Implementation Lessons of a Water Insecurity Intervention During a Drought in Mexico.

Background: We are early in our understanding of how to effectively implement interventions to mitigate the harm of extreme climate events on human health. We study the actions of the state government in Nuevo Leon, Mexico, which, in 2022, declared a state of emergency due to water shortages resulting from climatic and infrastructural issues. Objective: To document the facilitators and challenges to the rollout of the government's strategy to mitigate water insecurity, using the EquIR Implementation Science framework. Our analysis focused on the activities of the Ministry of Social Policy, which coordinated emergency activities. The government's response included water delivery by tanker trucks, installation of household and community cisterns, and distribution of packaged drinking water. Methods: We used three sources of information: gray and academic literature review, government documents, and 10 key-informant interviews. Findings: Facilitators of government actions were the declaration of an emergency as a policy instrument; multi- and inter-sectoral collaboration; the use of pre-existing social and data infrastructure; technical capacity to identify low-income households without water; and flexibility to convert regular activities to emergency response tasks. Salient challenges included citizen discontent about the lack of water; the absence of a preparedness plan; the scarcity of household equipment to store water; initial inefficiencies with water distribution using tanker trucks; difficulties in installing community cisterns in steep terrain; and staff burnout. A positive externality of the response was the improvement of water distribution in informal settlements. Conclusions: As the need to buffer human health from extreme climate events increases, lessons from Mexico about linking climatic events, social policy, and health outcomes can guide strategies in other locations with increasing drought. This case shows how climatic stressors, infrastructure deficiencies, and the population's coping capacity interact with the government's actions to shape the impacts of a crisis and its mitigation efforts. Successful mitigation strategies may result from strengthening inter-sectoral collaboration and an evidence-based culture of prevention.