Financing the Future: Strengthening Health Systems Amidst the Climate and Health Crisis

Climate change is projected to cause approximately 250,000 additional deaths annually between 2030 and 2050, with undernutrition, malaria, diarrhoea, and heat stress being the primary contributors. These figures exclude the many lives lost due to floods, non-communicable diseases, and other climate-induced factors. The healthcare sector is already under significant strain, and the additional burden from climate change is expected to cost health systems an extra $1.1 trillion annually. Concurrently, global economic losses due to climate change are estimated to range between $1.7 trillion and $3.1 trillion per year, further diminishing nations’ ability to finance healthcare adequately. This crisis underscores climate change as an existential threat to humanity.

The Intergovernmental Panel on Climate Change’s (IPCC) Sixth Assessment Report (AR6) paints a stark picture of accelerating climate risks. These risks are becoming more severe and harder to adapt to as global temperatures rise, leaving 3.6 billion people living in highly vulnerable regions. Nowhere is this vulnerability more pronounced than in Africa, where fragile systems amplify the effects of climate change, creating a perfect storm of challenges.

Climate change and health nexus

The healthcare sector itself is a significant contributor to greenhouse gas emissions, accounting for nearly 5% of global emissions—comparable to the output of 514 coal-fired power plants. If it were a country, it would rank as the fifth-largest emitter globally. These emissions arise from direct activities, such as energy use in healthcare facilities, and indirect activities, such as the production and disposal of medical supplies. With 71% of healthcare-related emissions originating from supply chains, addressing the sector’s carbon footprint is critical.

Across the globe, fragilities exacerbate the effects of climate change. Climate vulnerability and underlying fragilities—namely conflict, heavy dependence on rain-fed agriculture, and weak capacity—amplify each other, worsening the negative impact on people and economies. The countries suffer more severe and persistent GDP losses than other countries due to climate shocks because their underlying fragilities amplify the impact of shocks, particularly in agriculture. At the same time, climate shocks worsen underlying fragilities, such as conflict.

According to the United Nations Economic Commission for Africa, 17 out of the top 20 most affected countries are in Africa, with Africa’s fragile states as the greatest climate change casualties. Health systems in these countries bear the burden of climate change in both communicable and non-communicable diseases. 

For instance, Anopheles stephensi, an invasive malaria vector that is endemic to Asia, was reported in Djibouti in the year 2012. It has since been reported in Ethiopia, Sudan, Somalia and Kenya. The World Health Organization (WHO) has called on countries in Africa to increase surveillance efforts to detect and report this vector and institute appropriate and effective control mechanisms. This mosquito, a competent vector for both Plasmodium falciparum and P. vivax, has the potential to establish or increase transmission in urban settings where the malaria burden is generally lower than in rural settings, particularly in areas where poorly planned drainage and waste disposal systems create conducive larval habitats. Its ability to breed in containers increases its capacity to breed more in urban settings. In addition, climate change, which creates suitable climatic conditions for mosquito breeding, also means the potential for the spread and establishment of An. stephensi mosquitoes in cities in Africa is great.

Aridity associated with current climate change are drawbacks against efforts to improve agricultural productivity and livelihood of communities who depend on rain-fed agriculture. These areas are frequently affected by recurrent drought sometimes causing total crop failure, hence the perpetual vicious cycle of malnutrition, food insecurity and income poverty.  Malnutrition compromises the immunity in vulnerable populations such as children and pregnant women to fight diseases such as HIV, TB and malaria thus requiring greater care from the health system. The income challenges due to drought is also a risk especially in poor countries where populations still rely on out-of-pocket payment to receive healthcare. This negatively affects health seeking behavior leading to higher morbidity and mortality.

The destruction of health infrastructure further compounds these challenges. Cyclone Freddy, for instance, damaged or flooded over 300 health facilities across Madagascar, Malawi, and Mozambique, leaving communities without essential services. Such extreme weather events also heighten public health risks, including cholera outbreaks and the spread of vaccine-preventable diseases.

