Editing IPCC:AR6/WGII/Chapter-9 (section)

=== 9.10.3 Adaptation for Health and Well-being in Africa ===

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In this section, we focus on adaptation actions that are well-documented or shown to have the potential for substantially improving health or well-being. These adaptation options are assessed in Figure 9.36 and Table 9.11.

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'''Figure 9.36 |''' '''Adaptation options across multiple non-health sectors have potential for reducing risk for multiple health outcomes, considering their potential to reduce vulnerability.''' Reduced risk for health may result from targeted actions or as a result of co-benefits (see Table SM9.8 for a full list of references).

'''Table 9.11 |''' Co-benefits, barriers and enablers of adaptation responses to climate change impacts on human health in Africa (see Table SM9.9 for a full list of references).

{| class="wikitable"
|-
! '''Response category'''

! '''Co-benefits'''

! '''Inter-sectoral trade-offs and/or drawbacks'''

! '''Enablers'''

! '''Barriers'''

|-
| ''Policy development''

| Policies and plans that facilitate service delivery and guide national and international funding; decreased number of work hours lost; improved work performance, increased productivity

|
| Willingness of policymakers; political support; politically willing environment; inter-sectoral collaboration

| Lack of implementation; poor governance

|-
| ''Education and awareness''

| Promotion of sustainable living and circular economy

|
| Guarantee of sustained funding; political support; politically willing environment; increased accessibility of learning institutions

| Lack of implementation; historical and colonisation-related insensitivities

|-
| ''Health systems and primary healthcare services''

| Capacity building in communities; buffered economic impact of outbreaks/disasters; job creation

| Increased greenhouse gas emissions from building health infrastructure; increased energy demand; decreased productivity and increased work hours lost due to waiting times

| Guarantee of sustained funding; political support; politically willing environment

| Corruption and fraudulent activities around resource allocation

|-
| ''Surveillance, risk assessments, monitoring and research''

| Evidence to improve adaptation response; fast post-disaster recovery; increased awareness and disease prevention; improved health system functioning post-disasters

|
| Requires effective institutional arrangements and inter-sectoral collaboration; guarantee to sustained funding; requires skills development

| May be limited by uncertainty in modelled predictions and thresholds

|-
| ''Resource management''

| Improved health system functioning post-disasters; capacity building in communities; promotes economic growth/stability; increases the tourism potential of the area; increased accessibility/mobility of the community; reduced land degradation, desertification and bush encroachment; food security; decreased emissions

| Potential to increase energy demand; increased crowding/ population density; land use; microclimate and ecosystem disruption

| Guarantee of sustained funding; political support; politically willing environment; requires effective institutional arrangements and inter-sectoral collaboration; requires skills development

| Corruption and fraudulent activities around resource allocation

|-
| ''Vector control and disease prevention''

| Decreased mortality; improved work performance; increased productivity; improved mental health

| Increased GHG; decreased biodiversity; environmental impacts of production, packaging, and delivery; potentially detrimental to health

| Guarantee to sustained funding; funding and resources; future planning or retrofit required

| Last-mile access; cost per capita and capacity for service delivery

|}

In Africa, adaptive responses have begun to be implemented by local, national and international entities ( [[#Ebi--2017|Ebi and Otmani Del Barrio, 2017]] ). With strong leadership, these initiatives can be used as an opportunity for comprehensive, transformative change rather than incremental improvements to existing systems. Adaptation responses are necessarily context specific and can focus on providing services for vulnerable and high-risk populations ( [[#Dumenu--2016|Dumenu and Obeng, 2016]] ; [[#Herslund--2016|Herslund et al., 2016]] ).

Adaptation actions in the health sector range from building resilient health systems to preparing responses to health impacts of extreme weather events to reducing effects of increasing temperatures in residential and occupational settings ( [[#Kjellstrom--2016|Kjellstrom et al., 2016]] ; [[#Chersich--2019|Chersich and Wright, 2019]] ). A climate-resilient health system involves functional and effective health systems ( [[#WHO--2015|WHO, 2015]] ), national and local policy plans with resources for implementation, and long- and short-term communication strategies to raise awareness around climate change ( [[#Nhamo--2019|Nhamo and Muchuru, 2019]] ).

