The authors have declared that no competing interests exist.
Small island developing states (SIDS) in the Caribbean region are challenged with managing the health outcomes of a changing climate. Health and climate sectors have partnered to co-develop climate services to improve the management of emerging arboviral diseases such as dengue fever, for example, through the development of climate-driven early warning systems. The objective of this study was to identify health and climate stakeholder perceptions and needs in the Caribbean, with respect to the development of climate services for arboviruses.
Stakeholders included public decision makers and practitioners from the climate and health sectors at the regional (Caribbean) level and from the countries of Dominica and Barbados. From April to June 2017, we conducted interviews (n = 41), surveys (n = 32), and national workshops with stakeholders. Survey responses were tabulated, and audio recordings were transcribed and analyzed using qualitative coding to identify responses by research topic, country/region, and sector.
Health practitioners indicated that their jurisdiction is currently experiencing an increased risk of arboviral diseases associated with climate variability, and most anticipated that this risk will increase in the future. National health sectors reported financial limitations and a lack of technical expertise in geographic information systems (GIS), statistics, and modeling, which constrained their ability to implement climate services for arboviruses. National climate sectors were constrained by a lack of personnel. Stakeholders highlighted the need to strengthen partnerships with the private sector, academia, and civil society. They identified a gap in local research on climate-arbovirus linkages, which constrained the ability of the health sector to make informed decisions. Strategies to strengthen the climate-health partnership included a top-down approach by engaging senior leadership, multi-lateral collaboration agreements, national committees on climate and health, and shared spaces of dialogue. Mechanisms for mainstreaming climate services for health operations to control arboviruses included climatic-health bulletins and an online GIS platform that would allow for regional data sharing and the generation of spatiotemporal epidemic forecasts. Stakeholders identified a 3-month forecast of arboviral illness as the optimal time frame for an epidemic forecast.
These findings support the creation of interdisciplinary and intersectoral ‘communities of practice’ and the co-design of climate services for the Caribbean public health sector. By fostering the effective use of climate information within health policy, research and practice, nations will have greater capacity to adapt to a changing climate.
Small island nations in the Caribbean are highly vulnerable to climate change, whose effects include increased frequency and severity of droughts and increased intensity of tropical storms and hurricanes. Extreme weather and climate events affect directly or indirectly most dimensions of human well being, including mental and physical health, food, housing, freshwater, and livelihoods. Climate-driven early warning systems (EWS) to predict epidemics of dengue fever and other mosquito-borne diseases can help nations to adapt to changing climate conditions. In this study we assessed climate and health sector stakeholder perceptions and needs to inform the development of a dengue EWS. Stakeholders identified capacity limitations (financial resources, trained personnel), and the need for local research on climate-arbovirus linkages to inform decision makers. They identified six key strategies for strengthening the partnership between the climate-health sectors, and they assessed the viability of public health actions that could be take in response to short (2 week), medium (3 month) and long-term (1 year) forecasts of dengue fever epidemics. The results of this study contribute to Caribbean efforts to develop climate services for health, a key adaptation strategy to reduce the health impacts of climate change.
Small island developing states (SIDS) in the Caribbean region are highly susceptible to the health impacts of climate variability and long-term changes in climate [
Dengue fever, chikungunya and Zika fever are arboviral diseases transmitted by the
Changes in local climate can influence mosquito vector physiology and population dynamics, thereby affecting disease transmission. Warmer ambient temperatures increase the probability of arbovirus transmission by
Given the linkages between arboviruses, vectors, and climate, the World Health Organization (WHO) and experts in the Caribbean have recommended developing climate-driven early warning systems (EWS) and models to forecast arbovirus outbreaks [
The key ingredient for embedding climate services in public health operations is creating an enabling environment for partnership with different stakeholders. This is done by identifying the common priorities, needs for research, and by building necessary capacities for understanding among climate and public health stakeholders and researchers [
Stakeholders from the health and climate sectors ideally play a central role in the development and implementation of a forecast model through an iterative engagement process with modelers and other scientists [
Prior studies have focused on health sector perceptions of the effects of climate change and variability on overall health but have not assessed their perceptions of the potential role of climate services. Studies from the United States and Canada analyzed the perceptions and engagement of public health practitioners in the context of long-term climate change and impacts on health in general [
To address this gap, we conducted a study in the eastern Caribbean where we focused on four key areas, based on the GFCS health exemplar goals [
What are the perceptions of climate-health or climate-arbovirus linkages?