Adapting to these multifaceted challenges requires health systems to build resilience, not just to respond to crises but to prepare for future ones. This entails adopting low-carbon operational models and mobilising climate financing effectively. However, health financing in Africa is riddled with challenges. Many African nations struggle to access international climate funds due to technical and institutional capacity gaps. Additionally, climate finance remains heavily skewed towards mitigation projects, which, while important for reducing greenhouse gas emissions, often overlook the immediate needs of vulnerable populations in Africa.

Although global climate finance flows reached $1.3 trillion annually by 2021/2022, the distribution remains inequitable. A staggering 80% of this funding is directed towards developed countries and China, leaving African nations, which contribute only 3% of global emissions, with minimal resources for mitigation or adaptation. Accessing international funding mechanisms like the Green Climate Fund or the Least Developed Countries Fund is further complicated by stringent requirements that many low-income countries struggle to meet.

One of the primary barriers to accessing climate finance is the lack of awareness among African countries about major funding mechanisms and their requirements. This knowledge gap, coupled with the absence of centralised guidance for planning and implementing climate-financed projects, leaves countries ill-equipped to address the growing health impacts of climate change. Moreover, the predominant financing models—loans and concessionary funding—are often unsuitable for debt-distressed nations. With countries like Ghana, Zambia, and Ethiopia already grappling with fiscal crises, grants are a more viable option for financing adaptation and loss-and-damage responses.

While mitigation financing is critical for keeping global warming below 2°C, its benefits for Africa are indirect and long-term. Adaptation financing, on the other hand, addresses immediate needs such as cooling health facilities during heatwaves or ensuring reliable water supplies during droughts. These measures are essential for protecting communities from the direct health impacts of climate change. Additionally, Africa’s health systems require support to adopt low-carbon development pathways, which can reduce disease burdens associated with indoor air pollution from traditional cooking methods.

Capacity constraints also hinder the ability of African countries to access and utilise climate finance effectively. Many nations lack the technical expertise and robust data systems needed to develop compelling funding proposals. This disadvantage is particularly pronounced when competing for funds with institutions that have access to advanced technology and resources. Furthermore, governance issues, including fragmented coordination among state and non-state actors, limit the effective use of available resources. Without proper governance structures, opportunities to pool resources, generate evidence, and advocate for additional funding are often lost.

Building resilience within Africa’s health systems goes beyond securing finances. It requires a rethinking of financing governance to enhance efficiency and equity. For instance, political and economic barriers often exclude vulnerable communities from decision-making processes, leading to inequitable outcomes and unsustainable interventions. Ensuring community involvement and tapping into local knowledge are critical for achieving lasting solutions.

The challenges associated with climate-health financing demand a multifaceted response. Evidence thresholds for accessing international funds must be revisited to accommodate the limitations of low-income countries, at least in the short term. Simultaneously, capacity-building efforts should focus on equipping governments and non-governmental actors with the skills needed to conduct vulnerability assessments, coordinate stakeholders, and track resources effectively.

Given the fiscal constraints in many African countries, grants should be prioritised over loans to prevent further exacerbation of debt crises. Adaptation and loss-and-damage financing should also be scaled up to address Africa’s urgent needs, while mitigation financing can help transition health systems towards low-carbon models, reducing the long-term health impacts of climate change.

Ultimately, building resilience requires strong governance frameworks that ensure transparency, accountability, and collaboration among stakeholders. By addressing these systemic issues, African nations can better position themselves to access and utilise climate finance, safeguarding the health of their populations in an increasingly volatile climate.

In conclusion, Africa’s health systems stand at the frontline of the climate crisis. While climate-health financing presents an opportunity to mitigate and adapt to these challenges, systemic inequities in its distribution and access threaten to leave the most vulnerable populations behind. By addressing capacity gaps, revising financing models, and fostering inclusive governance, African nations can build the resilience needed to thrive in a warming world.

About the authors: 

• Shadrack Gikonyo- Amref Health Africa
• Raymond Kiwesa – Presidential Office for Regional and Local Government, Tanzania
• Emily Chirwa – Ministry of Health, Malawi
• Moreen Mwenda – Amref Health Africa