Developing a System Dynamics framework to model the complex feedback between climate extremes and health systems

The increasing frequency and intensity of climate extremes, such as floods and heatwaves, pose significant challenges to Maternal and Child Health (MCH) systems, disrupting the delivery and access to essential health services. Mothers and children, due to their heightened health vulnerabilities, are disproportionately affected, particularly in accessing preventive care such as antenatal services and immunizations. Understanding the drivers of climate vulnerability within health systems and their evolution under future climate extremes is critical for designing effective adaptation strategies. However, existing research has predominantly focused on static or qualitative frameworks, leaving a notable gap in quantitative, dynamic, and integrative modeling approaches capable of analysing feedback mechanisms and cascading impacts over time. This research addresses this gap by developing a conceptual and theoretical System Dynamics Modeling (SDM) framework. Informed by evidence-based Causal Loop Diagrams (CLDs) and local stakeholder engagement, the framework highlights critical feedback loops and leverage points influencing MCH system resilience during climate events. Specifically, the study presents findings on how supply-side components – such as service delivery, workforce availability, infrastructure functionality, and resource flows – interact under climate stressors like floods and heatwaves. Designed using Stella Architect and calibrated with real-world data from the REACH project in Zambia, the SDM framework incorporates climate variables (e.g., flood intensity, duration, and frequency; heatwave patterns) and MCH performance metrics (e.g., household health surveys and service utilization records). Key findings reveal pathways through which climate extremes impact system performance, such as infrastructure disruptions caused by flooding that reduce service delivery or prolonged heatwaves that impair workforce productivity, creating cascading system-wide effects. Furthermore, stakeholder engagement identified critical vulnerabilities, including transportation challenges, supply chain delays, and power outages, which informed potential intervention strategies. These strategies include implementing early warning systems to improve preparedness, investing in climate-resilient infrastructure to protect health facilities and road networks, and adopting adaptive governance frameworks for effective resource allocation and coordination during crises. While this study presents a foundation by identifying critical system dynamics and exploring preliminary intervention strategies, the SDM framework is designed to support future applications. It can be used to simulate diverse scenarios, evaluate the long-term impacts of interventions, and guide adaptive strategies to enhance the sustainability and resilience of MCH systems. By advancing from a qualitative CLD to a robust SDM, this research equips policymakers and planners with a dynamic tool for evidence-based decision-making. Ultimately, it contributes to global efforts to build resilient health systems capable of adapting to the escalating challenges of climate change, laying the groundwork for applications across diverse contexts. 

Keywords: Maternal and Child Health Systems, Climate Extremes, System Dynamics Modeling, Resilient Health Systems, Climate Change Adaptation 

Acknowledgments 

This work was conducted under the framework of the Economic and Social Research Council grant: Building Resilience to Floods and Heat in the Maternal and Child Health Systems in Brazil and Zambia (REACH), Grant Number: ES/Y00258X/1.