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.

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.

Climate change and women's mental health in two vulnerable communities of Bangladesh: An ethnographic study.

Climate change is one of the most significant challenges humanity faces in the 21st century, with its health impacts being profoundly felt in the most vulnerable countries. However, the mental health impacts of climate change, particularly concerning social inequality and gender dynamics, are less documented in the Global South. This paper focuses on the impact of climate change on women's mental health in two vulnerable communities in Bangladesh. This study employed qualitative methods, including, in-depth interviews, and focus group discussions (FGDs). The communities were selected based on their vulnerability to climate change. A total of 80 participants were selected using snowball sampling, and 55 interviews and 6 FGDs were conducted. Women are particularly vulnerable to climate change impacts on mental health due to their gender roles and responsibilities. Responsible for taking care of their families, they have to face additional challenges due to climate change impacts, such as increased workload, food insecurity, and social insecurity when their husband migrates to the cities for jobs. Women also face social and cultural barriers, which exacerbate their vulnerability to climate change impacts on mental health. Socioeconomic and environmental determinants appear to be embedded and lead to psychological suffering in relation to social roles and gender norms. Interventions should be designed to address the specific needs and challenges faced by women in these communities. Policymakers should take a gender-sensitive approach to address the mental health impacts of climate change in these communities. This study contributes to the growing body of research on the gendered impacts of climate change with a trajectory approach and provides insights for future research in this area.