Designing and Evaluating a Health System Resilient to Extreme Weather Events in Rural Madagascar

Michelle Evans (), Elinambinina Rajaonarifara (), Andres Garchitorena (), Fianamirindra Ralaivavikoa, Paulea Eugenie Rahajatiana, Karen Finnegan, Laura Cordier, Luc Rakotonirina, Bénédicte Razafinjato, Tokiniaina Randrianjatovo, Christophe Révillion (), Malazafeno Jocelyn Mbimbisoa and Matthew Bonds
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Michelle Evans: PIVOT [Ifanadiana, Madagascar], Blavatnik Institute [Boston] - HMS - Harvard Medical School [Boston]
Elinambinina Rajaonarifara: PIVOT [Ifanadiana, Madagascar], Université de Fianarantsoa
Andres Garchitorena: PIVOT [Ifanadiana, Madagascar], MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle - CNRS - Centre National de la Recherche Scientifique - IRD [Occitanie] - Institut de Recherche pour le Développement - UM - Université de Montpellier
Fianamirindra Ralaivavikoa: PIVOT [Ifanadiana, Madagascar]
Paulea Eugenie Rahajatiana: PIVOT [Ifanadiana, Madagascar]
Karen Finnegan: PIVOT [Ifanadiana, Madagascar], Blavatnik Institute [Boston] - HMS - Harvard Medical School [Boston]
Laura Cordier: PIVOT [Ifanadiana, Madagascar]
Luc Rakotonirina: PIVOT [Ifanadiana, Madagascar]
Bénédicte Razafinjato: PIVOT [Ifanadiana, Madagascar]
Tokiniaina Randrianjatovo: MIVEGEC - Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle - CNRS - Centre National de la Recherche Scientifique - IRD [Occitanie] - Institut de Recherche pour le Développement - UM - Université de Montpellier
Christophe Révillion: UR - Université de La Réunion, UMR 228 Espace-Dev, Espace pour le développement - IRD - Institut de Recherche pour le Développement - UPVD - Université de Perpignan Via Domitia - AU - Avignon Université - UR - Université de La Réunion - UNC - Université de la Nouvelle-Calédonie - UG - Université de Guyane - UA - Université des Antilles - UM - Université de Montpellier
Malazafeno Jocelyn Mbimbisoa: Direction régionale de la Santé Publique de Vatovavy
Matthew Bonds: PIVOT [Ifanadiana, Madagascar], Blavatnik Institute [Boston] - HMS - Harvard Medical School [Boston]

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Abstract: Background: Adapting health systems for climate change can lessen the negative impact of climate change on human health. Even when not targeting climate-health links explicitly, broad health system strengthening interventions (HSSis) can ensure that the health workforce, infrastructure, and networks are robust enough to respond to and recover from climate-driven shocks. Objective: We explored the ability of an HSSi in a rural health district of southeastern Madagascar to serve as a climate change adaptation in response to Cyclone Batsirai in 2022. Method: We conducted interrupted time series analyses of eight indicators of infectious disease and health system performance to assess the impact of Batsirai on two zones of the HSSi. We then examined how traditional domains of HSS, such as physical and human resources, combined with less formal domains, such as collective values, influenced health system resilience during this time. Findings: We found that the majority of indicators were resilient to Cyclone Batsirai, with only vaccination rates affected in the two months following the cyclone, particularly in the zone where the HSSi had only begun eight months prior. Changes in long-term trends were rare, and, when observed, revealed a slight slowing of progress, but not a regression to historical levels. After re-establishing the road network and providing additional supplies through an emergency response, the health system was able to resume routine service delivery without further external input, and health system indicators continued to improve. The agility and responsiveness of the health workforce were enabled by formalized protocols, a culture of flexibility, open communication, and data-informed action. Conclusions: HSSis that are designed to encourage local adaptation may increase health systems' resilience to extreme weather events, resulting in health systems better adapted to climate change overall.

Keywords: Climate adaptation; Cyclone; Health-system strengthening; Community health; Extreme weather (search for similar items in EconPapers)
Date: 2025-07-22
Note: View the original document on HAL open archive server: https://univ-reunion.hal.science/hal-05416421v1
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Published in Annals of Global Health, 2025, 91 (1), pp.40. ⟨10.5334/aogh.4759⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05416421

DOI: 10.5334/aogh.4759

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