Amrefs Strategie & Reaktionen auf den Klimawandel
(die verkürzte Strategie 2023-2030 von Amref Health Africa in Englisch )
AMREF Health Africa
Climate Change and Health
Over the years, climate change due to increased greenhouse house gases has led to increased temperatures, triggering extreme weather conditions such as droughts, floods hurricanes and air pollution (Raj & Singh, 2012). These have negatively affected the human environment in relation to air, food, water, shelter, and social infrastructure(WHO, 2018). It is estimated that Africa produces a paltry 3.8% of greenhouse gas emissions globally. As a sector, the healthcare system itself contributes to 4.4% of global net emissions worldwide, with about 78% estimated to originate from North America, East Asia/Pacific, and Europe/Central Asia.
Although the impacts of climate change have had global consequences, projections show that Africa will likely be affected more severely than other regions (Shepard, 2019). According to the World Bank, 210 million Africans are affected by climate change, and the resulting impacts are likely to add increased political, societal, economic and environmental instability. About 675 million people – 90% of them in Sub-Saharan Africa – are projected to remain without access to electricity in 2030, leaving them to rely on traditional biomass fuel for cooking, which contributes to increased emissions. Additionally, the climate change related death rate is between 60% and 80% higher in Africa, than in the next most vulnerable region (South East Asia), due to pre-existing vulnerabilities and the weakened ability of Africa to adapt to the impacts of climate change. Sub-Saharan countries are disproportionately affected and bear the burden of communicable diseases, and yet they have the weakest health systems. The region is also one of the most severely affected by climate change, because most of the population is dependent on climate sensitive economic activities. Economic insecurity for the African populations who rely on water fed production is also a driver of social demographic drivers (Vins et al.2015).
Climate change has led to exacerbation of vector-borne diseases, physical & psychological trauma, respiratory diseases, nutrition-related conditions, and non-communicable diseases (Campbell-Lendrum, Manga, Bagayoko, & Sommerfeld, 2015). For example, it is estimated that 250 000 more annual deaths will happen from undernutrition, diarrhea, and heat stress, while malaria transmission is spreading to new geographical regions (Parncutt, 2019; Ryan, Lippi, & Zermoglio, 2020). Unfortunately,
It is further estimated that the direct health costs will reach US$ 2-4 billion/year by 2030, which poses major threats to the universal health coverage agenda. Climate change ostensibly affects all areas of health. Climate change affects (human) health and must therefore be viewed as a cross-cutter in design and implementation of programs including WASH, food systems, nutrition, sexual reproductive health (SRHR), non-communicable diseases, infectious diseases among others.
Climate change uniquely impacts the health of women and girls in marginalized communities especially in Sub-Saharan Africa. Thus, worsening climatic changes have a negative impact on gender inequalities, widening the gender gap mediated through socio-economic, cultural, and physiologic factors (Sorensen, Murray, Lemery, & Balbus, 2018). Tenably, climate change disproportionately has more negative effects on women and girls and has ripple effects on their education, health, income, perpetuates Female Genital Mutilation (FGM) and early marriages and may reverse the gains made in taming negative norms and cultural practices (Esho 2022).
Climate change and health as an emerging priority
Amref Health Africa’s vision is for lasting health change in Africa and seeks to strengthen grass root health systems with a focus on, the vulnerable populations including women, youth and children. The Amref Corporate Strategy 2023-2030 is anchored within the Sustainable Development Goals (SDGs), with specific emphasis on SDGs 2,3,4,5,6,13 and 17. If unaddressed, climate change and health connections threaten the gains that Amref has made in providing access to primary health in Africa. To achieve its vision and mission, Amref is deliberate on addressing social determinants and emerging threats at the intersection of health, including the climate change and health nexus, to ensure that communities and health systems are adaptive to the climate crisis.
Amref Health Africa will employ an integrated model of programming in addressing climate change and health. At the implementation level, the focus will be to advance climate change and health mitigation and adaptation actions that are related to control of infectious diseases, non-communicable diseases, food systems, undernutrition, gender inequalities, WASH, and livelihoods. In addition, Amref will advance thought leadership and advocacy activities to cement the position of health in climate change conversations and investments at global, regional and country levels.
For Amref to achieve its vision of lasting health change, the following approaches must be contextualized at country level to address the intersection of climate and health.
Climate change does not only affect human health; it also causes devastating impacts on plant and animal health, exacerbating a worldwide crisis of biodiversity loss. Climate change and other human impacts such as land use change, pollution, and deforestation are destroying habitats, changing migration patterns, eroding soils, increasing the spread of diseases, and disrupting established ecosystems. Even with the enormous benefits it provides, One Health approach faces numerous challenges, including inadequate financing and the need for structural changes within government. Collaboration is needed in the development of tools to share information, that will encourage adoption of One Health approaches and the measurement of its impact.
Amref Health Africa has since its inception supported communities and governments through targeted capacity building to improve various competencies in tackling the existing health challenges. Amref is involved in the capacity building of human resources for health as a key strategic priority. For example, we have trained over 100,000 community health workers through the innovative LEAP platform which uses mobile phones, who have in turn reached over 3.5 million community members with health education. The Amref’s Institute of Capacity Development was created to address the training needs for both pre-service and in-service health workforce.
