The impact of climate change continues to be increasingly felt globally, with most of the vulnerable populations in Sub-Saharan Africa. This has called for increased intervention and a call to action for governments and stakeholders to ensure that the challenge does not escalate to being endemic. Healthcare remains at the core of these impacts, and the resilience of health systems is being tested like never before. Community Health Workers have remained vital in addressing healthcare issues in remote and underserved areas and have continually reinforced primary healthcare systems within the region. However, inadequate funding remains a formidable challenge in the sustenance of CH Programs and has led to insufficient resources, poor incentives, and a lack of necessary training and support for the CHWs. To ensure that CHWs are fully resourced, incentivized, trained, supervised, and supported in their efforts, a concerted effort is needed to secure robust financial investments. The need for these investments is urgent and cannot be overstated.
In an insightful webinar organized by the Financing Alliance for Health in early July, experts discussed the critical intersection of climate change and healthcare. The conversation centered around the urgent need for strategic investments in CHWs for climate-resilient health systems. Four distinguished panelists joined us:
- Dr. Johanna Sanchez, Senior Program Manager, Climate Change and Health, Grand Challenges Canada,
- Mr. Nathaniel Soloku, Health Economic Analyst, Ministry of Health in Sierra Leone,
- Ms. Dorothy Mwengei, Health Financing Technical Advisor, Financing Alliance for Health and,
- Mr. John Wabwire, Kenya’s Community Health Worker and climate activist.
HOW IS CLIMATE CHANGE IMPACTING HEALTH IN KENYA?
Mr. John Wabwire – We have been seeing the devastating effects of climate change on health in Kenya already. There has been a rise in temperatures and a change in weather patterns, noting an increased frequency of extreme weather events. An example is the recent floods in Kenya. This has led to a rise in vector-borne diseases like Malaria and waterborne diseases like cholera and typhoid. Malnutrition is also increasing due to the disruption of food security. Moreover, climate-related stress has led to a surge in mental health issues. I, along with community health workers, have been on-ground making efforts to mitigate these challenges, but they still affect us. Heat stress, dehydration, and other diseases leave most of us weak, affecting our daily duties. Some of these cases lead to mental health issues for both us and the communities, especially those displaced, and may, at times, cause trauma .
But we continue to face a big challenge—the lack of sufficient funds and resources, which makes it very difficult for us to support people affected by these calamities. Investing in common health workers will help us build climate-resilient health systems that will help us provide essential healthcare services to remote and hard-to-reach communities in our regions and Africa.
HOW CAN GOVERNMENTS ADDRESS CHALLENGES IN HEALTH SYSTEMS AS A RESULT OF CLIMATE CHANGE?
Mr. Nathaniel Soloku: In Sierra Leone, the government has launched a comprehensive National Adaptation Plan for Climate Change aimed at building a resilient health system and addressing the impacts of climate change across various sectors. The plan is led by the National Emergency Reception Agency (EPA) and involves extensive collaboration among government ministries and departments. In 2023, a ministerial delegation attended COP-28 in Dubai, leading to significant discussions with development partners upon their return. The country has established its first Health Unit for Climate Change within the Ministry of Health, supported by the World Bank, to enhance resilience and preparedness.
The government is also increasing domestic financing for climate resilience and fostering inter-sectoral collaboration. As part of these efforts, a $2 million malaria control program has been implemented, targeting six high-burden districts with vector control and household surveys. This initiative emphasizes the necessity of sustainable financing and proactive investment to ensure a robust response to the health challenges posed by climate change.
HOW CAN NON-STATE ACTORS MOBILIZE RESOURCES MITIGATING THE HEALTH IMPACTS OF CLIMATE CHANGE?
Dr Johanna Sanchez: We’re seeing a significant prioritization of health impacts from climate change, underscored at COP 28 and recently at the World Health Assembly in Geneva. These events have reinforced health as a critical focus, prompting funders like us to integrate climate change into our strategic plans. Since stepping into my role, I’ve engaged with global funders who are rapidly forming teams and drafting future programs with climate resilience in mind. This shift is exciting as it signals a collective recognition of the urgency and importance of addressing climate-related health challenges.
However, we’re facing a substantial challenge with data. We need more organized, locally driven data to identify priority areas for funding, particularly in sub-Saharan Africa. This data is crucial to understanding specific regional challenges and gaps in the health system. For instance, we need to determine whether more education, additional staff, or other resources are needed to improve community health workers who are on the front lines of climate impacts. Are they facing new diseases due to climate change, and do they have the training to address these issues?