Who are the key actors engaged in climate-arbovirus surveillance and control, and how can communication and partnerships amongst these actors be strengthened?
What are the current capabilities of the health and climate sectors to implement a climate-driven arbovirus EWS, and what capacities need to be strengthened so that the health sector can effectively access, understand and use climate/weather information for decision-making?
What climate/weather data are currently used by the health sector for arbovirus control, what added value does it provide, and how can climate/weather data be effectively tailored for arbovirus control operations?
The study protocols were reviewed and approved (or deemed exempt) by the Institutional Review Board (IRB) of the State University of New York Upstate Medical University, the IRB of the University of the West Indies, Cave Hill Campus, on behalf of the Ministry of Health of Barbados, and the Ministry of Health and Environment of Dominica. No informed consent was required, as all participants were adults (≥18 years of age), were public sector employees, and no identifying information was gathered.
This study focused on the perspectives of health and climate stakeholders from the countries of Barbados and Dominica (
(A) Location of the Caribbean region within the Americas, (B) Archipelago of islands making up the Caribbean and their location within Meso-America. (C) Location of Dominica (purple) and Barbados (green) within the islands in the region. This map was created using freely available country boundary datafrom GADM.org, rendered in ArcGIS. Image files were created using GIMP freeware.
Barbados | Dominica | |
---|---|---|
Mean annual dengue cases (2012–2016) [ |
2,274 | 169 |
Mean annual dengue incidence (2012–2016) per 10,000 people [ |
80.0 | 23.5 |
Total chikungunya cases since 2013 [ |
1,833 suspected |
3,590 suspected |
Total Zika cases since 2016 [ |
705 suspected |
1,263 suspected |
*Includes suspected and confirmed cases
Barbados (pop. 284,996; land area: 439 km2) has a service-based economy, with tourism accounting for 12% of the gross domestic product (GDP). Barbados is a water scarce country. Droughts threaten to reduce the already limited freshwater resources [
Dominica (pop. 73,543; land area: 750 km2) is characterized by abundant freshwater resources, forest and rugged terrain. Eco-tourism is becoming increasingly significant to its economy. The country was devastated by Hurricane Maria in September 2017, a category 5 hurricane that damaged 90% of buildings, resulting in USD 1.3 billion in damages, the equivalent of 224% of Dominica’s GDP in 2016 [
The national health agencies of both countries are supported by the Caribbean Public Health Agency (CARPHA) and the Pan American Health Organization (PAHO), the regional arm of the WHO. Each country has its own national meteorological and hydrological service (NMHS) supported by the Caribbean Institute for Meteorology and Hydrology (CIMH), the technical arm of the Caribbean Meteorological Organization (CMO). Details regarding the mandates and capabilities of the public health and climate national and regional organizations, with respect to arbovirus and vector surveillance and control, and climate monitoring and forecasting, are provided in
We collected data from key stakeholders from the climate and health sectors spanning senior leadership, managers, and expert practitioners. Stakeholders from the health sector were engaged in arbovirus epidemiology, vector control, or environmental health, at national and regional (Caribbean) agencies. Stakeholders from the climate sector were individuals involved in the development of climate services for the Caribbean region and managers/practitioners from NMHSs. Local leaders of the climate and health sectors assisted in identifying initial interviewees. Subsequent interviewees were identified through snowball methodology, whereby interviewees were asked to identify 2–3 additional stakeholders. We determined that we had effectively sampled all key stakeholders when no new names were identified; this was feasible given the relatively small size of the climate and health sectors in Dominica and Barbados.
