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Zambia. Upper Zambezi. Local village deserted because of floods. Credit: Anne & David (Use Albums) via Flickr

REACH

Building resilience to floods and heat in the maternal and child health system in Brazil and Zambia.

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About

REACH aims to develop decision tools to support preparedness measures at the district, facility and community levels in Brazil and Zambia, improving outcomes for Maternal and Child Health. REACH is a four-year inter-disciplinary research project funded by the Economic and Social Research Council (ESRC) and the Arts and Humanities Research Council (AHRC).  

Research

REACH uses system science methods to determine maternal and child health (MCH) system vulnerability to floods and heatwaves, and to identify, cost and evaluate adaptation interventions to enhance MCH outcomes. REACH has five research objectives.

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About
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REACH team

Project rationale

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.   

The REACH 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.  

Team overview 

We are an interdisciplinary team spanning research fields including health economics, health systems research, maternal and child health epidemiology, systems thinking, statistics, mathematics, computer science and engineering, disaster risk and resilience, policy engagement, knowledge translation and participatory research methods. 

Research
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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.

Who we are
REACH profiles
Profiles List
LSHTM

Josephine Borghi

health economist

Josephine Borghi is a health economist interested in understanding how policy reforms, climate and other shocks impact health systems, and how to strengthen systems towards UHC and resilience. Jo leads the Social Cohesion, Health and Wellbeing Group at the International Institute for Applied Systems Analysis.  She is also Professor at the London School of Hygiene & Tropical Medicine. 

Prof Anna Foss

Anna
Foss

Professor of Modelling for Public Health

Anna Foss’ methodological specialisms are mathematics, mathematical modelling, handling model uncertainty, and using agent-based modelling (ABM) to explore complex systems in public health. 

Dr Sari Kovats

Sari
Kovats

Associate Professor

Sari Kovats is an Associate Professor in the Department of Public Health, Environments and Society. Sari has a PhD in environmental epidemiology and is an expert on methods to assess the health impacts of climate change and knowledge translation for adaptation.

Dr Cherie Part

Cherie
Part

Research Fellow in Medical Statistics

Chérie Part is a Research Fellow in the Department of Public Health, Environments and Society. Chérie has a PhD in Veterinary Epidemiology. She is an expert in environmental epidemiology, and the development of statistical methods to assess the impacts of weather variability and climate change on human health. Cherie is leading Objective 1 with Dell.   

Sharif
Ismail

Clinical Assistant Professor

Sharif Ismail is a Clinical Research Fellow at LSHTM and a Consultant in Public Health Medicine practising in the UK. He has a PhD in health systems research from LSHTM.  Sharif is leading Objective 2 with Robert.  

Dr Fiammetta Bozzani

Fiammetta
Bozzani

Assistant Professor

Fiammetta Bozzani has a background in epidemiology and a PhD health economics. Her work is mainly in the area of economic and impact evaluation, with a practical focus on model-based analyses for supporting decision-making and resource allocation in low- and middle-income countries. 

Huiqi Chen

Huiqi Chen

PhD student

Huiqi Chen is undertaking PhD in Epidemiology and Health Statistics at Sun Yat-sen University, China. Huiqi is undertaking an 18-month research visit at LSHTM.   

Dr Sisay Debele

Sisay
Debele

Research Fellow

Sisay Debele a research fellow with over 10+ years in water systems, climate science, and nature-based solutions. He holds a PhD in Hydrology and Hydrodynamics, along with master’s degrees in Hydrology, Quantitative Water Management, and Meteorology. His skills include advanced statistics, data science, and climate change adaptation.

University of Zambia
Chitalu Chama Chiliba

Chitalu Chama Chiliba

Senior Researcher Fellow and Assistant Director

Chitalu Chama Chiliba co-leads the REACH Project. She is a Senior Researcher Fellow and Assistant Director at the Institute of Economic and Social Research at the University of Zambia.

