Climate change adaptation through spatial planning: the case study of the region of Western Macedonia

In this paper the compatibility and complementarity between the Regional Adaptation Action Plans (RAAPs) and other regional-scaled plans, such as the Regional Spatial Planning Frameworks (RSPFs), are examined, using as a case study the Region of Western Macedonia. The compatibility and complementarity of objectives, measures and tools between the RAAP and the RSPF of Western Macedonia are assessed. The analysis of the RAAP and the RSPF of Western Macedonia revealed the interconnection between spatial planning policies and adaptation to climate change policies. However, severe doubts are raised about the usability of the revised RSPF of Western Macedonia since it does not assess the crucial new conditions and priorities related to the region’s future development, including the de-lignification and the Just Transition initiatives.

Medical care payment improvement within diagnosis-related groups of patients with severe asthma requiring biologic disease-modifying drugs by regional adaptation mechanism in the Moscow Region

Objective: scientific rationale of changing approaches to medical care payment for hospitalization of patients suffering from severe asthma (SA) that require the prescription of biologic disease-modifying drugs (bDMDs) within the constraints of diagnosis-related groups (DRGs) on the level of the Moscow Region.Material and methods. For the federal model regional adaptation, the authors used the mechanism of subgroups selection in the structure of basic DRG No. 336 st36.003 and No. 139 ds36.004 “Treatment with biologic disease-modifying drugs and selective immunosuppressants” in the round-the-clock (RH) and day-time hospital (DH). Budget impact analysis (BIA) was performed to provide scientific and economic feasibility for the improvement of medical care payment for bDMDs proscribed to patients with SA within DRG at the level of the Moscow Region.Results. The analysis of cost of drug therapy and medical services per 1 case of hospitalization of patients with SA, that required bDMDs therapy, considering the classification criterion (international nonproprietary name of drugs and drug therapy regimens), showed 10 subgroups in DRG No. 336 st36.003 (level 1) and 9 subgroups in DRG No. 139 ds36.004. Expert estimates on the rate of hospitalizations and drug dosage regimen indicated for patients with SA were used to calculate the relative cost weights (CW). The highest CW was observed in the subgroup that received benralizumab in RH (CW=7.46) and in DH (CW=12.08) conditions. BIA demonstrated 110,103,901.53 rubles (or 31%) budget savings for the health care system of the Moscow Region.Conclusion. The implementation of the adapted DRG federal model in the conditions of the health care system of Moscow Region is an economically feasible approach to the organization of the inpatient medical care provided to patients with SA needing bDMDs prescription.

Some challenges of interdisciplinarity

This piece explores dialogue analysis inside a particular ongoing collective work, a regional adaptation to climate change research-action project in the southern part of Québec province, the Memphrémagog MRC. First, some precision is given to better understand what it means to work in interdisciplinary contexts such as this one, continuing the development of a terminology to be able to better identify collaboration between and with different professionals. These problems are then expressed in two case studies of dialogues as they have been documented in the research project.

Rapid Bioassessment Protocols Using Aquatic Macroinvertebrates in Africa–Considerations for Regional Adaptation of Existing Biotic Indices

Benthic macroinvertebrates are commonly used to assess water quality and ecological condition of aquatic ecosystems and they form the basis of several biotic indices. Many of these biotic indices are based on rapid bioassessment protocols (RBP). The first RBP based on macroinvertebrates, developed in Africa in the early 1990s, was the South Africa Scoring System (SASS). Since then SASS has been widely used in southern Africa and beyond, and has formed the basis of several other RBPs developed in Africa. This paper explores the RBPs and associated biotic indices currently used in Africa, primarily those that are rapid, field-based with low taxonomy (mostly family level) and which rely on sensitivity weightings of individual taxa to generate three metrics for interpreting water quality and ecological condition of aquatic ecosystems. Recommendations for future regional adaptation of RBPs, including calibration, validation, and modification of RBPs and biotic indices for new regions are provided. To date, five RBPs have been developed in Africa, while some existing biotic indices have been used outside their intended regional range. Key to the efficacy of any RBP and associated biotic index is the ability to detect a water quality impact, or change in river health. Important considerations when adapting an index for a new region or country include evaluating the suitability of the sampling protocol to local river conditions, evaluating the distribution of aquatic macroinvertebrate taxa in the region, assigning sensitivity weightings to new taxa in the region, evaluating the ability of the biotic index to detect impacts, evaluating within-country spatial and temporal variability in macroinvertebrate assemblages, and developing appropriate data interpretation guidelines based on metric scores and reference conditions. Often several iterations of a biotic index are needed, with improvement in efficacy with each version, following spatially and temporally comprehensive sampling. Future RBPs developed for bioassessment of rivers in Africa will promote the protection, conservation, and management of African riverine ecosystems.

Health system adaptation to climate change: a Peruvian case study

Despite mitigation attempts, the trajectory of climate change remains on an accelerated path, with devastating health impacts. As a response to the United Nations Framework Convention on Climate Change call for National Adaptation Plans, Peru has developed a national and decentralized regional adaptation plans. The purpose of this article is to understand the role and priority status of health within the adaptation planning and process. Peru was used as a case study to analyse the policy process in the creation of adaptation plans, encompassing the need to address climate change impacts on health with a particular focus on marginalized people. An actor, content and context policy analyses were conducted to analyse 17 out of 25 regional adaptation plans, which are available. The national adaptation plans (2002, 2015) do not include health as a priority or health adaptation strategies. In a decentralized health care system, regional plans demonstrate an increased improvement of complexity, systematization and structure over time (2009–17). In general, health has not been identified as a priority but as another area of impact. There is no cohesiveness between plans in format, content, planning and execution and only a limited consideration for marginalized populations. In conclusion, the regional departments of Peru stand on unequal footing regarding adapting the health sector to climate change. Findings in the strategies call into question how mitigation and adaption to climate change may be achieved. The lack of local research on health impacts due to climate change and a particular focus on marginalized people creates a policy vacuum. The Peruvian case study resembles global challenges to put health in the centre of national and regional adaptation plans. In-depth cross-country analysis is still missing but urgently needed to learn from other experiences.