Term of Reference (ToR) for Explanatory Research on Climate Change and Its Impact on Health

1. Introduction

Amref Health Africa, the largest African led international organization on the continent, provides training and health services to over 35 countries in Africa. Founded in 1957 as the Flying Doctors of East Africa to bring critical health services to remote communities, Amref Health Africa now delivers preventive, community-based health care.

Although Amref Health Africa has been formally registered in Ethiopia in 1998, a full-fledged country program with a country office started in 2002. Since then, the country program has grown from one project in Addis Ababa to more than 20 projects in Afar, Amhara, Benishangul-Gumuz, Gambella, Oromia, SNNP, Ethiopia Somali regions and nationwide health systems strengthening interventions focusing the capacity building of the national Health Extension Program.

Amref Health Africa in Ethiopia strongly committed to contribute towards closing the gap, Amref Health Africa has chosen to act in a holistic and integrated way, focusing on three interrelated thematic areas: (1) Human resource for health, (2) Communities systems strengthening (3) Health management information systems. Currently, Amref Health Africa in Ethiopia is working on prevention and control of diseases related to water, sanitation and hygiene to increase access among disadvantaged communities.

Amref Health Africa in Ethiopia delivers programs on maternal health, Child health, Water, Sanitation, and Hygiene (WASH), Communicable Diseases, None-communicable Diseases, Clinical Outreach Services, Emergency Nutrition, HEWs and Midwives Training and Operational Research. The training and the clinical outreach programs are being implemented nationally across all regions of the country.

Through its WASH program, Amref works to ensure access to and utilization of sustainable and improved WASH services by creating access to safe, affordable and adequate water supply, improved sanitation and hygiene services delivery and institutional capacity development. Amref addresses the root economic problems of the community by integrating WASH interventions with nutrition, livestock development, income generation and livelihood opportunities. Amref delivers all our WASH services in close collaboration with Ministry of Water, Irrigation and Energy, Ministry of Health and their respective regional government bureaus, nongovernmental organizations (NGOs), and local communities.

2. Project description

Amref is implementing a project entitled “Health, Climate change Mitigation and resilience in Gambella Regional state”, to contribute to the mitigation and adaptation of Climate change through building resilient societies and systems.  The project goal is to enhance communities’ health to climate change mitigation and resilience. It mainly focuses on, contributing to climate change mitigation and adaptation as well as to conduct research and learning for evidence-supported decision on climate change actions. The project also uses meteorological data to predict disease patterns, strengthen its early warning and preparedness.

Ethiopia has been experiencing the impacts of both climate variability and change. Climate change is having direct and indirect impacts on the health of people. Evidences show that since 1960 the mean annual temperature of the country has risen by about 1.3°C, an average rate of 0.28°C per decade. Spatial and temporal rainfall variability has been increasing. The length of the rainy season(s) and predictability of the rainfall amounts, frequency, distribution and timing (onset and ending) are decreasing. On the other hand, precipitation has showed different spatial and temporal patterns (increases or decreases) in different regions of the world. Nowadays, scientific evidence (analysis of rainfall data obtained from the meteorological stations) shows rainfall variability (decreasing; increasing; unpredictable frequency, distribution, duration and timing) depends on location and time (season, year). Such variabilities increase the frequency and severity of pests and diseases, and the prevalence of various tropical diseases (malaria, cholera, yellow fever, meningitis, etc.), which are sensitive to changes in temperature, rainfall and humidity (Adem and Bewket, 2011). It also, alter the ecology of some disease-vectors, and consequently the spatial and temporal patterns of transmission of vector-borne diseases.

For example, mosquito belt has considerably expanded to higher elevations due to the temperature increases, and hence malaria is expanding to highland areas which were formerly malaria-free.

Climate change direct and indirect impacts. The direct impacts are thermal stress and increased death due to increased floods, droughts and storms. In addition, the indirect impacts are food availability and quality, water availability and quality, Air quality and vector and water borne diseases.  It will lead to increased food and nutrition insecurity, and as such aggravates hunger and malnutrition, which are prevalent in Africa including Ethiopia.

Respiratory ailments like asthma and bronchitis will increase as a result of climate change.

Furthermore, heat waves increases heat-related injuries and deaths.

Climate change is expected to compound Ethiopia’s health challenges that the country is experiencing like- extremes climates, droughts and floods, increased temperature, and erratic rainfall. Severe/endemic droughts resulted in the drying up of water sources have led to serious water shortages that have compromised personal hygiene while increasing  transmission of faeco-oral diseases. The health effects of the disruptions include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and water-borne illnesses and other infectious diseases, and threats to mental health.