Bridget Bwalya

Bridget Bwalya

Senior Lecturer

Bridget Bwalya is a Senior Lecturer, Researcher and Consultant in the Department of Geography and Environmental Studies, University of Zambia. She is a Fellow of the Food Systems Research Network (FSNET)-Africa and was previously a fellow of the African Women in Agricultural Research and Development (AWARD).  

Richard Bwalya

Richard Bwalya

Research Fellow

Richard Bwalya is a Research Fellow at the Institute of Economic and Social Research (University of Zambia) and is concluding his PhD thesis on the evolution of the determinants of food insecurity in response to policy changes in Zambia.  

Moses Ngongo Chisola

Moses Ngongo Chisola

geospatial scientist

Moses Ngongo Chisola is a geospatial scientist specialising in hydrology and climate science at the University of Zambia. He has a PhD in Water Resource Management from the University of Pretoria, South Africa.   

Simona Simona

Simona Simona

Researcher

Simona is a researcher and lecturer in the department of social work and sociology at the University of Zambia. His research focuses on the use of quantitative and computational social science methods to exam structural sources of disparities in social and health outcomes in sub-Saharan Africa. He holds a PhD in sociology and quantitative social science methods from the University of Glasgow.

Chris Mweemba

Chris Mweemba

Health Economist / Lecturer

Dr Chris Mweemba is a health economist, lecturer, and Head of Department – Health Policy and Management at the University of Zambia, School of Public Health (UNZA-SOPH).

University of Brazilia
Everton Nunes da Silva

Everton Nunes da Silva

Professor

Everton Nunes da Silva co-leads the REACH project. He is Professor of public health in the Department of Collective Health at the University of Brasilia, Brazil. His research focuses on issues related to health technology assessment, policy evaluation, health funding and public health.

Deivson Costa

specialist in Complex Systems Modelling

Deivson Costa is a specialist in Complex Systems Modelling from the University of Brasilia with a Masters in Public Health from the same university, working with techniques such as System Dynamics, Multiagent Modelling, Stock and Flow modelling and Complex Network Analysis and Geospatial Statistics.  

Helen Gurgel

Professor

Helen Gurgel is Professor of geoinformation in the Department of Geography at the University of Brasilia, Brazil. Her research covers the geography of health to help develop a program of space-time analysis based on climate, environmental and health data to support public policy.

Federal University of Grande Dourados
Leticia Russo

Leticia Russo

health economist

Leticia Russo is a health economist with expertise in quantitative research methods. She is a professor in the Faculty of Business, Accounting and Economics at the Federal University of Grande Dourados, Brazil.  

Ivan Augusto Cecilio e Silva

PhD student

Ivan Augusto Cecilio e Silva is pursuing a PhD in Economics at the Federal University of Rio Grande do Sul. His thesis focuses on climate change, maternal and child health economics in Brazil, which has earned him a CAPES scholarship from the Brazilian Ministry of Education agency to pursue a six-month research visit to the London School of Hygiene and Tropical Medicine.

Oswaldo Cruz Foundation
Jorge Barreto

Jorge Barreto

Researcher

Jorge Barreto is a researcher at the Oswaldo Cruz Foundation - Fiocruz, Brasília, Brazil. He coordinates and implements projects on Health Systems Research and Knowledge Translation for Evidence-informed Policies and is a member of the Steering Group of EVIPNet Global.

Mariana Santana dos Santos

PhD graduate

Mariana Santana dos Santos has a degree in social communication and public health, a PhD and master’s in public health from the Aggeu Magalhães Institute/ Oswaldo Cruz Foundation (IAM/Fiocruz).

Idê Gomes Dantas Gurgel

Idê Gomes Dantas Gurgel

medical doctor

Idê Gomes Dantas Gurgel is a medical doctor with a PhD in public health. She has been working as a professor and researcher in the Laboratory of Health, Environment and Work (LASAT) of the Department of Collective Health at the Oswaldo Cruz Foundation in Pernambuco, Brazil (Fiocruz Pernambuco).  