Our strategy at GCC involves close collaboration and communication with other funders to ensure our efforts are complementary rather than duplicative. We’re aiming to pool funding and coordinate activities for maximum impact. Locally driven priorities are paramount; we want to work with those most affected by climate change to ensure our efforts are relevant and effective. At Grand Challenges Canada, we’re preparing to launch key landscape analyses and plan to release our funding initiatives by 2025, all while engaging in ongoing conversations with other funders to align our strategies.
Climate change is becoming a core consideration in all our global health initiatives, much like gender equity has been. It’s a lens through which we must view all our programs, ensuring that our efforts are comprehensive and far-reaching. Our goal is to make swift, impactful investments guided by robust data and local insights, ensuring that our health systems can withstand and adapt to the challenges posed by a changing climate.
WHAT GAPS AND BARRIERS HAVE YOU IDENTIFIED, ESPECIALLY IN POLICYMAKING?
Ms. Dorothy Mwengei: As a continent, sub-Saharan Africa isn’t lacking in good policies, but these policies often miss crucial public participation and alignment with societal needs. Reflecting on my own culture, where environmental conservation was traditionally respected, I see the value in creating policies that integrate cultural and social norms. For example, the Libreville Declaration of 2008, which involved finance, environment, and climate ministers, emphasized the broad impact of climate change across sectors like gender, agriculture, and infrastructure, as seen during the recent climate disaster in Kenya.
One significant gap is capacity; climate issues aren’t well integrated into other systems. It’s crucial that climate education becomes part of the curriculum across all sectors, including health. Health systems contribute significantly to greenhouse gas emissions, and health professionals need to be trained in climate change mitigation and adaptation.
Moreover, justice systems need to be more transparent and equitable. Current laws often disproportionately punish the disadvantaged while those with money evade accountability. According to SDG reports, it will take 186 years to close the legal protection gap and remove discriminatory laws at our current pace. We need to reinforce regulations to ensure they apply equally to all, regardless of social status.
Developing countries, though contributing minimally to greenhouse gas emissions, are severely affected by climate change. Therefore, global conversations should involve these countries at the center where wealth and resources are managed. This inclusive approach is essential to address the climate crisis effectively and equitably.
WHAT ARE THE AREAS OF SUPPORT NEEDED FOR COMMUNITY HEALTH WORKERS TO CONTINUE MITIGATING THESE CLIMATE CHANGE IMPACTS?
Mr. John Wabwire: As a community health actor working on the ground, I see firsthand the critical gaps in our ability to address climate change and its impact on health. CHWs lack adequate training on climate change despite being at the forefront of addressing its effects. This lack of knowledge hinders our ability to tackle climate-related health issues effectively. Additionally, we face severe resource shortages, including basic healthcare facilities, making it challenging to respond to climate impacts when they occur.
We desperately need funding to provide comprehensive training for community volunteers and workers on climate-related challenges. This training would enable us to control and mitigate the effects of climate change more effectively. Building trust with the community is crucial, but disasters often disrupt regular communication and engagement with both community members and other stakeholders.
To truly handle climate issues, we need more diverse training that integrates climate education with our existing health training. By equipping community health workers with the necessary knowledge and resources, we can better address the impacts of climate change and protect the health of our communities.
HOW CAN WE INTEGRATE CLIMATE, HEALTH, AND NCDS IN ADVOCACY EFFORTS TO MOBILIZE DOMESTIC AND INTERNATIONAL FUNDING?
Ms. Dorothy Mwengei: We’re witnessing a significant demographic shift in disease patterns across our region, with non-communicable diseases becoming increasingly prevalent and, to some extent, preventable. At the Financing Alliance for Health, we’re emphasizing community health workers’ role in early diagnosis and prevention efforts. As Dr. Johanna Sanchez highlighted, it’s crucial that we integrate climate considerations across all sectors because climate impacts every facet of society directly.
As we confront rising rates of non-communicable diseases, which now account for roughly 50% of global deaths, the burden is especially heavy in sub-Saharan Africa. Prevention must be our focus due to perpetual resource constraints. Reflecting on commitments like the Abuja Declaration from two decades ago, few countries have fully met their health financing pledges, exacerbated by climate change widening financial gaps.
Efficient resource utilization is essential, alongside increased funding. Prevention strategies offer a high return on investment; for instance, in Kenya, primary healthcare has shown a return of 1:16. Growing up in Kenya, I witnessed my father’s solitary struggle with diabetes decades ago, a stark contrast to today when diabetes affects every household.
Our challenge now is whether to invest in costly medical equipment or prioritize lifestyle changes, early screenings, and dietary adjustments—actions that also mitigate the impacts of climate change on nutrition. Let’s prioritize prevention strategies first, leveraging the lessons of our past declarations and effectively addressing our current challenges.
