Jàmbá - Journal of Disaster Risk Studies

ISSN: (Online) 2072-845X, (Print) 1996-1421

Page 1 of 10 Original Research

Climate adaptation in the public health sector in Africa:

Evidence from United Nations Framework Convention
on Climate Change National Communications

Authors: Climate change has potential to affect human health in various ways. Extreme temperatures
Godwell Nhamo1
and cold both result in deaths, while the changing habitats favouring the breeding of vectors
Shepherd Muchuru1
could result in the spread of diseases such as malaria, cholera and typhus. This article reviews
Affiliations: climate change adaptation measures in the African public health sector. The evidence is drawn
1
Institute for Corporate from National Communications of 21 countries as submitted to the United Nations Framework
Citizenship, University of
Convention on Climate Change (UNFCCC). This article combines the literature review and
South Africa, Pretoria,
South Africa grounded theory approaches with data obtained from the UNFCCC National Communications.
Among key adaptation measures emerging from the work are weather-based forecasting and
Corresponding author: early warning systems, public education and awareness, putting in place appropriate policies,
Godwell Nhamo,
surveillance, research and monitoring as well as improving public health infrastructure and
[email protected]
technology. The study recommends that African nations should commit to address health
Dates: impacts of climate change through the implementation of appropriate adaptation measures.
Received: 22 Mar. 2018
Accepted: 03 Sept. 2018 Keywords: Africa; adaptation; climate change; health; sustainable; UNFCCC.
Published: 09 Apr. 2019

How to cite this article:

Nhamo, G. & Muchuru, S.,
Introduction
2019, ‘Climate adaptation in Climate change is real, evident and convincing. Significant research has been conducted on
the public health sector in
climate change and its impact on human health, revealing the vulnerability of developing nations
Africa: Evidence from United
Nations Framework to the phenomenon (Haines et al. 2009). The changing climate is evident by rising sea level,
Convention on Climate increasing temperatures, hydrological cycle modification and increased climate variability
Change National (droughts, hailstorms, floods and extreme heat, cold and veld fires). Many such extreme weather
Communications’, Jàmbá:
Journal of Disaster Risk
events significantly impact human health. Among the key health risks identifiable are air
Studies 11(1), a644. https:// pollution, increased susceptibility to infectious and animal vectors causing diseases, food and
doi.org/10.4102/jamba. water stress as well as displacement of population. Such health risks cause malnutrition, with
v11i1.644 more than 18% of the affected population in developing nations (Food and Agricultural
Copyright: Organisation [FAO] 2005). The reasons for such health risks include weak public health systems
© 2019. The Authors. (Ford 2012) coupled with high poverty levels and inequality, low technology use and innovation
Licensee: AOSIS. This work and weak institutions that exacerbate vulnerability (Walpole, Rasanathan & Campbell-Lendrum
is licensed under the 2009). To this end, if climate change impacts are not dealt with intensively, they could hinder the
Creative Commons
Attribution License. attainment of the sustainable development goals (SDGs) in general (Nhamo 2017) and those
SDGs related to health.

A question then arises as follows: what adaptation measures exist in the public health sector in
response to the changing climate in African countries as portrayed in the United Nations
Framework Convention on Climate Change (UNFCCC) National Communications? This
article reviews climate change adaptation measures emerging from the UNFCCC National
Communications from 21 African countries. Such adaptation measures will benefit the present
and future generations if implemented in spite of severity of the health impacts of climate change.

Literature review
According to Haines et al. (2006), climate change is reportedly claiming over 150 000 lives and
5.5 million disability-adjusted life years per year since 1970 globally. The Intergovernmental Panel
Read online: on Climate Change (IPCC) has estimated further deterioration of the health sector in the near
Scan this QR future. The Fifth Assessment Report of the IPCC-AR5 concluded that, globally, rising temperatures
code with your
smart phone or and changing rainfall patterns were linked to a range of health outcomes (IPCC 2014). Climate
mobile device change-related alterations in weather and climate patterns would affect many determinants
to read online.
of health like thermal stress, floods, storms, droughts, bushfires, and food and water quality

