Healthcare system resilience in Bangladesh and Haiti in times of global changes (climate-related events, migration and Covid-19): an interdisciplinary mixed method research protocol

Abstract

Background Since climate change, pandemics and population mobility are challenging healthcare systems, an empirical and integrative research to studying and help improving the health systems resilience is needed. We present an interdisciplinary and mixed-methods research protocol, ClimHB, focusing on vulnerable localities in Bangladesh and Haiti, two countries highly sensitive to global changes. We develop a protocol studying the resilience of the healthcare system at multiple levels in the context of climate change and variability, population mobility and the Covid-19 pandemic, both from an institutional and community perspective. Methods The conceptual framework designed is based on a combination of Levesque’s Health Access Framework and the Foreign, Commonwealth and Development Office’s Resilience Framework to address both outputs and the processes of resilience of healthcare systems. It uses a mixed-method sequential exploratory research design combining multi-sites and longitudinal approaches. Forty clusters spread over four sites will be studied to understand the importance of context, involving more than 40 healthcare service providers and 2000 households to be surveyed. We will collect primary data through questionnaires, in-depth and semi-structured interviews, focus groups and participatory filming. We will also use secondary data on environmental events sensitive to climate change and potential health risks, healthcare providers’ functioning and organisation. Statistical analyses will include event-history analyses, development of composite indices, multilevel modelling and spatial analyses. Discussion This research will generate inter-disciplinary evidence and thus, through knowledge transfer activities, contribute to research on low and middle-income countries (LMIC) health systems and global changes and will better inform decision-makers and populations.

Local social-ecological context explains seasonal rural-rural migration of the poorest in south-west Bangladesh

“…This study extends this qualitative data collection (Phase II) to focus on one rural community experiencing waterlogging to explore the most environmentally challenging context and the interactions between different local issues. In the ClimHB conceptual framework [26], this study encompasses the changes (shock, events, stress), the (im)mobility and adaptative capacities of the population. Here, for this study, we use an inductive social-ecological approach drawing on previous studies using ecosystem services (i.e.…”

“…In the final section of the results, we used a social-ecological system approach to illustrate the complexity of the local context. This work builds conceptually on the ClimHB conceptual framework [26], and most specifically on the dimensions based on the FCDO (formerly DFID) framework, which includes context, disturbance, capacity to deal with, and action-reactions [34]. We based this representation on the analysis of qualitative data to reconstruct changes in livelihoods, following the path (changes>impacts on livelihoods>responses>impacts).…”

“…Bangladesh. The usual ethical criteria for qualitative health research was respected, [26]. Information about the study was provided before data collection, verbal consent was collected, respondents were informed of their right to withdraw at any moment, a debrief with respondents was conducted at the end, and written consent were collected before leaving.…”

Health Systems Reforms in Bangladesh: An Analysis of the Last Three Decades

“…Articles were included if they: (1) identified health sector reforms implemented in the last 30 years in Bangladesh; (2) focused on health sector reforms impacting health system dimensions; (3) were published between 1991 and 2023 in English; (4) were full-text peer-reviewed articles, literature reviews, book chapters, grey literature, or reports. Additionally, two studies were included from the references of studies that were selected during full-text screening.…”

“…Health sector reforms can be a powerful tool for countries to adapt their healthcare system in response to demands and external shocks (2,3). As Bangladesh is ranked seventh on the Global Climate Risk Index 2000-2019 (2), there is an increasing need to understand the effectiveness of health policies and reforms in Bangladesh in preparation for tackling emerging climate and climate-associated issues (4), including the recent COVID-19 pandemic (5). The Bangladesh health system is pluralistic and consists of the government, the private sector, the non-governmental organisations (NGOs) and the international donor organisations.…”