A survey instrument was developed for health sector stakeholders. Questions were informed by prior large-scale surveys of health practitioner perceptions of climate change impacts on health conducted in the United States, called “Are We Ready?” [
Printed surveys were distributed to health sector stakeholders at national vector control, environmental health, and epidemiology offices, as well as those who participated in national workshops on the development of climate services for arboviruses in Barbados and Dominica in April 2017. The workshop in Dominica was organized by the CIMH and the Ministry of Health and Environment (6 health sector participants). The workshop in Barbados was organized by the PAHO and the CIMH (21 health sector participants). Survey responses were entered into an online digital database using Qualtrics and responses were tabulated.
An interview instrument was developed for stakeholders from the climate and health sectors. Questions in the interview and survey were similar so that we could triangulate and validate the responses. We also asked which organizations they had partnered with to manage vector borne diseases, which organizations they would like to partner with, how climate and health fit within their current institutional priorities/mandates/competencies, and what strategies would stimulate collaboration between the climate and health sectors. In interviews with program directors, we asked additional questions about available climate and arbovirus/vector data and information, as well as arbovirus and vector surveillance and control strategies (see institutional competencies in
Project investigators interviewed stakeholders from the climate and health sectors through in-person meetings or via Skype in April and May 2017. Interviews were audio recorded following permission from interviewees. Recordings were transcribed and coded by project investigators to identify responses by research topic, country/region and sector [
During the Barbados national workshop, we conducted an exercise where health (n = 21) and climate sector (n = 6) participants were divided into small groups that included representatives from both sectors. Groups were asked to respond to different forecast scenarios (2-week, 3 month, and 1-year forecasts of
The study instruments were reviewed and tested by local collaborators, as well as the research team, prior to implementation. Instruments are available in
We surveyed 32 individuals from the health sector and interviewed 41 individuals from the climate (n = 10) and health (n = 31) sectors. Respondent demographics are shown in
Responses | Survey |
Interview |
---|---|---|
Total respondents | 32 | 41 |
Female | 72% (23) | 56% (23) |
Male | 28% (9) | 44% (18) |
Barbados | 63% (20) | 37% (15) |
Dominica | 31% (10) | 41% (17) |
Regional | 6% (2) | 15% (6) |
Health sector | 100% (32) | 76% (31) |
Climate sector | 24% (10) | |
18–30 | 9% (3) | |
31–40 | 25% (8) | |
41–50 | 31% (10) | |
51–65 | 25% (8) | |
> 65 | 3% (1) | |
No response | 6% (2) | |
Associate’s degree | 16% (5) | 0% (0) |
Bachelor’s degree | 22% (7) | 2% (1) |
Master’s degree | 59% (19) | 20% (8) |
MD or PhD degree | 0% (0) | 15% (6) |
No response | 3% (1) | 61% (25) |
1–5 years | 3% (1) | 0% (0) |
6–11 years | 13.5% (4) | 2% (1) |
12–15 years | 16% (5) | 5% (2) |
> 15 years | 62.5% (20) | 20% (8) |
No response | 6% (2) | 76% (31) |
*Data not gathered
**Only individuals from the health sector were surveyed
In surveys, health practitioners were asked to respond to a series of statements about the effects of climate variability on health in their jurisdiction and their ability to respond to these effects (
Results shown as % (n). This most frequent response per question is highlighted in bold. Adapted from [
Questions | No response | Don’t know | Disagree |
Neither agree nor disagree | Agree |
---|---|---|---|---|---|
My jurisdiction is currently experiencing one or more serious public health problems as a result of climate variability. | 6% (2) | 3% (1) | 13% (4) | 9% (3) | |
My jurisdiction is currently experiencing an increased risk of diseases transmitted by |
3% (1) | 6% (2) | 3% (1) | 9% (3) | |
In the next 20 years, my jurisdiction will experience increasing risk of diseases transmitted by |