Many health conditions associated with climate change are not new, and existing evidence-based interventions can be modified to address shifting disease patterns ( [[#Ebi--2017|Ebi and Otmani Del Barrio, 2017]] ). Adaptation options can build on a long tradition of community-based services in Africa ( [[#Ebi--2017|Ebi and Otmani Del Barrio, 2017]] ). Indeed, strengthening many of the services already provided (e.g., childhood vaccinations and vector control) will help curtail emerging burdens of climate-sensitive conditions. However, a disproportionate focus on emerging zoonotic and vector-borne viruses could undermine climate change adaptation efforts in Africa if it shifts the focus away from health system strengthening and leaves few resources for addressing other health impacts of climate change.

Core components of an adaptation response include rapid impact packages (e.g., mass drug administration for schistosomiasis), education of women and direct poverty alleviation ( [[#Bailey--2019|Bailey et al., 2019]] ). Where droughts are more frequent and rainfall patterns have shifted, adaptation support can be provided for strategies developed by communities, including the adaptation of livelihoods and diversification of crops and livestock ( [[#Mbereko--2018|Mbereko et al., 2018]] ; [[#Bailey--2019|Bailey et al., 2019]] ). Continued efforts through partnerships, blending adaptation and disaster risk reduction, and long-term international financing are needed to bridge humanitarian and sustainable development priorities ( [[#Lindley--2019|Lindley et al., 2019]] ; Cross-Chapter Box HEALTH in Chapter 7).

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==== 9.10.3.1 Risk Assessment and Warning Systems ====

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Improved institutional capacity for risk monitoring and early warning systems is key to support emergency preparedness and responsiveness in Africa, as well as shock-responsive and long-term social protection ( [[#FAO%20and%20ECA--2018|FAO and ECA, 2018]] ). Climate risk assessments grounded in evidence and locally appropriate technologies are important for identifying priority actions, the scale of intervention needed and high-risk geographical areas and populations. Potential tools include those developed by WHO ( [[#Ceccato--2018|Ceccato et al., 2018]] ) and the Strategic Tool for Analysis of Risk ( [[#Ario--2019|Ario et al., 2019]] ).

Warning systems that predict seasonal to intra-seasonal climate risks could assist in improving response times to extreme weather events (such as droughts, flooding or heat waves) and shifts in infectious diseases. Weather and other types of forecasting provide an advanced warning—a central tenet of disaster risk reduction ( [[#Funk--2017|Funk et al., 2017]] ; [[#Okpara--2017a|Okpara et al., 2017a]] ; [[#Lumbroso--2018|Lumbroso, 2018]] ). Models encompassing each component of the human–animal–environmental interface, including disease surveillance in humans and animals and remote sensing of vegetation indexes, water and soil can be used to project patterns of zoonose outbreaks ( [[#UNDP--2016|UNDP, 2016]] ; [[#Bashir--2019|Bashir and Hassan, 2019]] ; [[#Durand--2019|Durand et al., 2019]] ). Early warning systems may help better prepare for these and other forms of infectious disease outbreaks ( [[#Thomson--2006|Thomson et al., 2006]] ) but adaptation is possible in the absence of statistical tools through vaccination and surveillance, for example.

Surveillance systems for diseases and vectors are well-established in many parts of Africa ( [[#Ogden--2017|Ogden, 2017]] ). However, many data gaps remain, especially in monitoring climate-sensitive conditions such as diarrheal- and arbovirus-related diseases, and morbidity and mortality stemming from heat exposure ( [[#Ogden--2017|Ogden, 2017]] ; [[#Buchwald--2020|Buchwald et al., 2020]] ).