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 Page 2 of 10 Original Research

and quantity. Climate change will further affect the geographic potential areas, early warning systems for human health,
range and activity of infectious diseases. The climate change health vulnerability assessments to climate change, public
impacts are associated with the time period between 2030 and health and environmental education and institutional
2050 (Smith et al. 2014). In the assessment, sub-Saharan Africa coordination and disaster preparedness.
(SSA) is projected to have the greatest burden of mortality
impacts attributable to climate change by 2030 (World Health Thus, to make the health sector more resilient to the impacts
Organization [WHO] 2009). Furthermore, WHO estimates of climate change, it is imperative to promote enabling
38 000 deaths are projected for the year 2030 as a result of environments through well-informed policies in form of
extreme heat in elderly people, 60 000 because of malaria, adaptation options to prevent health-related diseases and,
48 000 because of diarrhoea and 95 000 because of childhood thus, promoting a sustainable health sector. The next section
undernutrition (WHO 2009). The projections show a dramatic focuses on the materials and methods used in generating
increase in climate and extreme weather events-related deaths data and analysing the findings.
by the 2050s, with heat exposure resulting in over 100 000
deaths annually (WHO 2009).
Research methods and design
Climate change is prompted to exacerbate infectious, food This article answers the following question: what adaptation
and vector-borne diseases, and other communicable diseases measures exist in the public health sector in response to the
(Campbell-Lendrum et al. 2015). From Papworth, Maslim & changing climate in African countries? The question was
Randalls (2015) observations, climate change will negatively answered through reviewing adaptation measures from 21
impact access to health services and nutritional security. Such African countries based on their National Communications
health impacts may be direct, through the outbreak of to the UNFCCC with the objective to outline national
diseases among the human population, or can be indirect, in progress on implementing the convention. A systematic
terms of outbreaks that impact plants and domesticated approach was employed through coding using both
animals (Springmann et al. 2016). These negative impacts on targeted health vulnerabilities and typology of adaptive
the health system will likely affect trade, agriculture and measures.
ultimately food security. This has raised concern to focus on
the spread and future distribution of infectious diseases with The 21 countries purposefully sampled include Botswana,
population increase and mobility (Tatem 2014). The changing Egypt, Eritrea, Gambia, Ghana, Guinea-Bissau, Kenya,
climate is also known for causing environmental pollution Lesotho, Malawi, Mauritius, Namibia, Nigeria, Rwanda,
that threatens human health. Accumulation of harmful Sierra Leone, South Africa, Sudan, Swaziland, Seychelles,
chemicals in human bodies through air, food and water may Uganda, Zambia and Zimbabwe. The countries were sampled
lead to diseases such as cardiovascular diseases, cancers and based on certain criteria. Firstly, those with the most updated
diabetes (Depledge et al. 2013). Other adverse impacts National Communications in the form of either the second or
include threat to food availability and water security, all with third National Communication report submitted to the
repercussions on human health. UNFCCC (see Table 1). The reason for considering the second
or third National communications was to gather the latest
Africa is more vulnerable to climate change because of
increased exposure to environmental threats resulting from TABLE 1: Sampled countries and National Communications chosen.
the changes in global environment, increasing population Country Second National Third National
Communication Communication
growth and low adaptive capacity (Hajat et al. 2014). This
Botswana 2011 -
leads to two assumptions: firstly, the wide range of health Egypt - 2016
impacts on human health and, secondly, the need to develop Eritrea 2012 -
appropriate adaptation strategies in the face of the changing Gambia 2012 -
climate. Impacts of the changing climate on human health are Ghana - 2015
either direct or indirect. Among the direct impacts are Guinea-Bissau 2011 -
extreme weather events such as cold spells, heat waves, Kenya 2015 -
cyclones, droughts and hailstorms (Louis & Hess 2008). Lesotho 2014 -
Indirect impacts include air pollution, infectious and vector- Malawi 2011 -
Mauritius - 2016
borne diseases, and all these affect human health (Haines et
Namibia 2011 -
al. 2006). Adaptation can be defined as the ‘ability of a system
Nigeria 2014 -
(policies, projects and programs) to reduce vulnerability
Rwanda 2012 -
to impacts of climate change’ (Papadaskalopoulou et al. Sierra Leone - 2016
2015:96). Adaptive capacity in this context refers to the ability South Africa 2011 -
of countries to engage in adaptation. To reduce the negative Sudan 2013 -
effects of climate change, appropriate and sound adaptation Swaziland 2012 -
strategies must be employed. The adaption options can be Seychelles 2011 -
drawn on a range of possible technological, behavioural Uganda 2014 -
changes and socio-economic status and among these are Zambia 2014 -

improved surveillance of infectious epidemic diseases in Zimbabwe - 2016

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 Page 3 of 10 Original Research

