Resilience to Climate-Induced Disasters and Its Overall Relationship to Well-Being in Southern Africa: A Mixed-Methods Systematic Review

Healthcare resilience: a meta-narrative systematic review and synthesis of reviews

OBJECTIVES

The COVID-19 pandemic has tested global healthcare resilience. Many countries previously considered 'resilient' have performed poorly. Available organisational and system frameworks tend to be context-dependent and focus heavily on physical capacities. This study aims to explore and synthesise evidence about healthcare resilience and present a unified framework for future resilience-building.

DESIGN

Systematic review and synthesis of reviews using a meta-narrative approach.

SETTING

Healthcare organisations and systems.

PRIMARY AND SECONDARY OUTCOME MEASURES

Definitions, concepts and measures of healthcare resilience. We used thematic analysis across included reviews to summarise evidence on healthcare resilience.

RESULTS

The main paradigms within healthcare resilience include global health, disaster risk reduction, emergency management, patient safety and public health. Definitions of healthcare resilience recognise various hierarchical levels: individual (micro), facility or organisation (meso), health system (macro) and planetary or international (meta). There has been a shift from a focus on mainly disasters and crises, to an 'all-hazards' approach to resilience. Attempts to measure resilience have met with limited success. We analysed key concepts to build a framework for healthcare resilience containing pre-event, intra-event, post-event and trans-event domains. Alongside, we synthesise a definition which dovetails with our framework.

CONCLUSION

Resilience increasingly takes an all-hazards approach and a process-oriented perspective. There is increasing recognition of the relational aspects of resilience. Few frameworks incorporate these, and they are difficult to capture within measurement systems. We need to understand how resilience works across hierarchical levels, and how competing priorities may affect overall resilience. Understanding these will underpin interdisciplinary, cross-sectoral and multi-level approaches to healthcare resilience for the future.

PROSPERO REGISTRATION NUMBER

CRD42022314729.

Epidemiology of floods in sub-Saharan Africa: a systematic review of health outcomes

Background

Floods have affected 2.3 billion people worldwide in the last 20 years, and are associated with a wide range of negative health outcomes. Climate change is projected to increase the number of people exposed to floods due to more variable precipitation and rising sea levels. Vulnerability to floods is highly dependent on economic wellbeing and other societal factors. Therefore, this systematic review synthesizes the evidence on health effects of flood exposure among the population of sub-Saharan Africa.

Methods

We systematically searched two databases, Web of Science and PubMed, to find published articles. We included studies that (1) were published in English from 2010 onwards, (2) presented associations between flood exposure and health indicators, (3) focused on sub-Saharan Africa, and (4) relied on a controlled study design, such as cohort studies, case-control studies, cross-sectional studies, or quasi-experimental approaches with a suitable comparator, for instance individuals who were not exposed to or affected by floods or individuals prior to experiencing a flood.

Results

Out of 2306 screened records, ten studies met our eligibility criteria. We included studies that reported the impact of floods on water-borne diseases (n = 1), vector-borne diseases (n = 8) and zoonotic diseases (n = 1). Five of the ten studies assessed the connection between flood exposure and malaria. One of these five evaluated the impact of flood exposure on malaria co-infections. The five non-malaria studies focused on cholera, scabies, taeniasis, Rhodesian sleeping sickness, alphaviruses and flaviviruses. Nine of the ten studies reported significant increases in disease susceptibility after flood exposure.

Conclusion

The majority of included studies of the aftermath of floods pointed to an increased risk of infection with cholera, scabies, taeniasis, Rhodesian sleeping sickness, malaria, alphaviruses and flaviviruses. However, long-term health effects, specifically on mental health, non-communicable diseases and pregnancy, remain understudied. Further research is urgently needed to improve our understanding of the health risks associated with floods, which will inform public policies to prevent and reduce flood-related health risks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12584-4.

When does risk become residual? A systematic review of research on flood risk management in West Africa

Flood events in West Africa have devastating impacts on the lives of people. Additionally, developments such as climate change, settlement expansion into flood-prone areas, and modification of rivers are expected to increase flood risk in the future. Policy documents have issued calls for conducting local risk assessments and understanding disaster risk in diverse aspects, leading to an increase in such research. Similarly, in a shift from flood protection to flood risk management, the consideration of various dimensions of flood risk, the necessity of addressing flood risk through an integrated strategy containing structural and non-structural measures, and the presence of residual risk are critical perspectives raised. However, the notion of "residual risk" remains yet to be taken up in flood risk management-related academic literature. This systematic review seeks to approach the notion of residual risk by reviewing information on flood impacts, common measures, and recommendations in academic literature. The review reveals various dimensions of impacts from residual flood risk aside from material damage, in particular, health impacts and economic losses. Infrastructural measures were a dominant category of measures before and after flood events and in recommendations, despite their shortcomings. Also, spatial planning interventions, a more participatory and inclusive governance approach, including local knowledge, sensitisation, and early warning systems, were deemed critical. In the absence of widespread access to insurance schemes, support from social networks after flood events emerged as the most frequent measure. This finding calls for in-depth assessments of those networks and research on potential complementary formal risk transfer mechanisms.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10113-021-01826-7.

Collective Responses to the 2018 Water Shortage in Cape Town: An Explorative Qualitative Study

In 2018, the Western Cape region in South Africa experienced a significant drought. At a certain date termed “Day Zero”, it was projected that about 3.7 million people in the City of Cape Town would run out of water. In this qualitative study, we provide a context for the situation and explore how a group of individual residents interpreted and adapted to the situation by changing their norms in order to preserve water. A systematic text condensation identified three superordinate themes that captured essential aspects of how the informants interpreted the situation and mobilized to cope with the environmental crisis. Three core processes are exemplified with direct statements from the informants. Specifically, these were labeled “making sense of the situation”, “taking part in the action” and “looking to the future”. The interview data suggest that the water shortage emerged as a significant existential experience transcending personal norms, mobilizing action, and reminding the informants about an uncertain future. The findings from this study may inform future research on pro-environmental action and sustainability.

Understanding disaster resilience in communities affected by recurrent drought in Lesotho and Swaziland-A qualitative study

Background

Lesotho and Swaziland experience intense, recurring drought resulting in disaster situations. Despite the recurrence of drought, both its influence on rural subsistence communities’ support systems and the actions that enable structures of resilience remain poorly understood. Each incidence of drought stimulates a disaster resilience discussion that stalls without achievement of positive results until the next disaster. This study has examined the influence of recurring drought on communities’ inherent resilience and proposes an evidence-based framework to enhance community resilience.

Methods

Data were collected from 16 focus group discussions (N = 197) in the Highveld, Midveld and Lowveld agro-ecological regions of Swaziland and Lesotho. Themes and subthemes have been identified, defined, categorised and narrated using structuration theory as a guide.

Results

Resilience activities were found to be characterised by knowledgeability and changes in behaviour in adapting and applying appropriate actions, all of which were enhanced by institutional support. The effectiveness of institutional support hinged on harnessing communities’ knowledge, social groups, value systems, connectedness, participation, decision-making and collectivism.

Conclusion

Large-scale interventions to build and strengthen resilience are urgently needed in order to maintain cohesiveness and development gains, especially because rural subsistence farmers make up the majority of these two countries’ populations. Policies that integrate resilience with national development planning must be urgently developed and executed.