Regional Institute for Population Studies, University of Ghana, P.O. Box LG 96, Legon, Ghana.
Department of Geography and Environment, Loughborough University, Loughborough, Leicestershire, UK.
Soc Sci Med. 2020 Aug;258:113072. doi: 10.1016/j.socscimed.2020.113072. Epub 2020 May 22.
Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 °C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.
极端天气事件对中低收入国家的城市健康构成重大威胁，特别是在撒哈拉以南非洲地区，那里存在系统性的健康挑战。本文调查了加纳阿克拉和塔马利与洪水和极端高温相关的卫生系统脆弱性，以及服务提供者和社区成员的韧性建设策略。我们在这两个城市选定地区的卫生机构进行了实地观察、降雨记录、温度测量和半结构访谈。结果表明，建筑条件差、供电不稳定、卫生和环境卫生条件差以及建筑环境，减少了贫困城市地区居民获得医疗保健的机会。卫生机构位于地势低洼地区，排水系统较差，夜间的温度比附近气象站的官方记录高出 6°C。这是由于建筑物的热惯性更大和城市热岛效应的综合作用。洪水和极端高温与社会经济条件相互作用，影响物理基础设施，并扰乱社区健康和卫生机构的运作。社区成员和卫生机构对基础设施和运营进行调整，以减少极端天气的压力，并改善向客户提供的医疗服务。这些措施包括：动员居民清理垃圾和疏通排水渠；抬高设备以防止洪水淹没；在极端高温期间改善通风；在停电期间使用备用电源进行紧急手术和储存。利益相关者建议采取更多行动来管理城市中洪水和高温对健康的影响，例如，提高排水系统排放洪水的能力，以及定期监测温度，以更好地管理卫生设施中的高温。最后，需要更及时和有针对性的信息系统和应急计划，以确保城市地区对极端天气事件做好准备。