available data from the selected countries. Secondly, the data analysis. Glaser (1978) permits systematic data collection
National Communications selected were those from English- and analysis (Hussein et al. 2014). The grounded theory was
speaking countries as the authors can only read and derived inductively through systematic collection and
understand English. analysis of data (Strauss & Corbin 1990). Data were collected
and contextualised to give meaning and draw conclusions
The National Communications reports were retrieved from from the submitted National Communications reports. The
the UNFCCC website. From the preliminary analysis, 35 adaptation themes and categories of the analysis all come
categories of adaptive measures in the public health sector from the National Communications reports. The emerged
emerged and these were later re-organised into six thematic themes captured the essence of measures and experience
areas, which included early warning systems, public drawn from varied country’s submissions and contexts
education and awareness, surveillance, research and instituted to make the health sector resilient and sustainable
monitoring, enhanced infectious disease control programmes, in as far as climate change is concerned.
policies development, improved public health infrastructure
Systemic coding enabled the listing of adaptation categories
and technology. Details of the themes and number of
and reformulating them as they emerge from the National
categories in each of the themes are presented in Table 2.
Communications reports. In the National Communications,
countries report adaptation priorities within and across
Following Patrick and Munro’s (2004) framework, this article
many sectors, with health being one of them. All coded
also employed a literature survey approach on the impacts of
actions and data were compared with the aim to enhance
climate change on public health system and a review of
validation and accuracy. All statements explaining adaptation
online submitted adaptation measures. In addition, the
options that pointed human health vulnerability and climate
grounded theory approach by Glaser and Strauss (1967), change were accepted in a way of facilitating authors’
which was documented later by Hussein et al. (2014), was position in establishing what qualifies as adaptation. The
also employed. Grounded theory entails the use of literature relationship of the emerged categories was analysed through
as data and in this case, data were retrieved from the National conceptualisation to give groups codes those with similar
Communications reports. The grounded theory approach content (where new concepts are core parameters of the data
aims to find a theory from data systematically obtained from and codes can be seen as dimensions of these concepts).
social research. It further explores integral social relationships Policies, projects or programmes containing multiple types of
and provides contextual meaning (Crooks 2001). The adaptation qualified as categories derived from adaptation
meaning was then derived from the retrieved information. themes. The theory was generated through categorising to
compare clusters of relationships within the context of the
Grounded theory approach provides comparative advantages emerging adaptation categories. Theorising constructs
such as its richness in imaginative concepts that are easy to system of explanations for the main concerns of the subject of
apply, ability to develop new ideas, and quick and easy for the research (Glaser & Strauss 1967).

TABLE 2: Emerging themes and categories of the reviewed adaptation measures.

Theme Categories
Early warning systems • The development of weather and seasonal forecasting and early warning systems
• Developing control programmes for infectious diseases
• Enhancing early warning on weather changes
• Strengthening hydro-agro-meteorological information warning system
• Developing risk maps that would allow mapping the areas most exposed to bad weather
• Introducing health alert networks
Public education and awareness • Provision of public education about the risks and appropriate protective behaviours
• Promote health education
• Improving garbage, waste collection and disposal
• Institutionalising health educational system, training and sensitisation
• Awareness creation about preventive options
• Training programmes for health personnel to deal with emerging diseases
• Promoting appropriate climate-health education in schools
Surveillance, research and monitoring • Strengthen the existing disease surveillance system
• Promote surveillance and research for disease and vectors
• Integrated disease surveillance and response
• Research and modelling
• Develop and implement more effective surveillance and emergency response systems
• Developing risk indicators (e.g. mosquito numbers and aeroallergen concentration) health outcomes (e.g. infectious disease outbreaks)
Infectious disease control • Vector control, case detection and treatment
• Promoting access to quality health services
• Improving vaccination programmes
• Improve access to safe/potable water and sanitation
• Integrated management of childhood infections
• Provision of malaria control programmes
Policies development • Developing action plans and strategies to control infectious diseases and vectors
• Developing policy and regulatory framework for disease control
• Mainstreaming climate change in health policies and strategies
Public health infrastructure and • Provision of improved housing insulation including subsidies for lower-income families
technology • Promoting engineering interventions such as clean water technologies and bio-latrines
• Developing improved public health infrastructure
• Increasing geographical accessibility to health services
• Encouraging planned housing in urban areas that avoid floodplain areas and swamps
• Adapting architectural designs to suit new weather regimes
• Continuous maintenance of national public health infrastructures