Climate and health adaptation indicators are required for Africa to strengthen institutional capacity for risk monitoring and early warning systems, emergency preparedness and response, vulnerability reduction measures, shock-responsive and long-term social protection, and planning and implementing resilience-building measures ( [[#FAO%20and%20ECA--2018|FAO and ECA, 2018]] ). National-level progress is assessed through the Lancet Countdown indicators ( [[#Watts--2018|Watts et al., 2018]] ), however, district- and local-level indicators are needed to measure levels of vulnerability and response effectiveness at a local level, and for informing planning local service delivery. Potential indicators include monitoring the number of excess health conditions during extreme heat events. Indoor temperature monitoring in sentinel houses and health facilities is a related indicator ( [[#Ebi--2017|Ebi and Otmani Del Barrio, 2017]] ), linked with threshold temperature levels at which health impacts occur, and the ability of the built environment to protect against these impacts (e.g., for heatwaves).

Measuring climate-health linkages is challenging due to the considerable diversity of the exposures, impacts and outcomes, as well as constraints in key technical areas. Increasing our understanding of this diversity and how this is influenced by adaptative changes is a major knowledge gap. This could be facilitated through a pan-African database of climate and other environmental exposures, together with real-time statistical support for analyses of climate and health associations.

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==== 9.10.3.2 Community Engagement ====

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Increased awareness can facilitate community engagement and action (see [[#9.4.3|Section 9.4.3]] ). In Ghana, for example, local communities understand the climate hazards that drive outbreaks of meningitis and adapt accordingly by improving housing to limit heat and exposure, changing funeral practices during outbreaks, increased vaccination uptake and afforestation ( [[#Codjoe--2014|Codjoe and Nabie, 2014]] ). Similarly, participation in community organisations improved child nutrition in vulnerable rural households in Eswatini ( [[#Anchang--2019|Anchang et al., 2019]] ). Interventions specifically targeting women are beneficial for food security, although they may be undermined by harmful gender norms in communities that are patriarchal, led by chiefs or have high rates of gender-based violence ( [[#Jaka--2018|Jaka and Shava, 2018]] ; [[#Kita--2019|Kita, 2019]] ; [[#Masson--2019|Masson et al., 2019]] ). The BRACED project in Burkina Faso and Ethiopia specifically adopted a gender-transformative approach as an integral part of resilience building ( [[#McOmber--2019|McOmber et al., 2019]] ). Improving ‘climate literacy’ could empower youth, women and men to be active citizens in promoting adherence of governments to international agreements in climate change ( [[#Mudombi--2017|Mudombi et al., 2017]] ; [[#Chersich--2019a|Chersich et al., 2019a]] ).

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==== 9.10.3.3 Health Financing ====

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Poor and low-income households often are not able to afford high out-of-pocket costs for medical care, or it consumes a large portion of their income. As a result, without financial aid, peoples’ health needs may not be met after a climate shock ( [[#Hallegatte--2017|Hallegatte and Rozenberg, 2017]] ). Microfinance (the provision of small-scale financial products to low income and otherwise disadvantaged groups by financial institutions) and disaster contingency funds can serve to reduce health risks of climate change for low-income communities ( [[#Agrawala--2010|Agrawala and Carraro, 2010]] ; [[#Ozaki--2016|Ozaki, 2016]] ), as can different forms of insurance and disaster relief ( [[#Fenton--2015|Fenton et al., 2015]] ; [[#Dowla--2018|Dowla, 2018]] ). Unconditional cash transfers in Kenya, Uganda and Zambia assisted vulnerable groups to absorb the negative impacts of climate-related shocks or stress and to prepare for these ( [[#Lawlor--2019|Lawlor et al., 2019]] ; [[#Ulrichs--2019|Ulrichs et al., 2019]] ). Based on several case studies in Africa, the Food and Agriculture Organization recommends a ‘Cash+’ approach which combines cash transfers with productive assets, inputs or technical training to address the needs of vulnerable households in emergency situations, and enhance livelihoods potential, income generation and food security ( [[#FAO--2017|FAO, 2017]] ). New economic models have been implemented in north Africa, focused on poor households, youth and women that enable access to credit and support the implementation of policies that balance cash and food crops, social safety nets and social protection ( [[#Mumtaz--2017|Mumtaz and Whiteford, 2017]] ; [[#Narayanan--2017|Narayanan and Gerber, 2017]] ; see also Sections 9.4; 9.8; 9.11).

