Promoting Interventions for Climate Change to Upscale Resilience in District Badin and Astore (PICCTURE)

About the Project

The Promoting Interventions for Climate Change to Upscale Resilience (PICCTURE) trial addresses the urgent challenge of climate change impacts on vulnerable communities in Pakistan. Climate change refers to long-term shifts in temperature and weather patterns, which can occur naturally but are now predominantly driven by human activities, especially the burning of fossil fuels such as coal, oil, and gas since the 1800s. According to the Intergovernmental Panel on Climate Change (IPCC), global surface temperatures are projected to rise by around 1.5°C above pre-industrial levels, leading to more frequent extreme weather events, intensified natural hazards, and escalating climate-related health risks worldwide.

Climate change is disrupting the interdependence between humans and the environment by increasing climate variability, amplifying disasters, and altering ecosystems, with profound economic, ecological, and health consequences. These impacts are disproportionately borne by low- and middle-income countries (LMICs) despite their minimal contribution to global greenhouse gas emissions. Recent climate-related crises in South Asia highlight the urgent need for community-level adaptation and resilience-building, particularly in populations most vulnerable to health risks, livelihood loss, and environmental displacement.

Pakistan ranks among the countries most affected by climate change according to the Climate Risk Index, and faces disproportionate risks from floods, droughts, glacial lake outburst floods, and cyclones. Recent catastrophic events, including the 2022 floods that displaced nearly 10 million people, highlight the pressing need for community-level adaptation strategies.

In this context, the PICCTURE trial aims to strengthen community resilience through structured training and outreach on climate-related health risks, heat adaptation, disaster preparedness, livelihood diversification, and financial literacy. The intervention is grounded in evidence from prior work demonstrating the effectiveness of community engagement and Lady Health Worker (LHW)-led interventions in improving maternal, child, and mental health outcomes in Pakistan, as well as identified research priorities emphasizing community-based climate adaptation strategies.

The trial includes two intervention arms and one control arm across climate-vulnerable districts, Badin and Astore. The first arm implements Village Management Committees (VMCs) to lead community training and household engagement on disaster risk reduction, livelihoods, and financial resilience. The second arm builds on this model by additionally integrating Primary Healthcare facilities (PHCs) and LHWs to strengthen health system linkages, improve community participation, and enhance climate-responsive care delivery. By generating evidence on scalable, culturally sensitive resilience-building approaches, the project contributes to global priorities for climate adaptation and informs strategies for protecting marginalized populations in South Asia and beyond.

Project Objectives

• To assess the impact of community-led versus combined community- and PHC-led strategies on strengthening community resilience and adaptation to climate change-related impacts.

Methodology / Approach

The PICCTURE trial is designed as a cluster-randomized controlled trial (cRCT) conducted in two climate-prone districts of Pakistan — Astore (Gilgit-Baltistan) and Badin (Sindh). Thirty clusters per district (10 per arm) are randomized into two intervention arms and one control arm. The target population includes all households with permanent residence in selected clusters.

The interventions comprise:

• Community-led strategies (CI arm): Village Management Committees (VMCs) trained in disaster risk reduction, livelihood diversification, financial literacy, and health awareness.
• Community plus Primary Healthcare engagement (CHI arm): VMC activities supplemented by Lady Health Workers (LHWs) and healthcare providers to strengthen health system linkages and climate-responsive care.
• Control arm: Usual services without additional intervention.

Data collection involves baseline and endline household surveys, process evaluations, and disaster event follow-up assessments. Surveys aim to measure primary outcomes (Disaster Resilience Index, Multidimensional Livelihood Vulnerability Index), secondary outcomes (health-seeking, morbidity, mortality, food security, mental health), and process indicators (financial literacy, preparedness, compliance).

The analysis approach follows an intention-to-treat framework, using mixed-effects regression models to account for clustering and difference-in-differences estimation. Both continuous and binary outcomes will be analyzed with adjustment for confounders.

The implementation model emphasizes participatory learning and action, with VMCs leading monthly/bimonthly sessions, supported by refresher trainings and structured monitoring. This dual-arm design allows comparison of purely community-led versus health system-linked resilience strategies, generating evidence for scalable climate adaptation models in LMICs.

Study Location

Pakistan

Please Note: The study is being implemented in Badin, Sindh, and Astore, Gilgit-Baltistan.

Target Population / Beneficiaries

The target population of the PICCTURE trial includes households with permanent residence in selected clusters of Astore (Gilgit-Baltistan) and Badin (Sindh). Each cluster represents a village or group of villages, averaging 100 households in Astore and 200 households in Badin.

Project Team​

Principal Investigator

Dr Jai Kumar Das Associate Director, Institute for Global Health and Development, Aga Khan University ​

Project Management and Coordination

Arjumand Rizvi

Other Key Team Members

Mushtaq Mirani

Ahmed Attiullah

Abdullah Babar

Muzna Hashmi

Research Partners

Institute for Global Health and Development Aga Khan University

The Hospital for Sick Children

Supported By

International Development Research Centre (IDRC) Canada

Grant Status

Active / Ongoing

Key Achievements

• Baseline data collection and field implementation started, including development of Village Management Committees (VMCs) for intervention delivery.

Expected Outputs / Deliverables

• Research publications
• Technical reports
• Community interventions

Reports and Resources

Why This Matters

The PICCTURE trial is expected to generate critical evidence on how community-led and health system-linked strategies can strengthen resilience against climate-related shocks in vulnerable populations. By training Village Management Committees (VMCs) and engaging Lady Health Workers (LHWs) and primary healthcare providers, the interventions aim to improve household preparedness, diversify livelihoods, enhance financial literacy, and promote climate-responsive health practices.

The anticipated outcomes include measurable improvements in Disaster Resilience Index (DRI) and Multidimensional Livelihood Vulnerability Index (MLVI) scores, alongside better health-seeking behaviors, reduced morbidity and mortality, improved food security, and stronger community disaster preparedness. Importantly, the trial will also assess real-world performance during climate events, providing insights into practical resilience-building under stress conditions.

This matters because Pakistan ranks among the most climate-affected countries globally, with millions displaced by floods and other hazards in recent years. Evidence from PICCTURE will inform scalable, culturally sensitive models for climate adaptation, guiding policymakers, health systems, and communities in South Asia and similar contexts worldwide. By bridging community action with health system support, the project contributes to global priorities for climate resilience and sustainable development.

Keywords

Climate Change; Disaster Resilience; Disaster Preparedness; Climate Change Adaptation; Community-Based Intervention

Contact

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