In this regard, the consultant will use meteorological data of climatological and physical parameters and correlates the data with climate sensitive diseases through retrospective method. Some of the data will be measured directly from the weather station

2.1. Rationale or purposes of the explanatory research

The purpose of this research is to generate evidence on climate change and its impact on health and propose intervention strategies and mitigations for future programming. The information gained from the assessment will also help to inform management and decision support on preparedness, early warning and contingencies. Moreover, the finding of this research will be used as a reference for further research questions.

2.2  Objectives of the Assignment

To systematically review hydro-metrological data of climate change and health significance, and retrospectively explain against important disease trends, correlate such impacts against published and unpublished data sources including metrological data for extracting lessons learnt for guiding decisions and implementations. It also looks in to the initiations of contingencies, epidemic response plans.

A.     Active research on air pollution (biomass vs biogas emission and its impact on health) in Negele Arsi

1.   The purpose of this research includes but not limited to – quantify and qualify the impact of cleaner energy sources like biogas on household health and climate change; use of measurements and scientifically acceptable models and calculation for the purpose; collection and collation of household health and health factor information and data including information on sources of energy. The assignment also involves further analysis and quantifications using the DALY, YLL and or YLD as appropriate, and presentation of the emission reductions in equivalents terms of CO2 emission reduction (CDE); and quantification of Green House Gass (GHG) emissions from deforestation- deforestation rate and carbon stocks from use of alternative energy sources.

B.     Systematic review using secondary data and including Gambella context  

2.      The purpose of this research is to generate evidence on climate change and its impact on health and propose intervention strategies and mitigations for future programming. The information gained from the assessment will also help to inform management and decision support on preparedness, early warning and contingencies. Moreover, the finding of this research will be used as a reference for further research questions. To systematically review hydro-metrological data of climate change and health significance, and retrospectively explain against important disease trends, correlate such impacts against published and unpublished data sources including metrological data for extracting lessons learnt for guiding decisions and implementations. It also looks in to the initiations of contingencies, epidemic response plans. The consultant is required to consult and collect data on the following:

Systematically review climate changes overtime and produce analysis of the metrological data trends against diseases of important significance for 5-10 years.

Explain and triangulate important disease trends and exceptions against important climate and metrological data, and other factors

Establish patterns for important diseases and cyclic occurrences and rates

Describe important associations and cofounding factors

Research Methodology

The methodology will follow but not limited, includes Setting, study design and data sources, Data review procedures, Data analysis, Definition of terms (if applicable),

The purpose of this explanatory research/systematic review includes producing trends of climate change vulnerability over years and its impact on health. Designing data collection procedures, developing a research protocols and work plans. Including use of large data from metrological authorities and Ethiopian Public Health Institute (EPHI) and regional health bureau and analyzing using appropriate data analysis tools and models .

If possible estimate also DALY, YLL and or YLD as appropriate.

Data sources

The data sources are published and unpublished reports with priority to integrate health data with meteorology, Public health Emergency Management and Disaster prevention and Food security Agencies and link the impact on malaria, cholera, dengue fever, yellow fever and meningitis, scabies diseases….etc.

Meteorology Agencies: information on temperature (min, max, average), rainfall (min, max, average), humidity, and wind speed/direction etc.

Public health Emergency Management: Early warning & Preparedness and Response & recovery

Disaster prevention and Food security Agencies: vegetation index, land management

CSA: Population, shape files.

Specific tasks to be done by the consultant

The consultant will perform the following task:

·      The consultant will work closely with Amref WASH program, M&E and Project team and will be responsible for the preparation of the research paper.

·      Review published and unpublished reports and systematically review them

·      Develop protocol that clearly defines the methodologies for data collection, entry, cleaning, compilation, analysis of data and report writing. This should also include outline the proposed report structure, deliverables, timelines and budget for the research. Amref health Africa will approve proposed methodologies, procedures and instruments.

·      Develop data extraction tools and Amref health Africa will reviewed them.

·      Develop data collection strategy and plan, lead the data collection process; and data quality assurance process (include identification and training of data collectors,  and pre-testing of data collection tools)

·         Coordinate and conduct data collection, processing, analysis, management and reporting

·      Develop a 1st draft report and submit to Amref Health Africa Ethiopia.

·      Develop a 2nd draft report and submit to Amref Health Africa Ethiopia

·         Conduct a final debriefing at an Amref health Africa Ethiopia Office

·      Present the research reports, discussion, findings and recommendation in presence of researchers and members of the organization. Develop and submit three hard copies and three soft copies on CD ROM of the report incorporating all comments given by Amref Health Africa Ethiopia.