The Amref International University (AMIU) was established to deepen the knowledge and to advance the research and innovation agenda.
Early warning systems (EWS) are an important component of building the resilience of health systems to cope with the additional demands of climate change - particularly acute climate-related disasters. EWS can help officials plan in anticipation of crises so that they can mitigate the impact of climate-related crises on individuals’ health as well as on the health system in general. For example, EWS could be used to predict outbreaks of vector-borne diseases following floods; or to identify communities which are most likely to be impacted by food insecurity as a result of droughts
There is an opportunity to combine these two approaches, to help predict disease outbreaks by modelling the likely health impacts of extreme weather events. Cross-sectoral collaboration can help build on existing initiatives to gather and analyze data and support disaster mitigation and response. We will support partnerships between those working on meteorological warning systems and those working on predictive modelling of disease, to develop models that better combine the two.
Amref will systematically strengthen its engagement in Community-Based Disease Surveillance System (CBDS) combined with Events Based Surveillance (EBS) to collect and transmit timely data based on ground situational analysis for risk assessment, rapid detection and prompt response. We will also work to build a curated, open stack of data relevant to measure and monitor climate-health linkages in-country, and work towards an integrated Africa system leveraging on machine learning. All the datasets will be pre-processed, analyzed, and made available to countries leveraging existing and relevant global datasets.
We will build relationships with the local climate and health ecosystem players at country level to create a pre-processed, well-documented, up-to date data stack, to strategically transform the climate-health research and development ecosystem in Sub-Saharan Africa. Further, also invest in technology and tools that enable two-way communication with individuals including those in vulnerable and hard-to-reach communities: systematically collecting, organizing and analyzing microdata on climate and health, whilst also providing valuable warnings and safety advice. We envisage that strong surveillance will strengthen the local health systems while providing unparalleled local knowledge and up-front experience with the effects of the epidemic on the ground. Amref will incrementally explore the enabling technologies to allow prompt reporting such as Mobile Jamii Afya Link (M-Jali) and the Mdharura mobile based Apps.
Health related climate change adaptation and mitigation actions
In line with the Building Resilience Against Climate Effects (BRACE) framework by the Centre for Disease Control (CDC), Amref Health Africa will systematically work with various stakeholders to support communities adapt to the changing environmental conditions to protect their health. This approach will integrate actions related to other approaches first to (i) identify the scope of climate impacts and associated potential health outcomes, (ii) quantify the additional burden on health outcomes associated with climate change, including those to women and girls, youth and other vulnerable groups, (iii) Identify the most suitable health interventions for the identified health impacts of greatest concern, (iv) deliver regular bespoke adaptation plan adoptable by communities and governments, and (v) Evaluate the value of each action and related outcomes.
Specifically, under climate change adaptation, Amref will leverage its footprint in Africa and relations with other stakeholders to:
a) Water security: Amref will leverage on decades of experience in sustainable water, sanitation and hygiene (WASH) to address water security and provide economy wide co-benefits to communities, including job creation, health benefits, and sustainable water management.
b) Food systems and security: Food systems are not only about what we eat which is one of the biggest drivers of health and well-being, but goes beyond to include production, farming, processing and supply chains which have impact on our planet, driving climate change and threatening the environment. It is for this reason that Amref in this strategy, will not only focus on food security for nutrition, but food safety for overall well-being of humans and environment. Conflict, climate change, environmental crises and emergencies are also making food systems fragile. As a result, communities do not have safe and regular access to healthy and nutritious food. We will focus on transformation towards resilient and low-emissions agricultural and food systems which can be achieved through three paradigm- shifting investment .
c) Livelihoods of people and communities: Amref will promote climate resilient livelihoods of women and young people that have an impact on health, and build their resilience to climate effects especially in the areas related to agriculture and food security and care of the ecosystems, among others.
d) Integrated climate change and health programming: Amref will develop and implement new models of integrated climate change and health programming that includes sexual and reproductive health and rights (SRHR), maternal, newborn, and child health (MNCH), and nutrition, potentially with benefits in addressing the interconnected challenges and promoting holistic well-being.
e) Climate change and urban health: Urbanization is one of the leading global trends of the 21st century with significant impacts on health. Climate change impacts urban life on access to quality basic services, infrastructure, housing, human livelihoods and health. With the rapid urbanization comes inadequate housing and transport, poor sanitation and waste management, and air quality that fails below standard guidelines. Amref will focus on working with government departments and the ministry of health to ensure better air quality, water and sanitation, and other environmental determinants in the urban areas.
f) Amref in collaboration with partners like the WHO will support governments to conduct vulnerability assessments and integrate the findings on health into National Adaptation Plans. As part of national strategies, Amref will build capacity and provide funding for district governments to undertake localized assessments of climate impacts and develop local adaptation and crisis response strategies. Amref collaboratively with Amref International University (AMIU) and partners will set up the center for policy and research to coordinate and to support evidence-informed policy development, contribute to knowledge creation, and facilitate effective policy implementation on climate change and health and other program areas in Africa.
At the global and regional level, Amref will continue offering thought leadership in climate change and health by engaging and influencing in global forums such as the Africa Climate Week (ACW), Conference of Parties (COP) World Health Assembly (WHA) among others. At country level, Amref will continue forging strategic partnerships with climate and health actors and participate in strategic forums and working groups.