3% (1) | 13% (4) | 3% (1) | 0 (0) | |
I am worried about the impact of climate variability on the health and well-being of people in my jurisdiction. | 3% (1) | 0% (0) | 0% (0) | 3% (1) | |
The effects of climate variability on the health of people in my jurisdiction is an urgent problem. | 3% (1) | 3% (1) | 0% (0) | 13% (4) | |
There are options/solutions to reduce the effects of climate variability and to improve the health of people in my jurisdiction. | 3% (1) | 3% (1) | 16% (5) | 13% (4) | |
The people in my jurisdiction are worried about the effects of climate variability on their health and wellbeing. | 6% (2) | 3% (1) | 22% (7) | 13% (4) | |
My health department currently has ample expertise to assess the potential public health impacts associated with climate variability that could occur in my jurisdiction. | 3% (1) | 0% (0) | 19% (6) | 38% (12) | |
Dealing with the public health effects of climate variability is an important priority for my health department. | 6% (2) | 0% (0) | 13% (4) | 22% (7) | |
I am knowledgeable about the potential public health impacts of climate variability. | 3% (1) | 0% (0) | 16% (5) | 3% (1) | |
The other relevant senior managers in my health department are knowledgeable about the potential public health impacts of climate variability. | 13% (4) | 3% (1) | 19% (6) | 13% (4) | |
My health department currently has ample expertise to create an effective plan to protect local residents from the health impacts of climate variability. | 6% (2) | 6% (2) | 22% (7) | 31% (10) | |
My health department currently has sufficient resources to effectively protect local residents from the health impacts of climate variability. | 9% (3) | 6% (2) | 19% (6) | 9% (3) | |
My health department is able to effectively communicate the health impacts of climate variability to local communities. | 9% (3) | 0% (0) | 31% (10) | 19% (6) |
Survey respondents were asked to identify the relative importance of climate and non-climate risk factors in triggering epidemics of diseases transmitted by
Results shown as % (n) of survey respondents, ranked by risk factors identified as “very important.” The most frequent responses are marked in bold.
Categories | No response | Slightly important | Moderately important | Important | Very Important |
---|---|---|---|---|---|
Introduction of a new virus to a susceptible population | 0 (0) | 0 (0) | 0 (0) | 9.4 (3) | |
Water storage behavior | 3.1 (1) | 0 (0) | 0 (0) | 15.6 (5) | |
Insecticide resistant mosquitoes | 0 (0) | 6.3 (2) | 6.3 (2) | 18.8 (6) | |
Heavy rainfall | 0 (0) | 3.1 (1) | 6.3 (2) | 43.8 (14) | |
Human movement | 0 (0) | 3.1 (1) | 6.3 (2) | 43.8 (14) | |
Insufficient staff/resources for vector control | 0 (0) | 0 (0) | 12.5 (4) | ||
Lack of community knowledge and awareness | 0 (0) | 3.1 (1) | 15.6 (5) | 37.5 (12) | |
Limited community engagement/mobilization | 0 (0) | 3.1 (1) | 6.3 (2) | 34.4 (11) | |
Drought conditions | 3.1 (1) | 31.3 (10) | 9.4 (3) | 25 (8) | |
High-risk housing conditions | 9.4 (3) | 12.5 (4) | 21.9 (7) | 25 (8) | |
Low risk perception by communities | 3.1 (1) | 3.1 (1) | 12.5 (4) | 31.3 (10) | |
Economic barriers to mosquito control by households (e.g., cost of screens or insecticide) | 0 (0) | 9.4 (3) | 31.3 (10) | 25 (8) | |
El Niño or La Niña events | 3.1 (1) | 6.3 (2) | 18.8 (6) | 21.9 (7) | |
Warmer air temperatures | 6.3 (2) | 25 (8) | 18.8 (6) | 18.8 (6) |
Regional and national interviewees were also asked to discuss climate and non-climate risk factors for arbovirus epidemics. They indicated that frequent (re)-introduction of viruses and vectors was associated with human movement between the islands due to trade and tourism. In Dominica, interviewees identified human movement between rural and urban areas as a risk factor. With respect to climate, interviewees identified the onset of the hot, rainy/wet season as a risk factor for arbovirus transmission, although they perceived that the linkages between rainfall and dengue fever have become less clear due to water storage practices. Two interviewees highlighted this contradiction,
“If the rain falls very heavily, within two weeks [we] expect to have an increase in number of cases. It’s always associated with rainfall.”
