health service delivery during climate-induced disasters in vulnerable communities A low-and-middle-income-country (LMIC) award led by the National Institute of Health, Mozambique which aims to develop an intervention that can reduce health service delivery disruption at the community-level , service-level, and district-level in the most vulnerable communities of two provincial districts in Mozambique. Commencing in January 2024, the three-year award will involve the engagement of community members and stakeholders in participatory systems; dynamic modelling to map out causes and consequences of health service delivery disruption in disaster-affected settings; and the design of a multi-component intervention to address the challenge of extreme weather events in Mozambique. 

This multicomponent intervention will involve building a robust data surveillance system to provide the data needed to inform adequate preparedness and response, the implementation and development of the intervention, as well as capacity-building of public health sector staff that can progress the preparedness and response of health facilities and services during extreme weather events. The project has five objectives:

1. To outline the causes and consequences of disrupted access to equitable health care services by using two modelling approaches. Two groups of identified stakeholders will work together to identify variables considered to be causal factors, and those that are consequences of disrupted access to health services during extreme weather events in Mozambique.

2. To design interventions aimed at improving disaster resilience across health services through robust preparedness, response, and recovery strategies. The proposed intervention/strategy will be multi-component using a modified intervention mapping approach that will address critical weak points in disaster preparedness that lead to high morbidity and mortality.

3. To develop a robust and integrated data surveillance system, and methods to monitor and assess the impact of disasters on population health. A rapid assessment of data collection for non-communicable diseases will take place, followed by in-depth interviews with front-line data collectors, information technology staff and epidemiologists. With the information produced in this assessment, the current data surveillance system will be reprogrammed followed by a quick assessment of the feasibility of the system on a small scale. 

4. To implement and evaluate an integrated disaster preparedness response and recovery strategy to build climate-induced disaster resilience. Based on outcomes from objectives two and three, interventions will involve community, healthcare, and government-level individuals to implement the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to evaluate the multilevel intervention/strategy. Quantitative and qualitative data will be integrated using a narrative approach to provide a comprehensive understanding of the effectiveness and implementation of interventions to improve disaster resilience at multiple levels in the most vulnerable communities of Mozambique.

5. To strengthen capacity for integrated community-engaged research using systems science and implementation science methodologies among faculty members in Mozambique with interest and enough skills to continue working in climate and health.