Centre Population et Développement (Ceped), Université de Paris, IRD, INSERM, Ceped, F-75006, Paris, France.
Herbert Wertheim School of Public Health & Scripps Institution of Oceanography University of California, San Diego, CA, USA.
BMC Health Serv Res. 2022 Mar 15;22(1):340. doi: 10.1186/s12913-021-07294-3.
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.
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.
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.
由于气候变化、大流行病和人口流动对医疗保健系统构成挑战，因此需要进行实证和综合研究，以研究和帮助提高医疗保健系统的弹性。我们提出了一个跨学科和混合方法的研究方案，ClimHB，重点关注孟加拉国和海地这两个对全球变化高度敏感的国家的脆弱地区。我们制定了一个方案，从机构和社区的角度研究医疗保健系统在气候变化和可变性、人口流动以及新冠疫情背景下的多层次弹性，既研究弹性的结果，也研究弹性的过程。
设计的概念框架基于 Lévesque 的卫生保健获取框架和外交、联邦和发展办公室的弹性框架的结合，以解决医疗保健系统的产出和弹性过程。它采用混合方法顺序探索性研究设计，结合多地点和纵向方法。将研究 40 个分散在四个地点的集群，以了解背景的重要性，涉及 40 多名医疗服务提供者和 2000 户家庭进行调查。我们将通过问卷、深入和半结构化访谈、焦点小组和参与式拍摄收集主要数据。我们还将使用与气候变化敏感的环境事件和潜在健康风险、医疗保健提供者的功能和组织有关的二级数据。统计分析将包括事件历史分析、综合指数的制定、多层次建模和空间分析。
这项研究将产生跨学科的证据，因此，通过知识转移活动，将有助于对中低收入国家医疗保健系统和全球变化的研究，并将为决策者和民众提供更好的信息。