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The study comprehended some of the limitations that come out seasonal and weather forecasting for disaster planning,
with employing self-reporting as source material. The well-informed educational and public awareness
methodology, the analysis of self-reports by countries in the programmes (Government of Egypt 2016). Follow-up
UNFCCC, may result in both underinclusive and interventions are made by social and health actors to the
overinclusive findings (Gosling et al. 2004). Some countries vulnerable people in a way of achieving appropriate and
may be more skilful at taking (or motivated to take) credit for total responsiveness to the issued warnings. Moreover, the
measures already taken and characterising them as government is developing infectious diseases control
adaptation, while other countries may be less skilful or programmes informed by the early warning systems. The
motivated at articulating that connection. As such, the study control programmes address diseases such as lymphatic
took this into consideration during the design stages. filariasis, rheumatic heart disease, Rift Valley fever, rheumatic
However, as noted by Robins, Norem and Cheek (1999), self- fever, schistosomiasis, tuberculosis, malaria, and water- and
reporting comes with advantages of information richness food-borne diseases (Government of Egypt 2016).
and its extraordinary practicality. It also presents both an
Similarly, Nigeria is enhancing its seasonal weather
efficient and inexpensive data source (Trapnell 2006) and can
forecasting systems by providing up-to-date and relevant
be administered in mass testing sessions (as opposed to one-
information well in advance, such as dry spells, heavy storms
on-one interviews). Hundreds of variables can easily be
and heat waves (Government of Nigeria 2014). The system
collected in one sitting.
can issue health alerts through analysing and integrating
weather and health thresholds data. The idea is streamlined
Results to deal with various health challenges faced in the country’s
There are 51 African countries, which are signatories to the ecological zones as a result of the changing climate. The
UNFCCC. Of the 51 countries, the study selected 21 English- government is also working towards making data available
speaking countries and with the most updated National that can be used for analysis (statistical) of climate data.
Communications. Following a careful review of the National Research is being carried out on infectious diseases, heat
Communications, it further emerged that 18 out of the 21 wave-related sickness, water- and food-borne diseases, socio-
countries were either implementing or considering to economic effects from extreme weather events including
understanding urban vulnerabilities to heat wave and cold
implement the adaptation measures from the thematic areas
spells (Government of Nigeria 2014).
identified (see Table 3). The remaining countries were silent.

Lesotho is considering developing early warning systems,

Weather-based forecasting and early warning focusing largely on adverse health-related conditions;
systems enhancing knowledge generation, management and
The sampled countries are carrying out intervention information sharing to improve communication networks.
measures to make the health sector more sustainable and The early warning systems are meant to capacitate the
resilient to the impacts of climate change. A good example is Ministry of Health and Social Welfare (MOHSW)
the adaptation showcased by Egypt. The Government of (Government of Lesotho 2014). Rwanda, through its Ministry
Egypt is developing early warning systems through carrying of Natural Resources, is implementing and strengthening

TABLE 3: Summary status regarding the implementation of adaptation measures.

Country Categories
Early warning Public education Surveillance, research Infectious disease Policies Public health infrastructure
systems and awareness and monitoring control development and technology
Gambia - ++ ++ + + ++
Lesotho ++ - + - ++ -
Malawi - ++ - - + -
Mauritius - + + - + -
Nigeria ++ ++ - - + -
Rwanda ++ ++ - ++ + -
South Africa ++ - ++ ++ ++ ++
Seychelles - - + - + -
Uganda + - - ++ ++ -
Zambia + - - - + -
Egypt ++ - ++ ++ ++ ++
Guinea-Bissau - - - - + -
Eritrea + + ++ ++ + +
Sierra Leone + + + ++ + +
Namibia - - - - ++ -
Botswana - + ++ ++ + -
Zimbabwe - - - - + -
Ghana - + ++ - ++ -
++, implemented; +, in consideration.

