Presentation

Funded by the French National Research Agency (ANR) as part of the presidential call “Make Our Planet Great Again” (MOPGA), the “Climate Change, Migration and Health Systems Resilience” (ClimHB) project is an interdisciplinary and empirical public health research project (2019-2023).

Data collection will take place in Haiti and Bangladesh, in localities affected by social and environmental impacts of climate change, and characterized by high residential mobility. This study aims to contribute to the global reflection on access to care and the resilience of health systems, through the lens of mobility and climate vulnerability.

Climate change is causing significant environmental disruption and degradation, making the living conditions of already precarious populations even more uncertain in many regions in the South. Often indirectly, and in relation to many other social factors, these climatic disturbances reinforce existing migration trajectories.

Because of their geographical situations, topologies and political and sociodemographic contexts, Bangladesh and Haiti are two of the countries most exposed to the frequency of climate risks. Part of Bangladesh is located at a very low altitude and is threatened by rising water levels. Its capital, Dakha, is a megalopolis whose rising urbanization makes it one of the most densely populated and poor cities in the world. In Haiti, the rural exodus is increasing, and consecutive periods of drought dramatically accentuate the food shortages the country is facing. Haiti and Bangladesh were also respectively ranked 138th and 88th by the World Health Organization (WHO) in 2000 on the performance of 191 health systems worldwide.

ClimHB aspires to contribute, empirically, to the definition of health system resilience parameters, an emerging research topic in global health. It considers the resilience of health systems through the issue of access to care, which is the ultimate goal of any resilient health system.

This project thus seeks to assess the accessibility and the level of resilience of local health systems in Haiti and Bangladesh, as well as the capacities of populations, who are in a situation of mobility (or immobility), to access care.

The project will focus on two lines of analysis:

1.the study of the population’s capacities to access health care, and the links between geographical mobility and the health trajectories of migrant and host populations;

2.the study of the accessibility, and the level of resilience of health infrastructures and health care providers (financing, functioning, information system, human resources and integration into the political system, etc.).

ClimHB will attempt to identify operational action levers for public authorities and local communities to enable a transformation of local health systems vulnerable to the impacts of environmental instability and mobility.

Within the framework of the implementation of mixed methods of field data collection and analysis, different disciplinary inputs will be mobilized: demography, social epidemiology, medical anthropology, etc., through experts in these disciplines. Through a partnership with BRAC University – James P. Grant School of Public Health (JPGSPH), and in Haiti, with the Higher School of Infotronics of Haiti (ESIH), a rigorous collection, through the use of questionnaires and interviews, will allow collaboration between the different research units and experts involved in the project.