Rethinking Investments in Climate Resilient and Environmentally Sustainable Health Systems: Perspectives from Africa

By guest contributor Rudolf Abugnaba-Abanga

The Climate and Health Network for Collaboration and Engagement (CHANCE) organized its second annual conference from the 24^th to 25^th of August 2023 in Gaborone, Botswana, with the theme, “Accelerating Climate Adaptation and Policy Development for Africa.” The conference brought together health system researchers, policymakers, and practitioners across Africa. Also in attendance were the WHO African Regional Office (AFRO) and the Ministries of Health (MoH) of Botswana, Kenya, Malawi, Tanzania, Madagascar, and South Africa.

The conference showcased several successful transdisciplinary collaborations among health systems researchers and practitioners from the Global North and South in rolling out innovation around climate-resilient health systems. Notable among these include adapting health systems to heat in Ghana (Codjoe et al., 2020), coastal resilience in Tanzania, malaria-early warning systems in Ethiopia, and efforts for learning and networking among researchers, policymakers, and practitioners by the CHANCE Network, which is expanding across Africa.

As an advocate for improved technical support by the WHO AFRO to its Member States for developing national capacity, appropriate tools, and communication for climate-resilient and environmentally sustainable health systems, I was delighted to hear Brama Kone, the WHO AFRO Technical Officer for climate change and health, outlining the Alliance on Transformative Action on Climate Change and Health (ATACH) initiative. WHO AFRO aims to support countries in building climate-resilient and sustainable low-carbon health systems in five strategic areas of: (1) financial and technical support to member countries in designing their COP26 health commitments; (2) capacity building and technical support for vulnerability and adaptation assessment and drafting health national adaptation plans (HNAPs); (3) support country proposals to the Green Climate Fund (GCF) and support win-win partnerships and intersectoral collaboration; (4) enhancing capacity building of the health sector in the AFRO region and; (5) advocacy for the ATACH initiative.

Despite the renewed energy and commitments to climate-resilient and low-carbon health systems by most African countries, I firmly believe that African governments must have a mind shift from business-as-usual to a more proactive approach. I call for African Governments to adopt “thick mainstreaming” approaches – that is, mainstreaming national climate and health system agenda into sub-national program policies with built-in monitoring, accountability, and participatory mechanisms. This approach will encourage bottom-up approaches, innovation, autonomous adaptation and leverage the trust in the health systems to build momentum for intersectoral collaboration and sustainable action in partnership with actors and the citizenry.

In the following paragraphs, I outline three critical actions Africa needs to enhance climate–resilient and low-carbon health systems and ensure sustainable action.

Changing the narative

Climate change is undoubtedly the greatest threat to human populations in the 21^st century. Our health systems will witness massive disruptions due to climate hazards and an increased burden of climate-sensitive diseases (Lugten & Hariharan, 2022). African governments’ branding climate change as a “health” issue can stimulate “citizen movements” to support sustainable climate action. Specific to health systems, the trust in the health systems by populations and the continuous investment towards Universal Health Coverage (UHC) by different levels of governance can be leveraged by non-state actors and citizenry to prioritize health system adaptation and mitigation to climate change in the national development agenda. (Climate–resilient and Environmentally Sustainable Health Systems)

Political commitment

Most African countries have committed to climate action and, most recently, to the goal of building climate-resilient and low-carbon health systems through the ATACH initiative. Interestingly, most initiatives of the MoHs present at the CHANCE Network Conference received funding from development partners or the GCF. The over-reliance of MoHs in Africa on international funding to drive health systems adaptation and mitigation raises questions of ownership and genuine commitment. Recent flooding events in Pakistan resulted in 1730 deaths, wide-scale disruptions of healthcare services and exposure of 8 million people to disease and undernutrition (Zaidi & Memon, 2023). The 2022  flooding in South Africa resulted in damages to health infrastructure worth R187,000,000.00. Recent flooding in the lower Volta basin in Ghana displaced 26,000 people, with hospitals and mortuaries submerged in water for weeks. The above examples suggest that countries cannot achieve UHC without investing in climate-resilient health systems, hence the need for African governments to take bold steps to own processes and commit domestic funding. Implementing health systems climate-resilient actions or adaptation can save money by minimizing negative impacts on health infrastructure and coping with population health demands during extreme climate events or hazards (WHO, 2015).

Decolonizing climate change funding

The stringent GCF proposal process has limited the Least Developed Countries(LDCs) in Africa and conflict-ridden countries with high climate change vulnerabilities due to weak government institutions. Furthermore, many countries cannot access funds directly through their independent and national entities, limiting ownership(Garschagen & Doshi, 2022). Africa must call for immediate reforms in the global funding architecture for climate change, including the newly established Loss and Damage Fund, which will focus on averting, minimizing, and addressing the incurred and irreversible loss and damage associated with climate change in developing countries. Any reforms should include decentralizing global climate funding mechanisms, encouraging strong participation of the most affected populations in its governance, and targeting efforts to capacitate their independent and national entities’ access and utilize GCF funds appropriately.

In conclusion, African governments must begin translating global commitments to building climate–resilient and low-carbon health systems to concrete action on the ground by adopting thick “mainstreaming” approaches. Finally, I call on state and non-state actors from the Global South to strongly take action in decolonizing international climate change financing mechanisms by demanding active participation in its governance by the most vulnerable. African countries must immediately strengthen and capacitate their national and independent entities to tap into existing global climate financing mechanisms.

The author wishes to thank Dr. Renzo Guinto and Dr. Sari Kovats – colleagues from the Thematic Working Group on Climate –Resilient and Sustainable Health Systems of Health Systems Global – for their generous review and invaluable comments.

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About the author:

Rudolf Abugnaba-Abanga is a health, development and sustainability professional with 20 years of national and international experience working with government, INGOs, local NGOs, academia, and development partners in Africa in health governance, social accountability for health, young people’s sexual and reproductive health rights, women’s socio-economic empowerment, and community participation in partnership with local and international consortia. He is a PhD candidate at the University for Development Studies, Ghana, focusing on climate-resilient and sustainable health systems in low-resourced sub-national settings. He has served on the Global Steering Council of the Peoples Health Movement (PHM) and is currently the vice chair for Africa of the Thematic Working Group on Climate–Resilient and Sustainable Health Systems of Health Systems Global.

References

1. Codjoe, S. N., Gough, K. V., and  Wilby, R. L., et al. (2020). Impact of extreme weather conditions on healthcare provision in urban Ghana. Social Science & Medicine, 258, 113072. https://doi.org/10.1016/j.socscimed.2020.113072
2. Garschagen, M., & Doshi, D. (2022). Does funds-based adaptation finance reach the most vulnerable countries? Global Environmental Change, 73, 102450. https://doi.org/10.1016/j.gloenvcha.2021.102450
3. Lugten, E., & Hariharan, N. (2022). Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming. Health Security, 20(5), 435-439. https://doi.org/10.1089/hs.2022.0050
4. Zaidi, S., & Memon, Z. (2023). Pakistan floods: Breaking the logjam of spiraling health shocks. EBioMedicine, 93. https://doi.org/10.1016/j.ebiom.2023.104707

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