Evaluation of Climate-Resilient and Environmentally Sustainable Healthcare Adaptation Solutions in Primary Healthcare Facilities Serving Host Communities and Forcibly Displaced Myanmar Nationals in Teknaf, Bangladesh: A Study Protocol

Abstract

In coastal Bangladesh, climate-related hazards threaten health and primary healthcare (PHC) systems, already constrained by infrastructure, workforce, and energy gaps. Teknaf, a coastal sub-district of Cox’s Bazar, hosts part of the approximately 1.19 million Forcibly Displaced Myanmar Nationals (FDMNs) living in Cox’s Bazar District, adding pressure on PHC facilities. Terre des hommes (Tdh), Climate Action Accelerator (CAA), and icddr,b, with local stakeholders, developed Climate-Resilient and Environmentally Sustainable Healthcare (CRESH) solutions for thirteen PHC facilities in Teknaf. This protocol describes a RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance)-guided longitudinal, mixed-methods evaluation to assess implementation feasibility, acceptability, fidelity, adaptation, immediate outcomes, potential indicators of sustainment, and scale-up of CRESH solutions. The evaluation comprises pre–post facility surveys (13 facilities, approximately 35 staff per round), pre–post beneficiary surveys in three facility catchments (186 interviews per round), and initial and concurrent qualitative assessments (interviews, focus group discussions, and facility observations). Data collection runs from January to October 2026 within a 22-month project (March 2025–December 2026). Quantitative data will be analyzed with survey-design methods in Stata 17, and qualitative data by framework analysis. Without a comparison group and with a short implementation period, observed changes will be reported as changes following implementation rather than as effects caused by CRESH. Study findings will inform policy, effectiveness trials, and scale-up in Bangladesh and similar climate-vulnerable, displacement-affected settings.