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==== 9.10.3.4 Disease-specific Adaptations ====

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===== 9.10.3.4.1 Adaptation to prevent malaria =====

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Increasing distribution and coverage of long-lasting insecticide-treated bed nets, improved diagnostic tests and increasing health service access could mitigate the impacts of climate change on malaria if aligned with the predicted or actual burden of malaria ( ''medium confidence'' ) ( [[#Kienberger--2014|Kienberger and Hagenlocher, 2014]] ; [[#Thwing--2017|Thwing et al., 2017]] ). Understanding seasonal shifts in malaria transmission suitability as a result of climate change can guide more targeted seasonal public health responses and better planning for different types of management and control interventions based on the impact. For example, an increase in the number of months where climate conditions are suitable for mosquito survival will require public health responses for an extended period of time ( [[#Ryan--2020|Ryan et al., 2020]] ).

In malaria-endemic areas, repeated malaria infections can provide temporary immunity, which reduces new clinical cases ( [[#Laneri--2015|Laneri et al., 2015]] ; [[#Yamana--2016|Yamana et al., 2016]] ). Conversely, where people have little or no immunity, exposure to malaria can lead to epidemics ( [[#Semakula--2017a|Semakula et al., 2017a]] ; [[#Ryan--2020|Ryan et al., 2020]] ). Pregnant women and infants remain at risk of severe malaria, regardless of immunity status. Vector control and case management capacity should be rapidly scaled up in newly affected areas where risks for epidemics are high and populations are especially vulnerable. Poverty-alleviation initiatives underpin malaria control as the malaria burden is strongly tied to socioeconomic status ( [[#Huldén--2014|Huldén et al., 2014]] ; [[#Degarege--2019|Degarege et al., 2019]] ).

Contextualised risk studies on local drivers of transmission are still lacking and present a major gap in developing appropriate adaptation strategies ( ''high confidence'' ). Progress has been made identifying and ranking vulnerability and exposure indicators ( [[#Protopopoff--2009|Protopopoff et al., 2009]] ; [[#Onyango--2016a|Onyango et al., 2016a]] ), however, better linking of biophysical and socioeconomic determinants of risk in integrated assessment models is needed ( [[#Caminade--2019|Caminade et al., 2019]] ; [[#Zermoglio--2019|Zermoglio et al., 2019]] ), as are applied approaches to develop adaptation strategies for risk management ( [[#Leedale--2016|Leedale et al., 2016]] ; [[#Onyango--2016b|Onyango et al., 2016b]] ; [[#Sadoine--2018|Sadoine et al., 2018]] ).

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===== 9.10.3.4.2 Adaptation to reduce diarrhoeal disease =====

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Reducing pathogen concentrations in water and across food chains is fundamental for controlling diarrhoeal diseases ( [[#van%20den%20Berg--2019|van den Berg et al., 2019]] ). Diarrhoea prevention and treatment post-disaster, encompass social mobilisation campaigns, water treatment, enhanced surveillance, and vaccination and treatment centres for cholera ( [[#Cambaza--2019|Cambaza et al., 2019]] ) and typhoid ( [[#Neuzil--2019|Neuzil et al., 2019]] ).