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hydro-agro-meteorological early warning system by creating Gambia is continuously providing public health awareness
and rehabilitating new hydro-meteorological stations. The and education programmes. The health awareness
country is developing risk maps to enable mapping areas programmes are carried out to assist communities to make
that are prone to extreme weather events, so as to provide informed decision on diseases prevention measures. The
alerts to people in advance of imminent disasters like floods health promotion and educational programmes are
and hailstorms. The ministry is also rolling out awareness incorporating climate science and addressing the impacts of
and capacity building programmes to the public to subscribe climate change on both non-infectious and infectious diseases
to health insurance systems (Government of Rwanda 2012). (Government of Gambia 2012). Likewise, Mauritius was
Similarly, the South African government developed early considering to conduct regular awareness training
warning systems to identify possible outbreaks of water- programmes for the health officials. Public health awareness
borne diseases. Early warning systems are further used for programmes are accompanied by simulation exercises,
water monitoring and early corrective action application especially interventions in emergencies (Government of
especially in dealing with freshwater algal blooms (WHO/ Mauritius 2016). Nigeria is raising awareness on critical
UNICEF 2010). health issues that would enable community members to take
pre-emptive actions against health challenges (Government
Uganda developed its Health Sector Strategic and Investment of Nigeria 2014). The Nigerian government is working in
Plans (HSSP I and HSSP II). One of the key priorities within close collaboration with other relevant government agencies,
the strategies is to develop early warning systems that will Mass Media and non-governmental organisations (NGOs).
lead to the dissemination of weather forecasts to communities Climate-health education programmes are being promoted in
for timely response and preparedness (Government of schools to render good practices in community and personal
Uganda 2014). Zambia, Eritrea and Sierra Leone were healthcare under the changing climate. The government is
considering developing and testing early warning systems expanding community health services delivery through
coordinated by one national agency and with the involvement establishing mobile clinics in dispersed settlements and
of vulnerable communities. Through early warning systems, difficult terrains (Government of Nigeria 2014).
the governments will be able to promote community early
warning on weather changes and to respond in advance for Sierra Leone is providing community health education aimed
malaria and other diseases outbreaks (Government of Eritrea at encouraging individuals to identify and eradicate breeding
2012; Government of Sierra Leone 2016; Government of sites of vectors (Government of Sierra Leone 2016). Sierra
Zambia 2014). Leone employs CHW and volunteers to educate the public in
stress management, enhanced community education in the
areas of food poisoning, hygiene and sanitation. Other health
Public education, training and awareness
education programmes being carried out include the
Malawi, through the Ministry of Health and Population eradication of taxes on electric fans, food handling, rodent
Services (MoHPS), is rolling various programmes for and pest eradication and community health inspections for
educating the public on risks and behavioural change to deal mosquitoes. Similar health educational programmes are
with climate change impacts on its health system. For being considered by Botswana and Ghana through the
instance, the government is promoting the use of cooling fans Integrated Management of Childhood Infections (IMCI). This
during very hot days, opening windows to allow ventilation, programme provides adequate public education on access to
putting on loose-fitting and light clothes, avoiding exertion improved sanitation and safe water. Through this initiative,
and if need be water sprinkling on clothes (Government of community health educators are employed as main health
Malawi 2011). The public is being educated on waste and information providers at community level (Government of
garbage collection and refusal disposal to avoid breeding of Botswana 2011; Government of Ghana 2015).
mosquitoes (Government of Malawi 2011). The educational
system is being institutionalised with training and
sensitisation programmes on health issues. Community Surveillance, research and monitoring
Health Workers (CHWs) are deployed in various areas of the The Government of Gambia is designing health databases on
country to assist communities on health education. The diseases and various cases including those of communicable
CHWs are using participatory hygiene and sanitation diseases (Government of Gambia 2012). User-friendly
approaches and hygiene and sanitation in school environment geographical information systems are being developed to
in promoting climate-health education either in communities provide real-time and remote data to assist with
or in schools (Government of Malawi 2011). A typical example epidemiological description of systems in any place. Disease
is in Rwanda, where participatory hygiene and sanitation in monitoring is being carried out to control infectious epidemic
schools in 2008, reached approximately 78% of the population disease. Response and planning actions assist the government
(Government of Rwanda 2012). Community health workers to provide public health interventions in a timely manner.
are capacitated to promote best health educational services to The government is carrying out research in various locations
the public. Some of health educational practices being to determine trends and patterns of diseases. Research has
promoted include the use of improved latrines and promote helped the government to investigate conditions that are
a culture of handwashing after visiting the toilet both in favourable for breeding of vectors (mosquitoes) and spread
institutions and households (Government of Malawi 2011). of diseases (Government of Gambia 2012).

