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).
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.
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.
- 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.
Josephine
Borghi
Professor of Health Economics
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.
Anna
Foss
Professor of Modelling for Public Health
Anna Foss is an Associate Professor of Mathematical Epidemiology. Her methodological specialisms are mathematics, mathematical modelling, handling model uncertainty, and using agent-based modelling (ABM) to explore complex systems in public health.
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.
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 Research Fellow Clinical Train
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.
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
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.
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 and at the Institute of Economic and Social Research at the University of Zambia. Her research focuses on health financing, maternal and child health, intervention evaluation and understanding the consequences of implemented policies.
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).
Oliver Kaonga
Researcher and Lecturer
Oliver Kaonga is a researcher and Lecturer in the Department of Economics. He has over 10 years of professional experience in research, policy analysis, advocacy, and teaching. He holds a PhD in Economics from the University of York.
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
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.
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.
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, which focuses on climate change and maternal and child health economics in Brazil, has earned me a scholarship from CAPES, a Brazilian Ministry of Education agency, for a six-month research visit to the London School of Hygiene and Tropical Medicine.
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, and PhD and Masters in Public Health from the Aggeu Magalhães Institute/ Oswaldo Cruz Foundation (IAM/Fiocruz).
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
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).
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.
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.
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
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
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
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
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.
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.
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.
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.