(Health Sector, Barbados)
“With these droughts, there doesn’t seem to be, in the last few years, a real dengue season.”
(Health Stakeholder, Barbados)
In Barbados, interviewees indicated that household water storage was associated with drought conditions and the resulting water scarcity. Another risk factor was the national legislation requiring that all new buildings greater than 1,500 square feet have rainwater storage receptacles as a drought adaptation strategy; however, the receptacles had become potential
In Dominica, interviewees commented that water storage had increased following Tropical Storm Erika in 2015. When the storm damaged the piped water systems, people began storing freshwater in 55-gallon drums around the home. This behavior continued despite repairs to water systems. One interviewee described the effects of Erika,
“After the Tropical Storm Erika, everything just got a little more vulnerable than it used to be… it was just one downpour of rain that caused all of the destruction.”
(Health Stakeholder, Dominica)
In Dominica, interviewees noted that
Interviewees identified other ways that climate affected health in their jurisdiction. This included increased risk of morbidity due to the interaction of heat stress and diabetes associated with hotter days and nights, leptospirosis (
“[During droughts] people are not able to go to their farms; they don’t have food and their nutrition suffers. They don’t have income … they cannot get their medications… So, its just the rippling effect.”
(Health Stakeholder, Dominica)
However, due to the lack of local research, interviewees recognized that most of these linkages were anecdotal or hypothetical, as summarized by one interviewee,
“So we have
(Health Stakeholder, Dominica)
Regional and national interviewees identified a network of agencies and funders engaged in climate-arbovirus surveillance and control (
Organizations that partner with the health sector (in white) in Barbados and Dominica on issues related to vector control and climate services for health. Organizations in black are current functioning partnerships. Organizations in red are partnerships that need to be strengthened with the health sector.
Interviewees indicated that the key partnerships to be strengthened were the private sector (tourism, vector control companies, media), academic institutions, and civil society organizations. Interviewees proposed that the tourism sector, hotels, could support vector control, given their concern with reducing disease risk for tourists. In Barbados, health interviewees stressed the need to regulate insecticide use by private vector control companies to reduce the risk of insecticide resistance in mosquito vectors. Private media were identified as partners who could assist with public health messaging, and civil society organizations could help with community mobilization during health campaigns. Interviewees identified the need for stronger collaborations with academic partners to generate evidence to inform public health decision-making.
Regional and national interviewees identified six strategies to strengthen the communication and partnerships amongst these actors.
First, they highlighted the importance of an integrated approach to the development of climate services for health spanning research, operations, a platform for data and knowledge sharing, outreach, awareness raising, education, an in-country response, and mitigation plans and policies.
Second, interviewees emphasized the importance of engaging senior leaders from the health sector to raise the profile of climate and health on the health agenda, and to ensure that actions are driven from the top-down.
Third, they highlighted the importance of formal collaboration agreements amongst climate, health, and other sectors. Regional stakeholders mentioned the multi-lateral agreements recently signed amongst the CIMH, the CARPHA and other regional Caribbean agencies (see
Fourth, they suggested that national committees on climate and health be established to specify the work that would be done jointly, the roles of each partner, a timeline for an operational plan, and standard operating procedures (SOPs) with a framework for communication, and reporting guidelines. Development of data sharing protocols between the climate and health sectors was identified as a priority given the sensitivity of sharing health information.
Fifth, interviewees indicated the importance of creating shared spaces for dialogue between the climate and health sectors, such as regional and national climate and health forums. An interviewee from the regional climate sector stated,
“Just sitting with people in the sectors makes such a big difference… Understand them, what drives them, what are their needs? Because we might think they need something they don’t… Sometimes it’s about forgetting yourself and putting yourself in the other person’s shoes to really figure out what the need is about. That’s true engagement.”