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Egypt is embarking on research and disease surveillance education, social mobilisation and other prevention measures
through the gap identification approach. Surveillance and such as the use of insecticide-treated nets, mosquito repellents
research provide satellite data essential to monitor disease and low-cost anti-malarial drugs (Government of Gambia
patterns (Government of Egypt 2016). Research is being carried 2012). Vector control programmes will be implemented
out on non-communicable diseases, heat-related sickness, together with public awareness and health education
water- and food-borne diseases and socio-economic impacts programmes at community level. In addition, vector control
from extreme climatic events. Lesotho is considering developing programmes are incorporating climate science elements and
monitoring and surveillance systems that include enhancing climate change impacts on infectious and non-infectious
knowledge management to improve information sharing and diseases. The government is considering expanding
communication networks (Government of Lesotho 2014). The vaccination programmes through its Expanded Programme
government is establishing weather monitoring systems for of Immunisation to be administered to children from the age
adverse health-related conditions throughout the country. To of 9 months throughout the country in all clinics. Similarly,
reduce the vulnerability of the people from health hazards, the Rwanda is implementing a nation-wide mosquito control
Government of Mauritius is considering preventative measures programme to completely eradicate new infections from the
through strengthening the existing disease surveillance system falciparum parasite (Government of Rwanda 2012). The
(Government of Mauritius 2016). government is rolling out improved latrines and instituting a
culture of handwashing with soap after toilet use in various
In South Africa, through collaborative research, the institutions and households. As of 2012, 55% of households
government launched the Lubombo Spatial Development did not have access to improved latrines, with only 34% of
Initiative between Mozambique and Swaziland. The households practicing handwashing after toilet use. Uganda
collaborative research led to a 70% decrease in malaria formed the Epidemic and Disaster Preparedness and
prevalence in Maputo Province (Mozambique) between 1999 Response programme to spearhead infectious and epidemic
and 2005 and a further 99% and 98% decrease in notified disease control. The Malaria Control Programme is promoting
malaria cases in South Africa and Swaziland, respectively effective and prompt malaria case management at household,
(Maharaj et al. 2016). The research aimed to intensify health facilities and community levels. An example of direct
surveillance, community advocacy and training, control programmes linking health to climate change interventions is
parasites using artemisinin-based combination therapy and the Highland Malaria Control Programme in Kabale District,
vectors by indoor residual spraying using DDT or pyrethroids which is linked to weather predictions and forecasting
(Department of Environmental Affairs [DEA] 2011). Similarly, (Government of Uganda 2014).
Seychelles is carrying out research to establish mosquito
index distribution and associated impacts of the changing Egypt is improving its vaccination programmes as part of its
national epidemic disease control (Government of Egypt
climate to communities. The work provides relevant data
2016). The programme is providing vaccinations for all
and information to predict the spread of diseases, epidemics
school children and infants against diseases and is free of
and the impact of climate change (Government of Seychelles
charge. Vaccination is also carried out for emerging diseases
2011). Eritrea has been working closely with ministries of
such as swine flu and human papilloma virus causing cancer
transportation and communication, environment, energy
cervix to vulnerable communities. Similarly, many other
and mines to promote research and surveillance for disease
countries (e.g. Botswana, Eritrea and Sierra Leone) are
and vectors (Government of Eritrea 2012). Sierra Leone is
promoting health programmes to control vector and epidemic
considering promoting behavioural change and proliferation
disease (Government of Botswana 2011; Government of
of rival habitats through entomological surveillance
Eritrea 2012; Government of Sierra Leone 2016). In Africa,
behaviours and epidemiological surveillance (Government
diarrhoea, cholera and typhoid are usually associated with
of Sierra Leone 2016). The government is carrying out
water security issues (quantity and quality) (Government of
surveillance in communities vulnerable to diseases outbreaks
Botswana 2011; Government of Egypt 2016; Government of
for environmental sanitation purposes. Ghana and Botswana
Rwanda 2012).
are strengthening their disease surveillance and response
systems to improve health measures. This is being carried
out through improved drainage, immunisation, sanitation Policy development
and hygiene for vulnerable communities. Surveillance, Almost all countries sampled had some form of legal and
research and monitoring is assisting the governments in the policy provisions for sustainable health sector, although
provision of ambulances for emergency health preparedness many were carried out in an era when climate change was
in vulnerable areas (Government of Botswana 2011; not pronounced. Uganda developed health sector policies
Government of Ghana 2015). that include the Health Strategic Plan II (NHPII) (2005/2006–
2009/2010) and the Health Policy of 2000 (Government of
Infectious, epidemic disease control Uganda 2014). The government later updated the health
policies to specifically address climate change impacts to the
programmes health sector. In this regard, the NHP II (as updated to the
Gambia is considering introducing vector control Health Strategic Plan (HSSP III) provides interventions and
programmes through its planned health investment in policy direction on climate change and human health.

