Impact of extreme weather conditions on healthcare provision in urban Ghana
Impact of extreme weather conditions on healthcare provision in urban Ghana
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DOI：
10.1016/j.socscimed.2020.113072
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发表时间：
2020-08-01
影响因子：
5.4
通讯作者：
Griffiths, Paula L.
中科院分区：
文献类型：
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作者：
Codjoe, Samuel N. A.;Gough, Katherine, V;Griffiths, Paula L.
极端天气事件对中低收入国家的城市健康构成重大威胁，特别是在存在系统性健康挑战的撒哈拉以南非洲。本文调查了加纳阿克拉和塔马利与洪水和极端高温相关的卫生系统脆弱性，沿着服务提供者和社区成员的复原力建设战略。我们采用了实地观察，降雨记录，温度测量，和半结构化的采访，在卫生设施内选定的地区，这两个城市。结果表明，建筑条件差，电力供应不稳定，卫生和个人卫生差，以及建筑环境减少了贫困城市地区居民获得医疗保健的机会。卫生设施位于低洼地区，排水系统差，夜间温度可能比附近气象站的官方记录高6摄氏度。这是由于建筑物的热惯性和城市热岛效应的结合。洪水和极端高温与社会经济条件相互作用，影响有形基础设施，扰乱社区健康和卫生设施的运作。社区成员和卫生设施进行基础设施和业务调整，以减少极端天气压力，改善向客户提供的医疗保健。这些措施包括：动员居民清理垃圾和疏通下水道;提升设备以保护其免受洪水侵袭;在极端高温下改善通风;以及在停电期间使用替代能源进行紧急手术和储存。利益攸关方建议采取更多行动，以管理洪水和高温对其城市健康的影响，例如提高排水系统的防洪能力，并进行例行温度监测，以更好地管理卫生设施中的高温。最后，需要更及时和更有针对性的信息系统和应急计划，以确保城市地区为极端天气事件做好准备。
Extreme weather events pose significant threats to urban health in low- and middle-income countries, particularly in sub-Saharan Africa where there are systemic health challenges. This paper investigates health system vulnerabilities associated with flooding and extreme heat, along with strategies for resilience building by service providers and community members, in Accra and Tamale, Ghana. We employed field observations, rainfall records, temperature measurements, and semi-structured interviews in health facilities within selected areas of both cities. Results indicate that poor building conditions, unstable power supply, poor sanitation and hygiene, and the built environment reduce access to healthcare for residents of poor urban areas. Health facilities are sited in low-lying areas with poor drainage systems and can be 6 degrees C warmer at night than reported by official records from nearby weather stations. This is due to a combination of greater thermal inertia of the buildings and the urban heat island effect. Flooding and extreme heat interact with socioeconomic conditions to impact physical infrastructure and disrupt community health as well as health facility operations. Community members and health facilities make infrastructural and operational adjustments to reduce extreme weather stress and improve healthcare provision to clients. These measures include: mobilisation of residents to clear rubbish and unclog drains; elevating equipment to protect it from floods; improving ventilation during extreme heat; and using alternative power sources for emergency surgery and storage during outages. Stakeholders recommend additional actions to manage flood and heat impacts on health in their cities, such as, improving the capacity of drainage systems to carry floodwaters, and routine temperature monitoring to better manage heat in health facilities. Finally, more timely and targeted information systems and emergency response plans are required to ensure preparedness for extreme weather events in urban areas.