(Climate Stakeholder, Regional)
This engagement would facilitate functional working relationships and increase the trust among people in both sectors, allowing sectoral stakeholders to learn about the needs and perspectives of the other, what information can be shared, and the resources available to help each other. One regional interviewee stated,
“Once we build the trust, then we build the network, then we can see what the willingness to collect, to centralize, to digitize, and to share the data really is.”
(Climate Stakeholder, Regional)
For example, interviewees suggested that the MoH could partner with their NMHS so that new weather stations are placed in areas that are strategic for arbovirus surveillance, and the NMHS could participate in epidemiological surveillance meetings of the MoH.
The sixth strategy (proposed by regional climate interviewees) was that climate services for health be framed as a national development priority, increasing buy-in from decision makers and funding from international development agencies. One regional interviewee stated,
“I think people will embrace climate and health… [it is] a real sustainable development goal… Health has always been a critical sector.”
(Climate Stakeholder, Regional)
Health sector survey respondents were asked to identify the strengths and weaknesses of their institution with respect to the implementation of an arbovirus EWS (
“Having got the data, how do we use it? What do we use it for?”
(Health Stakeholder, regional)
EWS = early warning system, GIS = geographic information system, VBDs = vector borne diseases. Results shown as the number of health sector survey respondents (n = 32).
NMHS interviewees confirmed that they had limited resources to implement climate services for health. They emphasized the need to learn more about the health sector end-user needs. In Dominica, the NMHS identified the need for basic resources to increase their monitoring and forecasting capacities, including a staff meteorologist, adequate transportation to and from meteorological stations, financial resources, instrumentation, and improved security to prevent vandalism to the meteorological stations. They stated,
“We use our personal vehicles, but some of the areas are a bit challenging, and we are two females, so sometimes …depending on where we are going, we need somebody else to go with us, for security”
(Climate Stakeholder, Dominica).
Regional interviewees highlighted the importance of training, nurturing, and retaining a cohort of practitioners with expertise in climate and health to ensure the sustainability of an arbovirus EWS. National health sector interviewees emphasized the need to increase their skills in modeling and data analysis through technical workshops on how to use climate information, data, models and other tools to predict epidemics. They identified the need for training on climate and health linkages, greater understanding of climate services for health, how to use climate services for health during emergencies/disasters, and how to communicate the effects of climate on health to local communities. National health sector interviewees suggested that training activities be practical and interactive, such as workshops where multisectoral teams respond to simulations of epidemic warnings.
Regional and national health sector interviewees expressed an urgent need for training on geographic information systems (GIS) to visualize and analyze arbovirus, vector, and climate information. They found that GIS was a highly effective tool that allowed them to use field data to make informed decisions, and to communicate risk information back to the public.
“It is so much easier, better, to use maps when you are doing presentations. Especially if you are doing something with the public where you can actually show them their community and say, ‘There you have breeding sites. There is where you have the problem.’ And they can actually see it. You can actually show it to them.”
(Health Stakeholder, Dominica)
Interviewees from both countries highlighted the need for better data collection and storage practices in the health sector in order to create high-quality, long-term datasets.
Regional and national interviewees stressed the need to increase local research capabilities, in part by strengthening collaboration with universities (
“We want more evidence-based decision-making. We want data… That’s priority #1… to get the evidence.”
(Health Stakeholder, Regional)
Regional interviewees recommended conducting case studies or demonstration projects to generate local evidence on climate-health linkages. They suggested focusing these investigations and interventions at the medium-term (climate variability) time scale (e.g., seasonal variation, year-to-year variation in extreme climate events), rather than the long-term (climate change) time scale. Interviewees highlighted that a collaborative research process with investigators from the climate and health sectors would facilitate data sharing, build trust, and foment a culture of research on climate and health.
Health sector survey respondents were asked about their current use of climate information (
National and regional interviewees confirmed that the arbovirus alert systems in Dominica and Barbados were based solely on epidemiological surveillance. The health sector and PAHO issue an alert when the number of reported cases surpasses a pre-determined threshold established by the historical average for the same week or month (see Lowe et al. [
National interviewees described the current use of climate information for arbovirus control. The health sector considers wet/dry seasons and extreme climate events when planning vector control programs, for example, by increasing larviciding efforts at the onset of the wet season or increasing community campaigns on safe water-storage during droughts. Occasionally, the health sector requests climate data from their NMHS (typically shared as Excel files). However, the health sector does not formally incorporate climate information, such as seasonal climate forecasts, into their planning process. Overall, climate information was reported to play a minor role in decision-making, which was instead driven by policies, regulations, and specific competencies of the organizations.