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Furthermore, Uganda formed clusters on environmental adequate public health infrastructure to provide reliable
health, disease prevention and health promotion to improve transportation, safe and clean water, telecommunications
factors for environmental health. The HSSP III further and clean electricity (Government of Eritrea 2012). In
mainstreams climate change matters through the formation addition, the MoH collaborates with the private sector
of guidelines on climate change mainstreaming in the health engaged in health-related activities to provide best health
sector, staff sensitisation on climate change and adaptation in services to its people. Similarly, Egypt is maintaining the
the Ministry of Health (MoH) and other relevant departments, national public health infrastructure. The country is working
enhancing early warning systems and weather forecasts towards closing the gap in health indicators between its
dissemination to health practitioners for timely response and Lower Egypt and Upper regions and between rural and
preparedness (Government of Uganda 2014). urban areas (Government of Egypt 2016). The lowest health
indicators are found to be in the rural areas of Upper Egypt
The South African government enacted its Air Quality Act plagued with non-communicable and infectious diseases.
(AQA) in 2007 in an effort to reduce greenhouse gas emissions From Egypt Demographic Health Survey (El-Zanaty & Way
and air pollutants. The AQA requires the development of air 2005), it emerged that the country is closing the gap by
pollutants control plans at a national, provincial and local targeting 90% with access to improved health services. The
level as well as in urban centres. The country also developed country is working towards providing healthcare for
the South African Air Quality Information System (SAAQIS) managing coronary heart disease, complicated diabetes
to provide all relevant information to climate change, among rural areas and cancer (Government of Egypt 2016).
legislation and air quality control initiatives. To meet the aim
of the AQA, the government further developed the National South Africa is promoting public health buildings through
Framework on Air Quality Management of 2007 to render modifying architectural designs to suit weather changes and
medium- to long-term plan to meet the objectives of the AQA regimes (DEA 2011). The government is encouraging new
(DEA 2009). building infrastructure that can curtail energy use and enable
natural cooling. Roofs are being made stronger to be able to
Countries like Lesotho, Ghana and Namibia have developed resist heavy storms and strong winds that can be disastrous
National Adaptation Programmes of Actions (NAPAs) to to people. For example, at a 3.28 ºC rise in temperature,
address climate change, including impacts in the health human health and comfort can be adversely affected (DEA
sector (Government of Ghana 2015; Government of Lesotho 2011). In addition, The Gambia is promoting proper waste
2014). Several programmes were developed addressing disposal to prevent toxic contamination and pathogenic
health concerns of climate change that included pests, vectors during floods (Government of Gambia 2012). There are many
and disease control as well as water, sanitation and hygiene. technologies under consideration to reduce the impacts of
The NAPAs outline disaster preparedness, epidemic and the changing climate on human health populations. An
response to be spearheaded by the ministries of health and example is in Kanifing Municipal Council (KMC), where
adopting WHO’s strategy on Integrated Disease Surveillance there is improvement of public health infrastructure through
and Response. The governments have a multi-sectoral the enforcement of building regulations and promotion of
National Climate Change Policy to provide advisory role to health-housing environment. Improved technological and
relevant line ministries regarding policies on climate change preventative measures are being considered in high-risk
issues and ministries responsible for environment. areas where majority of people use untreated water. Sierra
Leone is working on initiatives to change building designs to
The Government of Namibia passed its Disaster Risk reduce heat stress (Government of Sierra Leone 2012). Other
Management Act (No. 10 of 2012) (Government of Namibia technological adaptation options include sustainable housing
2015). The main objective of the policy was to provide a design standards in areas subjected to strong winds and high
framework on disease preparedness, prevention, response rainfall. A good example is that the government is
and recovery. The government established the Cholera encouraging people to paint their house roofs with white or
Outbreak Response Team. The team comprises representatives silver to reduce heat absorption, cross-ventilation of windows
from WHO, United Nations International Children’s and to pay attention to settlements design.
Emergency Fund, the Namibian Red Cross Society and the
Centre for Disease Control and Prevention. The team is
controlling timely outbreaks of cholera and has established
Discussion
the Cholera Treatment Centres, provision of proper sanitation, The results of this analysis provided a foundation that there
safe water and health education (including food handling are a number of adaptation measures being instituted by
practices and personal hygiene) for the affected community countries in sustaining public health systems under the
(WHO 2014). changing climate. Many of the several activities being
reported for this study as climate change adaptation were
likely already underway as part of general health protection.
Public health infrastructure and technology In addition, some of the findings from the UNFCCC National
The Government of Eritrea is working towards improving Communications reports mirror traditional ways of dealing
people’s accessibility to healthcare service. The MoH is with the health systems in Africa. These interventions have
cooperating and working with other ministries in ensuring continued to be used and scaled up with the understanding

