GB-CHC-222655-GB-CHC-222655-NIHR204854 Liverpool School of Tropical Medicine Our research aims to improve the preparedness of health services to respond to the needs of the poorest and mostmarginalised urban residents before, during and after extreme weather events in 10 locations in Sierra Leone, Kenya and India.The health impacts of climate change will be concentrated among the poorest urban populations, particularly the one billionpeople living in informal settlements. Marginalized urban people are exposed to extreme weather events due to where they liveand how they work and are particularly vulnerable to impacts on health and wellbeing due to poor access to services. It hastherefore been recognised that the greatest gains in health in the context of climate change will be achieved through reducingthe risks faced by the urban poor, including by targeting informal settlements.How to reduce these health risks through strengthened health service delivery which is responsive, equitable and peoplecentredis, however, currently unclear. Access to quality formal healthcare in marginalised urban settings is often limited,especially for certain people such as the elderly and persons with disabilities. Health services are therefore provided by acomplex system of formal and informal providers. In extreme weather events including heatwaves and floods, health servicedelivery is often non-existent, inaccessible, or unaffordable.We will work in equitable partnership with marginalised urban communities and health system providers and managers in India,Kenya and Sierra Leone throughout the research process, in key cities where we have longstanding partnerships and a trackrecord of delivering research and action for improved health and wellbeing. This proposal brings together globally recognisedexpertise in health systems, urban health, community engagement, participatory research, and climate change.The mixed methods participatory action research is divided into five phases. Phase one will bring together all stakeholders tocollaboratively finalise the research design and plans for capacity strengthening, ethics, and safeguarding. Capacitystrengthening of all actors including the research team will occur throughout phases two to five. In phase two, we will conductmixed methods assessments to fill existing data gaps on health impacts, community vulnerabilities and capacities and healthservice preparedness in each setting. Informed by these assessments, in phase three we will collaboratively design packagesof interventions to improve health service provision in extreme weather events. In phase four we will implement and evaluatethem. Intervention packages are likely to include utilisation of existing technologies such as mobile phone applications and two way information systems. We will monitor, evaluate and share learning within and across settings throughout the project.Phase five focuses on knowledge uptake at the local, national and global levels. This process will create and communicateevidence-based models to improve the responsiveness of health systems and service delivery to extreme weather events. George Institute for Global Health Centre of Dialogue on Human Settlement and Poverty Alleviation (CODOHSAPA) Sierra Leone Urban Research Centre (SLURC) Institute of Gender and Children's Health Research Shack Dwellers International - Kenya UK - Department of Health and Social Care (DHSC) Liverpool School of Tropical Medicine Liverpool School of Tropical Medicine International Public Health Faye Moody Programme Manager 01517053280 faye.moody@lstmed.ac.uk https://www.lstmed.ac.uk/ Pembroke Place, Liverpool, L3 5QA 297866 242540 61030 217189 95795 76700 238293 211670 291088 77220 159230 97356 34978 1st disbursement received from NIHR at LSTM 1st disbursement received from NIHR at LSTM for Urban SHADE project. 1st disbursement received from NIHR at LSTM for Urban SHADE project. 305950 2nd disbursement received from NIHR at LSTM 2nd disbursement received from NIHR at LSTM 2nd disbursement received from NIHR at LSTM 284964 3rd disbursement received from NIHR at LSTM 3rd disbursement received from NIHR at LSTM 3rd disbursement received from NIHR at LSTM 24919 LSTM quarter expenditure covering April-Jun 2024 LSTM quarter expenditure covering April-Jun 2024 40845 LSTM quarter expenditure covering Jul-Sept 2024 LSTM quarter expenditure covering Jul-Sept 2024 46608 LSTM quarter expenditure covering Oct-Dec 2024 LSTM quarter expenditure covering Oct-Dec 2024 52558 LSTM quarter expenditure covering Jan-Mar 2025 LSTM quarter expenditure covering Jan-Mar 2025 45445 LSTM quarter expenditure covering April-Jun 2025 LSTM quarter expenditure covering April-Jun 2025 28969.51 22833.52 45013.39 22100.25 64207.59 66989.50 123376.73 29811.26 84161.93 36194.82 40651.50 60635 50966.50 110806.50 31454.49 76118.78 39866.10 19772.80 36097.17 35912.94 22137.63 81424 60603 61136 59646 14428.90 45304.51 23949 80337.30 54373.50 87598 19530.47 54297 53115.11 230883 Income Apr - Jun 25 147246 Oct - Dec 25 Income 360950 Jul - Sep 25 Income 284694 4th installment from NIHR 319888 Jan - Mar 26 Income 19816.03 32800