At the national workshop in Barbados, health and climate stakeholders were asked to identify the interventions they would implement if they were provided with short (two week), medium (three month) and long-term (one year) forecasts of vector abundance and dengue incidence (
“A year can feel like a long time away. With three months, there will be a sense of urgency and you can do meaningful activities, although there might not be new resources.”
(Health Stakeholder, Barbados)
Both regional and national health sector interviewees highlighted the ways in which climate services would improve their planning for arbovirus interventions. By integrating climate and/or disease forecasts into their seasonal and annual planning processes, they felt that they could be proactive and effective at preventing outbreaks, as described by this interviewee,
“We know we have
(Health Stakeholder, Dominica)
Interviewees indicated that climate services have to provide reliable information early enough such that the health sector can target control efforts in high-risk areas during certain times of the year. This would result in a more efficient use of limited financial and human resources, as described by this interviewee,
“When you know that there is an impending threat, you would come up with specific activities that you would conduct. It doesn’t necessarily mean that those activities would be at a higher cost, but you can be more specific… It will be easier for us to respond to an impending threat, instead of running around.”
(Health Stakeholder, Dominica)
Interviewees indicated that forecasts of disease risk could be used to inform hospitals about staffing needs, stocking of medicines and laboratory diagnostic reagents, and the development of targeted educational materials for the public. They suggested that warnings be communicated to the public through social media and other outlets to motivate community mobilization for preventative practices. Health sector interviewees indicated that they would feel more motivated and inspired in their day-to-day work if they could see how the epidemiological and vector data that they collected was used to inform decision-making.
Health sector survey respondents were asked how they would prefer to receive information from an arbovirus EWS. The top responses were a climate and health bulletin (91%), an interactive GIS platform (66%) and internal meetings within their departments (59%) (
“We need it [climate services] packaged in such a way that the health professional would understand. Pick it up, and look at it, and understand it.”
(Health Stakeholder, Dominica)
“Decision makers at the policy level are not healthcare providers. They are administrators, they are politicians, and we need to help them. We need to feed them [decision makers] with the kind of information they can understand, and [so] they can feel comfortable making decisions.”
(Climate and health workshop participant, Barbados)
A climate-informed epidemic EWS is a potentially powerful tool to guide public health decision making. Our study confirms that an arbovirus EWS would benefit the Caribbean health sector–a region that is highly vulnerable to extreme hydrometeorolgical events and arboviral disease outbreaks. However, we found that the development of climate services for arboviral diseases will require stronger partnerships, strengthening of local capacities, and greater investment in local research on climate-health linkages. Our findings are echoed by Huang et al [
In this study we identified strategies and opportunities to initiate a successful process of joint collaboration between the climate and health sectors (see
We found that health sector stakeholders demonstrated concern, awareness and a high-level understanding of the impacts of climate variability on arboviruses and health in general. People from the health sector identified an increased risk of arboviral diseases associated with climate variability. In this region, climate variability is associated with droughts and tropical storms; interviewees identified both as having the potential to increase the risk of arboviral disease outbreaks, as confirmed in prior research [
Prior studies suggest that climate-health awareness has increased in the Caribbean over time. Earlier studies found that there was limited knowledge about climate and health linkages amongst nurses and doctors in private and public sectors [
Our results also highlight the importance of considering non-climatic drivers of arbovirus epidemics (e.g., human movement, insecticide resistance, and community mobilization), which were perceived to be as important or more important than climate factors in determining arbovirus outbreaks. Prior studies have highlighted the importance of human movement in propagating arbovirus transmission [
Despite high levels of awareness, our findings suggest that the climate and health sectors do not feel ready to develop and implement an EWS or other adaptation measures due to limited institutional capacity (resources and expertise). This was also found in prior studies of health care professionals in the U.S. and Canada [
