AB119. Evaluating sustainable resilience in public health programs

Background: In a world where every aspect of global public health is affected by climate change, health interventions are required to include climate resilience as an outcome or impact in the planning and evaluation of programs. Since 40% of the world’s population is highly vulnerable to the impacts of climate change, the penultimate task is to make the transition to plan and design for adaptation and resilience. For the most vulnerable, every aspect of public health is affected by climate change, yet health interventions, whether embedded in larger development programs or as stand-alone projects, do not include resilience to climate impacts as an outcome. This has led to a patchwork of approaches often without clear connections between the nature of the climate-related hazard, the specific health vulnerabilities of the population, the adaptation (interventions), and measurable and specific outcomes that enhance resilience and promote the sustainability of improved health. This study will illustrate a theory of change that explicitly identifies climate effects and places sustainable resilience at the center of the design and evaluation of health programs. This Theory of Sustainable Resilience (TOSR) will allow health program evaluators to systematically capture changes in risk, vulnerability, and resilience in natural and human systems.

Methods: Case studies are used to illustrate evaluation with respect to risk reduction, resilience, and the dynamic relationship between resilience and long-term sustainable impacts. Qualitative and quantitative assessment tools surface relevance, strategy, elements of systems resilience, and the conditions that drive sustainable resilience.

Results: Two case studies, malaria prevention and food security/nutrition, illustrate this conceptual framework for evaluation.

Conclusions: TOSR guides evaluators and planners to embed climate effects into health programs, tying the climate shock to the adaptive response (the intervention), and the intervention to the outcomes of reduced vulnerability and increased transformative resilience. Effectiveness in the TOSR is determined by reduced vulnerability and increased resilience, where resilience is transformative, dynamic, and sustainable. Climate change is addressed as systems change, reframing health interventions not only as technical fixes but to invest in communities’ capability to plan, govern, manage, and innovate. Transformative resilience is a necessary condition for sustainable resilience. Assessing the sustainability of transformative resilience requires a commitment to ex-post evaluation. Examining what has been learned from the design and implementation of the intervention after the end of the program and how these ‘learnings’ have been integrated back into program design is evidence of the community’s capability to continuously adapt and enhances the likelihood of streams of benefits. This framework should be tested, tweaked, and extended across public health programs.

Keywords: Climate resilience; evaluation; public health