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Designing and Evaluating a Health System Resilient to Extreme Weather Events in Rural Madagascar.
Michelle V Evans1,2, Elinambinina Rajaonarifara1,3, Andres Garchitorena1,4
1NGO Pivot, Ranomafana, Ifanadiana, Madagascar.
Annals of Global Health
|July 28, 2025
Summary
Health system strengthening interventions (HSSis) enhance resilience to climate change impacts. A Madagascar study showed HSSis helped a rural district recover quickly from Cyclone Batsirai, demonstrating their adaptive capacity.
Area of Science:
- Climate change adaptation strategies
- Public health resilience
- Health system strengthening
Background:
- Climate change poses significant threats to human health, necessitating adaptive health systems.
- Health system strengthening interventions (HSSis) can build capacity to withstand climate-driven shocks.
- Broad HSSis can bolster health workforce, infrastructure, and networks for climate resilience.
Purpose of the Study:
- To evaluate an HSSi in Madagascar as a climate change adaptation measure.
- To assess the HSSi's effectiveness during Cyclone Batsirai in 2022.
- To explore factors influencing health system resilience during extreme weather events.
Main Methods:
- Interrupted time series analysis of eight infectious disease and health system performance indicators.
- Comparison of two zones within a rural health district in Madagascar.
- Qualitative examination of HSS domains, including resources and collective values.
Main Results:
- Most health indicators remained resilient post-Cyclone Batsirai.
- Vaccination rates were temporarily affected, especially in areas with recent HSSi implementation.
- Health system performance recovered without sustained external input, driven by workforce adaptability.
Conclusions:
- HSSis designed for local adaptation enhance resilience to extreme weather.
- Strengthened health systems are better adapted to overall climate change impacts.
- Workforce agility, protocols, and communication are key to health system resilience.
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