Our results confirm that climate information is neither routinely applied nor used in planning arbovirus/vector interventions in Barbados or Dominica, notwithstanding major advances in climate science and climate-health research globally. The operational co-production of tools and products, such as the quarterly Caribbean Health Climatic Bulletin is a noteworthy first step. The bulletin includes qualitative expert statements on probable health risks associated with seasonal climate forecasts (three months ahead). However, there is significant scope for the development of the next generation of climate services that focus on quantitative probabilistic forecasts of disease risk [
When comparing the results of this study to prior studies on health sector perceptions of climate, one key difference is that our study focused on people working with arboviruses, environmental health, and climate, whereas other studies focused on health-care providers or public health professionals in general. However, given the relatively small size of the health sector in Barbados and Dominica, we interacted with most senior leadership in interviews and national consultations, in particular those involved with overall management of the public health sector, epidemiological programs, environment, climate change and health. Although we did consider a regional perspective, the results of this study may not be generalizable to all of the Caribbean. Country-level studies should be conducted to capture the nuances of local governance structures, disease epidemiology, and climate.
Our results were skewed towards the health sector perspective rather than the climate sector, given that more health sector stakeholders were interviewed, and only health sector stakeholders were surveyed. In part, this reflected that there were many more people working in the national health sectors than in the national climate sectors. On the climate side, our results were skewed towards the regional perspective, given that regional stakeholders had more experience with climate services for health.
The results of this study provide recommendations to enhance an interdisciplinary dialogue and partnership within an active community of practitioners, decision makers, and scientists [
One of the key conclusions of this study is the need to strengthen the provider-user interface, as currently there is only limited consideration of the products needed by health sector users. Climate services for health can only become operational with the will and support of the climate and health sector institutions. At the same time, it is necessary to create appropriate ‘communities of practice’ and to emphasize the co-design of climate services products [
To engage senior leadership in the establishment of collaboration agreements (MOUs) between the climate and health sectors, with a focus on climate services for health as a national development priority.
To strengthen the capacity of NMHS through their designation as National Climate Services Centers (NCSC) [
To strengthen partnerships with key sectors such as tourism (hotels), private vector control, universities, civil society groups, and private media.
National Adaptation Plans for Climate Change, including recent regional efforts to create Health National Adaptation Plans, may be an opportunity to include a policy or mandate for the inclusion of climate in health sector decision-making, and may be an opportunity to strengthen climate services, applying long-term scenarios for planning in health and other sectors (see
To strengthen health sector engagement in the region through annual forums focused on climate services and capacity building tailored to the health sector. This could build on existing regional climate meetings like the bi-annual Caribbean Climate Outlook Forum convened by the CIMH (see
To strengthen analytic capabilities in the health sector, and to develop data visualization tools for non-experts.
To support local research on climate-health linkages through stronger partnerships with academic institutions, particularly at the climate variability time scale.
This document describes the mandates and competencies of regional (Caribbean) and national (Barbados and Dominica) climate and health sectors with respect to arbovirus and vector surveillance and control, and climate monitoring and forecasting. Information was gathered through face-to-face interviews with key stakeholders.
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This document contains (1) an interview instrument used with climate and health decision makers, managers and expert practitioners, (2) supplemental interview questions regarding climate and health data, institutional mandates and competencies, and (3) a survey for health sector decision makers, managers, and expert practitioners.
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This activity was conducted at a national consultation at the PAHO in Bridgetown, Barbados, in April 2017, with 27 representatives from the national Ministry of Health and Wellness (MoH) of Barbados, the Barbados Meteorological Services, the CIMH, and the PAHO. Participants were divided into small groups that included representatives from climate and health sectors. Groups were asked to respond to different forecast scenarios (2-week, 3 month, and 1-year forecasts of
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Results from surveys are shown as % (n).
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Results from surveys are shown as % (n).
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Results shown as % (n).
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Results shown as % (n).
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