Opinion: Financing climate resilient health systems needs focus
System-based investment in preparing health systems for climate impacts is vital but often overlooked. In Ethiopia, Cordaid has
worked with health authorities to adapt performance-based financing to integrate drought responses in health facilities.
Climate change is the “greatest global health threat facing the world in the 21st Century,” according to a 2022 Lancet report on health and the climate crisis. Yet, little funding is made available to the countries most affected by it to withstand the related health impacts. The World Health Organization estimates that every year almost 13 million people lose their lives to environmental causes. That is due to direct impacts, such as the 1,739 people who lost their lives due to severe floods in Pakistan in 2022, as well as the indirect impacts of food and water shortages. The Horn of Africa is currently being confronted by an unprecedented number of disease outbreaks and climate-related food crises, with 47 million people facing acute hunger. Meanwhile, insect-borne diseases are expected to affect an additional 4.7 billion people worldwide by 2070 as a result of global warming. There is an increasing need for donors and development partners to invest in system-based approaches that foster climate-resilient health systems and not wait for a crisis before acting. Pressure on health systems There is an urgent need to make health systems everywhere climate resilient. While the COVID-19 pandemic showed us the importance of strong health systems, it also highlighted global inequalities, with severe repercussions. The global response to climate change’s health impacts must start by strengthening health systems in areas most affected by climate change. Ethiopia is one example of a country heavily affected by climate change. The country is facing weather extremes, including both severe droughts and floods. For the past three years, the country has been experiencing prolonged drought in its Oromia and Somali regions, causing displacement as the majority of the population depends on agriculture and pastoralism. In Borena, one of Oromia’s hardest-hit zones, crops have failed and farmers are forced to see their cattle perish amid the drought. Currently, in the Borena zone, there are over 39,500 drought-induced displaced households or 221,200 individuals, according to data from the Borena Zonal Health Office. In total, Borena has lost 30% of the livestock head, the majority of which are cattle valued at over $372 million. How health is impacted In the face of these new pressures, Ethiopia’s health system needs to address the 20.4 million people in need of food assistance across the country. It also needs to monitor disease outbreaks and anticipate epidemic risks. Recently, mosquito-borne dengue fever has been re-emerging in Ethiopia, with the first cases reported in Dire Dawa in 2013, and outbreaks have occurred elsewhere since including in Borena. As a result of extreme flooding, nearly 70 million people are at risk of cholera in Ethiopia. The health system also needs to adapt to cater to the needs of communities displaced due to droughts and the ration of water in health facilities to ensure stable supply and proper hygiene. Droughts have also been shown to negatively impact the mental health of pastoralist communities that find it harder and harder to access water and maintain their livestock. In addition, stressors on livelihoods, food supplies, and access to water for hygiene purposes are all associated with challenges to sexual and reproductive health and rights. Lack of urgency The key to mitigating the health impacts of a changing climate is to make sure health systems are resilient, especially where climate change is most severe. In 2021, the Ethiopian government developed its National Health Adaptation Plan designed to strengthen its health system and facilities to deal with the impacts of climate change. A climate-resilient health system is one that is continuously assessing and adapting. It could, for instance, contain epidemic outbreaks before they reach neighboring regions and countries, or before the outbreak has time to turn into a pandemic. Despite this, global financing to fund such adaptation remains scarce. For most high-income donor countries, the health impacts of climate change are still relatively mild so the need to invest is not treated as urgent. Donors and development partners cannot wait for the situation to escalate globally before addressing the already visible effects of climate change on human health in some parts of the world. In addition, the objective should not just be to mitigate the short-term needs but to reduce the overall risks and vulnerability of communities to climate change in the long term. Performance-based financing While climate change is often referred to as a crisis, that should not divert us from treating climate change as a protracted condition and from delivering adequate financing in response. More funds should be made available to development programs that address climate change and health from a system-based perspective. Donors and development partners should align with country priorities and long-term plans in order to contribute to health systems strengthening. The Ethiopian Federal Ministry of Health, in their Guidance for Building Climate Resilient Health System policy document, “calls upon development partners and stakeholders collaboration in addressing the health risks climate change through … the development and improvement of climate resilient health systems and health care facilities.” Existing development programs can adapt to the priorities set by countries affected by climate change. In Ethiopia, Cordaid is currently adapting its performance-based financing, or PBF, program in Borena. PBF is a system-based approach that remunerates health facilities based on performance. After an initial pilot that started in 2015, all health facilities in Borena have been participating in the PBF program since 2020, implemented in close collaboration between Cordaid Ethiopia and the Oromia Regional Health Bureau, with funding from the Embassy of the Kingdom of the Netherlands. Since then, the facilities have successfully been incentivized to increase the utilization and quality of essential health services. In response to the protracted drought, the program is now adopting additional incentives to maintain the quality of critical services such as measles vaccination, pneumonia treatment, and screening and treatment for malnutrition. The additional support will enable facilities to secure the availability of water, nutrition, and essential medicines. Donors and development partners have a responsibility to finance climate-resilient health systems. And to do so with a long-term vision and system-based approach in mind. Investments must move beyond emergency relief if we are to face the challenges that climate change will bring and if we are to reduce the human suffering caused by extreme weather. Polite Dube, the regional PBF health technical adviser at Cordaid Ethiopia, and Maarten Oranje, an expert PBF health at Cordaid Global Office, contributed to the research and review of this opinion article. Visit the Planet Health series for more in-depth reporting on the current impact of the climate crisis on human health around the world. Join the conversation by using the hashtag #PlanetHealth.
Climate change is the “greatest global health threat facing the world in the 21st Century,” according to a 2022 Lancet report on health and the climate crisis. Yet, little funding is made available to the countries most affected by it to withstand the related health impacts.
The World Health Organization estimates that every year almost 13 million people lose their lives to environmental causes. That is due to direct impacts, such as the 1,739 people who lost their lives due to severe floods in Pakistan in 2022, as well as the indirect impacts of food and water shortages. The Horn of Africa is currently being confronted by an unprecedented number of disease outbreaks and climate-related food crises, with 47 million people facing acute hunger. Meanwhile, insect-borne diseases are expected to affect an additional 4.7 billion people worldwide by 2070 as a result of global warming.
There is an increasing need for donors and development partners to invest in system-based approaches that foster climate-resilient health systems and not wait for a crisis before acting.
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Ashrafedin Youya is senior environmental health expert and assistant director of hygiene and environmental health directorate at Ethiopia’s Federal Ministry of Health. He has more than 17 years worth of experience working in government and NGOS. He worked directly on Ethiopia’s National Health Adaptation Plan. Youya is experienced in coordinating and managing hygiene and environmental health programs at regional and national level, including during emergency situations.
Molu Dima Fayo is the deputy head of the Borana Zone Health Office, involved in drought-response from a health perspective at the zonal level. He has 14 years of experience in public health, including as a hospital pharmacist and as a team leader of the Zonal Level Health Office Promotion and Support. He holds a bachelor degree in pharmacy and a master’s degree in public health.
Adriana Parejo Pagador is an advocacy communications officer at the Dutch development aid organization Cordaid, with expertise in global health, climate, migration, and gender. She has five years of experience working in the development and humanitarian field. She holds a Master of Science in International Development Studies from the University of Amsterdam, as well as a Master of Science in Public Administration of Migration and Diversity from the Erasmus University Rotterdam.