Garibaldi Dantas Gurgel Junior

Garibaldi Dantas Gurgel Junior

medical doctor

Garibaldi Dantas Gurgel Junior is a medical doctor and PhD in social policy and social work. He has been working as a professor and researcher in the Laboratory of Health System Governance-GSS at the Oswaldo Cruz Foundation in Pernambuco, Brazil (Fiocruz Pernambuco).

Aline do Monte Gurgel

Biomedical Scientist

Aline do Monte Gurgel is a Biomedical Scientist and PhD in Public Health. She has been working as a researcher and professor in the Laboratory of Health, Environment and Work (LASAT) of the Department of Collective Health at the Oswaldo Cruz Foundation in Pernambuco, Brazil (Fiocruz Pernambuco).  

Makerere University

Agnes Rwashana Semwanga

Associate Professor

Agnes Rwashana Semwanga is an Associate Professor of Information Systems at Makerere University College of Computing and Information Sciences. Agnes leads Objective 4 with Anna Foss, and Objective 5. 

Lund University
Dell Saulnier

Dell Saulnier

postdoctoral fellow

Dell Saulnier is a postdoctoral fellow at Lund University. She has a PhD in health systems research from Karolinska Institutet and a background in epidemiology and global health.  Dell is leading Objective 1 with Cherie. She is also supporting Objectives 2-4.

International Institute for Applied Systems Analysis
Reinhard Mechler

Reinhard Mechler

leader of the Systemic Risk and Resilience (SYRR) Research Group

Reinhard Mechler is the leader of the Systemic Risk and Resilience (SYRR) Research Group in the IIASA Advancing Systems Analysis (ASA) Program. 

Nikita (Nike) Strelkovskii

Nikita (Nike) Strelkovskii

Research Scholar

Nikita (Nike) Strelkovskii is a Research Scholar at the Cooperation and Transformative Governance and Exploratory Modeling of Human-natural Systems Research Groups of the Advancing Systems Analysis Program.

Stefan Hochrainer-Stigler

Stefan Hochrainer-Stigler

senior research scholar

Stefan Hochrainer-Stigler is a senior research scholar with the Systemic Risk and Resilience (SYRR) research group at IIASA, and the leader of the Systemic Risk Analysis and Modelling theme.

Robert Sakic Trogrlic

Robert Sakic Trogrlic

Research Scholar

Robert Sakic Trogrlic is a Research Scholar in the Systemic Risk and Resilience (SYRR) Research Group of the IIASA Advancing Systems Analysis (ASA) Program. Robert is leading objective 2 with Sharif. 

Romain Clerq-Roques

Romain Clerq-Roques

Research Scholar

Research Scholar in the Systemic Risk and Resilience (SYRR) Research Group of the IIASA Advancing Systems Analysis (ASA) Program. Romain recently completed his PhD which involved an agent-based model of the health effects of biodiversity loss.

University of Bern
Rachel Cassidy

Rachel Cassidy

Research Associate

Rachel Cassidy is a Research Associate at KPM Center for Public Management and the Swiss Institute for Translational and Entrepreneurial Medicine. Rachel is supporting Objective 4.

Kuwait University
Abdullah Alibrahim

Abdullah Alibrahim

Assistant Professor

Abdullah Alibrahim is an Assistant Professor at Kuwait University, with research interests at the intersection of healthcare, data analytics, and engineering. Abdullah is working on Objectives 4 and 5.  

In memoriam
Brian Chiluba

Brian Chiluba

Epidemiologist and Biostatistician

We remember our colleague, Brian Chiluba, a distinguished Epidemiologist and Biostatistician at the University of Zambia (UNZA), School of Health Sciences. He made a significant contribution to this project and we miss him. 

News and events
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Climate-resilient and sustainable health systems in Africa

Rudolf Abugnaba-Abanga, vice chair for the African region in the Thematic Working Group on Climate resilient Health Systems in Health Systems Global, presented his research on climate resilience in primary care facilities in Ghana. The webinar was chaired by Prof Felix Obi, HSG Board Member.