The focus isn’t solely on managing existing cases of diabetes and hypertension but rather on preventing them where possible. At the Financing Alliance for Health, we’re conducting a cost analysis to understand the financial strain these diseases place on our health sector. Screening is vital, yet we view a high number of cases as a call to action rather than a success. Personally, knowing my genetic predisposition to diabetes, I emphasize prevention through exercise, a balanced diet, and avoiding risk factors like alcohol and smoking. We aim to emulate successful strategies in preventing communicable diseases, like reducing diarrhea costs in Makueni County, by implementing similar preventive measures for non-communicable diseases through our community health worker platform.
HOW CAN POLICY SUPPORT HELP BUILD CLIMATE-RESILIENT HEALTH SYSTEMS? AND WHAT DOES IT REALLY MEAN TO CREATE AND BUILD A CLIMATE-RESILIENT HEALTH SYSTEM?
Mr. Nathaniel Soloku: In Sierra Leone, policies play a pivotal role in shaping effective responses to climate change. For instance, Sierra Leone has initiated a national adaptation plan that has been developed through collaboration across sectors. This approach ensures that climate issues are integrated into broader governmental strategies, fostering political will and enhancing domestic funding for implementation.
Involving community health workers from the outset is crucial. By training them on climate-related interventions and integrating their efforts into policy frameworks, such as sustainable city planning and deforestation reduction, we mitigate risks like the devastating 2017 mudslide that claimed over 1,000 lives due to inadequate policies. Thus, integrated and inclusive policies are essential drivers for building resilient health systems that span from local communities to national levels.
ARE THERE LOCALLY DRIVEN INNOVATIVE SOLUTIONS YOU HAVE COME ACROSS THAT ARE SCALABLE?
Dr Johanna Sanchez: Entering the intersection of climate and health, I’ve been intrigued by the emerging innovative digital solutions, such as early warning systems tailored for community health workers. These tools, evolving from initiatives in Kenya, show promise in preparing us for upcoming climate challenges like heightened heat stress. As someone focused on health impacts, I see how crucial it is for these technologies to scale effectively across ministries of health, ensuring they benefit vulnerable populations, including those with conditions like diabetes, vulnerable to climate-related health risks.
Mr. John Wabwire: I believe investing in government health workers is pivotal for building resilient health systems amidst climate challenges. By empowering community health workers, we can deliver essential care to remote areas and swiftly respond to emerging health needs during crises. Our role extends to providing culturally sensitive care tailored to diverse community needs, which not only enhances health outcomes but also contributes to mitigating climate impacts. Acting as early warning systems, we can anticipate and prepare for environmental hazards like floods, leveraging local knowledge to educate and empower communities in climate adaptation. Training in climate resilience and utilizing technologies like mobile health tools are crucial steps in integrating climate-sensitive interventions into our daily healthcare practices, fostering community resilience and sustainability.
FINALLY, WHAT’S THE ONE KEY TAKEAWAY FROM THIS AND OTHER DISCUSSIONS?
Mr. Nathaniel Soloku: My take-home message revolves around the critical need for innovative financing mechanisms to support climate health initiatives. Governments must prioritize existing taxes and explore how these funds can be redirected toward financing solutions that effectively address climate-related health challenges. Moreover, harnessing the power of grassroots organizations and community health workers is key to intensifying sensitization efforts and ensuring widespread understanding of climate health issues at the community level.
Ms. Dorothy Mwengei: My one message is the community of workers’ slogan – “If it’s not happening in the community, it’s not happening anywhere.” Community health workers need to be empowered, not in terms of capacity building; they should be renumerated for the work that they initially do. They should be supported and supervised, and I think intersectoral collaboration would help mitigating and adapting to the climate crisis that we’re experiencing.
Dr. Johanna Sanchez: We need locally led, locally driven solutions and innovations. You need everybody to put their heads together and come up with ways to make these solutions scalable. And then come, look for us because we are looking for those innovations to have the most impact and funding.
While the effects of climate change on Sub-Saharan Africa (SSA) remain largely unexplored, there is significant potential for impactful work in this field. At Financing Alliance for Health, our commitment is to pioneer solutions that promote resilience and strengthen healthcare systems. By ensuring Community Health Workers receive the support needed, through focusing funding and investments towards community health work is a step towards a robust health care system and ultimately achievement of Universal Health Coverage. As SSA remains particularly vulnerable to climate impacts, it is crucial that all stakeholders collaborate to mitigate these challenges and secure a healthier, more sustainable future for the region.