In parts of Sofala Province, the journey to a health clinic can be only a few kilometres. But after heavy rains, those few kilometres can become impossible.
Bridges disappear beneath floodwaters, roads become impassable and clinics wait for medicines that cannot arrive. For people living with HIV or TB, a routine clinic visit can quickly become a health emergency.
These are the realities communities in Beira City and Dondo District shared with researchers working on the ASTRA project in Mozambique.
ASTRA, the Adaptations to Strengthen Healthcare Delivery and Resilience to Extreme Weather Events in Southern Africa project, is a four-year research initiative working across Mozambique, South Africa and Zambia. It focuses on how extreme weather events such as floods, cyclones, heatwaves and droughts can disrupt healthcare and place additional pressure on people already living with HIV and TB. The project brings together researchers, health professionals and communities to co-design practical interventions that can help health systems and communities prepare for, respond to and recover from these disruptions.
Aurum is part of the international research consortium, with Professor Salome Charalambous, Aurum’s Group Chief Health Officer, serving as Co-Principal Investigator alongside Professor Collins Iwuji of the University of Sussex and Africa Health Research Institute (AHRI). The wider consortium brings together partners including AHRI, the University of Sussex, Zambart, Johns Hopkins University School of Medicine and the London School of Hygiene & Tropical Medicine.
In Mozambique, Rogério Chiau, an Aurum Co-Investigator, leads the country team, working alongside Ezequiel Ossemane and colleagues on the ground.
Working across four communities in urban Beira and rural Dondo, the ASTRA team is exploring how increasingly frequent extreme weather events are disrupting access to healthcare and what can be done to strengthen resilience before the next crisis strikes.
The stories the team heard from the communities were both powerful and deeply practical.
Families described crops being destroyed by floods, communities being displaced and roads becoming inaccessible. In some areas, bridges are submerged during periods of heavy rainfall, cutting communities off from healthcare facilities. In addition, medicines can no longer be delivered, health workers cannot reach communities, and people living with chronic conditions risk missing essential treatment.
One account particularly stayed with the research team. During severe flooding, community members explained that even burying loved ones became difficult because local cemeteries were underwater.
That means understanding more than roads, bridges and health facilities. The team is also learning about community networks, local leadership, cultural beliefs and the ways people respond to extreme weather before, during and after an event.
Ezequiel describes the approach as learning from communities rather than judging them.
The work has not been without challenges. Poor road conditions have made some communities difficult to reach, while the team has had to navigate complex local stakeholder relationships and ensure that women and other voices are adequately represented in community engagement. Yet they have continued to find ways to reach the communities and build trust.
In a year marked by disruption across the global health landscape, ASTRA offers a different kind of resilience: the willingness to listen, adapt and build solutions around the realities people are already facing.
“There were so many issues that we heard from the communities,” Ezequiel Ossemane reflected.
For the ASTRA team, these experiences matter because resilience cannot be designed from a distance. “Our approach is not to come from the top to the community. We need to have the information from the community to the top,” noted Rogério Chiau.