Improved WASH requires robust water and sanitation infrastructure ( [[#Duncker--2017|Duncker, 2017]] ; [[#Kohlitz--2017|Kohlitz et al., 2017]] ; [[#Venema--2017|Venema and Temmer, 2017]] ) and technological adaptations (Gabert, 2016; [[#van%20Wyk--2017|van Wyk et al., 2017]] ), such as waterless on-site sanitation ( [[#Sutherland--2021|Sutherland et al., 2021]] ), diversification of water sources (e.g., rainwater harvesting ( [[#Lasage--2015|Lasage and Verburg, 2015]] ) and groundwater abstraction ( [[#MacDonald--2012|MacDonald et al., 2012]] )), and sharing of best practices across the continent ( [[#WASH%20Alliance%20International--2015|WASH Alliance International, 2015]] ; [[#Jack--2016|Jack et al., 2016]] ; see also [[#9.7.3|Section 9.7.3]] ; [[IPCC:Wg2:Chapter:Chapter-4|Chapter 4]] [[IPCC:Wg2:Chapter:Chapter-4#4.6.4|Section 4.6.4]] ). Hand hygiene can be improved through the creation of handwashing stations, increased access to soap and simple technologies such as the foot-operated Tippy taps ( [[#Coultas--2020|Coultas and Iyer, 2020]] ; [[#Mbakaya--2020|Mbakaya et al., 2020]] ).

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===== 9.10.3.4.3 Adaptation to reduce conditions related to heat exposure =====

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Reducing morbidity and mortality during extreme heat events requires changes in behaviour and health promotion initiatives, health system interventions and modifications to the built and natural environment. Health promotion initiatives include promoting adequate hydration and simple cooling measures, such as drinking cold liquids, water sprays and raising awareness of the symptoms and importance of heat stress, including heatstroke ( [[#Aljawabra--2018|Aljawabra and Nikolopoulou, 2018]] ). Adaptive measures are especially important for high-risk groups such as outdoor workers, the elderly, pregnant women and infants. Health systems interventions may include early warning systems, heat health regulation and health workers providing cooling interventions, such as supplying cool water or fans, during heat waves. Changes to the built environment include painting the roofs of houses white and improving ventilation during extreme heat ( [[#Codjoe--2020|Codjoe et al., 2020]] ), the use of insulation materials or altering the building materials used for the construction of housing to improve their ability to moderate indoor temperatures ( [[#Mathews--1995|Mathews et al., 1995]] ; [[#Makaka--2006|Makaka and Meyer, 2006]] ).

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===== 9.10.3.4.4 Adaptation to prevent malnutrition =====

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Transformative adaptation requires integration of resilience and mitigation across all parts of the food system including production, supply chains, social aspects and dietary choices ( [[#IPCC--2019a|IPCC, 2019a]] ). Adaptation to prevent malnutrition goes hand-in-hand with adaptation to prevent food insecurity, as is discussed in [[#9.8.3|Section 9.8.3]] ; [[IPCC:Wg2:Chapter:Chapter-5|Chapter 5]] [[IPCC:Wg2:Chapter:Chapter-5#5.12.5|Section 5.12.5]] .

Urban agriculture and forestry can improve nutrition and food security, household income and mental health of urban farmers while mitigating against some of the impacts of climate change, like flooding and landslides (by stabilising the soil and reducing runoff, for example), heat (by providing shade and through evapotranspiration) and diversifying food sources in case of drought ( [[#Zezza--2010|Zezza and Tasciotti, 2010]] ; [[#Lwasa--2014|Lwasa et al., 2014]] ; [[#Battersby--2020|Battersby and Hunter-Adams, 2020]] ).

The health sector needs to collaborate and coordinate adaptation activities with other sectors, as well as civil society and international agencies, to engage communities in health promotion ( [[#Irwin--2006|Irwin et al., 2006]] ; [[#Commission%20of%20Social%20Determinants%20of%20Health--2008|Commission of Social Determinants of Health, 2008]] ; [[#Braveman--2014|Braveman and Gottlieb, 2014]] ). The importance of social determinants of health, such as socioeconomic status, education and the physical environment in which people live and work and their consideration during development are highlighted in [[IPCC:Wg2:Chapter:Chapter-7|Chapter 7]] (see Sections 7.1.6; 7.4.2)

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