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 Page 8 of 10 Original Research

of adaptation in the era of climate change. Most African The results also showed how African countries are
countries, especially those in lower resource settings, general participating in adaptation responses, international treaties
health sector strengthening is a form of climate change and in health areas. This is explained by countries like
adaptation. Similarly, in settings with high burdens of Uganda, Ghana and South Africa that support other
climate-sensitive health impacts, it can be difficult to international treaties such as the World Health Assembly’s
distinguish climate change adaptation planning from general resolution (2008), which stipulates the need for member
health sector planning. To this end, this can make adaptation states to commit strongly on human health protection from
planning difficult (Ford et al. 2014). Furthermore, several climate change. Other treaties that are included in the
impacts that are likely to affect health systems are managed Environmental Sustainability Index measure, of which
primarily by other sectors, and the health sector needs to African countries are signatories, are health-focused,
collaborate closely with other sectors and ministries to effect addressing adaptation from environmental perspectives
comprehensive adaptation activities for health. with a specific health component. For instance, International
treaties such as the Montreal Protocol on Substances that
Many countries reported challenges faced while employing Deplete the Ozone Layer has been regarded as successful in
adaptation measures in the health sector. Financial reducing negative environmental impacts (Mader et al. 2010).
constraints make the adoption of adaptation measures Our evidence suggested the need to include and establish the
very slow. Although determinants such as financial relationship between social spending, and countries’
resources are key for employing adaptation measures, priorities on sustainable adaptation measures, which in the
other contextual factors are also significant, such as human near future must be an essential motive on developing model
perception. However, countries can access international drivers for adaptation.
funding for adaptation at the national level. This can be
done, for instance, through the UNFCCC Adaptation Decision makers are streamlining climate change impacts to
Fund, Green Climate Fund and the Global Environmental highly planned adaptation emanating from people’s awareness
Facility. Therefore, this analysis found that resource on personal risks from the changing climate. The number of
availability may impact countries’ engagement in adaptation measures identified in this study depicts a strong
adaptation processes. Policy and institutional factors are relationship between people’s perceptions on the changing
important as they affect how fully the adaptation process climate risks and adaptation. The established link could be
can be instituted (Kovats, Ebi & Menne 2003). attributed to reasons such as continued people’s views on
climate change and its effects on their health status. This
The study further revealed that African countries are also implies that there could be sufficient public perceptions and
employing institutional structures focusing on environmental opinion across African countries in supporting climate change
governance and other incentives that can enable them to be policy through the implementation of adaptation measures.
high adaptors to the changing climate. This is shown by
countries such as Uganda, Lesotho, Ghana and Namibia that Other results showed that existence of extreme weather
events stirs the willingness and motive for employing
developed National Adaptation Programme of Actions as a
adaptation (Adger et al. 2013). The study provided a platform
way of addressing and implementing adaptation options
for future studies to systematically investigate the association
including those for health sector. Although African countries
between extreme weather events experience and adaptation.
lack financial resources, they are working towards health
Moreover, the present study investigated only adaptation
adaptation. The presence of obstacles that can hinder the
options employed by countries without investigating
capacity of adaption should be translated into health
individual and private adaptation measures experiencing
adaptation action.
high and personal risk from the changing climate.
The results further indicated that determining the progress
of countries in employing adaptation measures with a Conclusion
large country sample is fruitful, including providing a This study reviewed adaptation measures contained in the
good basis to formulate more complex hypothesis regarding UNFCCC’s National Communications from 21 African
institutionalising adaptation options by countries. Further countries. The results indicate that there are a number of
analysis is crucial to understand the motive and drivers for adaptation measures instituted by countries in promoting a
adaptation and to understand the needs related to institutions sustainable public health sector, making it resilient to the
and infrastructure for their implementation. The results have changing climate. Key adaptation measures that emerged are
shown that low-income countries like those in Africa are weather-based forecasting and early warning systems, public
willing to allocate their little finances and pay attention to education and awareness, surveillance, research and
adaptation issues affecting their development sectors such as monitoring, enhanced infectious disease control programmes,
health. These results were in line with reviewed literature policy development, improved public health infrastructure
suggesting that low-income nations are engaging in and technology.
adaptation, and this can provide an obligation for developed
countries to start facilitating transfer of technology and There are various benefits reported from the implementation
resources to developing nations. of such adaptation measures. These include increased

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 Page 9 of 10 Original Research

international, regional and sub-regional cooperation;

increased health benefits (improved latrines and the culture
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