Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.4.2.10 Monitoring, Evaluation and Learning ====

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''Monitoring, evaluation and learning (MEL) can assess the ability of nations and communities to prepare for and adequately respond to the health risks of climate change over time'' ( ''high confidence'' ) ''( [[#Boyer--2020|Boyer et al., 2020]] ).'' MEL describes a process that includes baseline assessment, prioritising actions and activities, identifying key indicators to track, ongoing data collection and periodically considering new information (Kruk et al., 2015). MEL determines whether adaptation options achieved their goals and whether resources were used effectively and efficiently ( [[#Boyer--2020|Boyer et al., 2020]] ). One of the challenges for MEL in the context of adaptation is that climate risks vary as a function of time, location, socioeconomic development, demographics and activities in other sectors ( [[#Ebi--2018a|Ebi et al., 2018a]] ). MEL indicators in the health sector need to account for factors related to governance, implementation and learning as well as for exposures, impacts and programmatic activities, all of which are context dependent and are often outside the health sector ( [[#Boyer--2020|Boyer et al., 2020]] ; [[#Ebi--2018a|Ebi et al., 2018a]] ; [[#Fox--2019|Fox et al., 2019]] ).

''No universal standardised approach exists for monitoring or evaluating adaptation activities in the health sector'' ( ''high confidence'' ) ''.'' Candidate indicators of climate change health impacts and adaptation activity, typically at the national level, are available ( [[#Bowen--2017|Bowen and Ebi, 2017]] ; [[#Cheng--2013|Cheng and Berry, 2013]] ; [[#Kenney--2016|Kenney et al., 2016]] ; [[#Navi--2017|Navi et al., 2017]] ; [[#WHO--2015b|WHO, 2015b]] ). Indicators are best grouped by category of activity, that is, vulnerability, risk and exposure; impacts; and adaptation and resilience ( [[#Ebi--2018a|Ebi et al., 2018a]] ). As health adaptation expands, enhanced monitoring will be needed to ensure that scientific advances are translated into policy and practice. A promising initiative that emerged since the AR5 is the ''Lancet Countdown'' , which represents a global effort at tracking various indicators of exposures, impacts, adaptation activities, finance and media activity related to climate change and health ( [[#Watts--2018a|Watts et al., 2018a]] ), although this effort is principally focused on monitoring and does not explicitly focus on evaluation adaptation efforts or learning from adaptation efforts.

Community-based monitoring of adaptation responses to health impacts, especially by Indigenous Peoples, has not been widely undertaken, despite its potential to improve monitoring of and local adaptation to environmental change ( [[#Kipp--2019|Kipp et al., 2019]] ). The health sector has been particularly weak at recognising the climate impacts on and the adaptation needs of Indigenous Peoples and in engaging Indigenous Peoples in monitoring progress ( [[#Ford--2018|Ford et al., 2018]] ; [[#David-Chavez--2018|David-Chavez and Gavin, 2018]] ; [[#Ramos-Castillo--2017|Ramos-Castillo et al., 2017]] ). Successful adaptation to the health impacts of climate change in Indigenous Peoples requires recognition of their rights to self-determination, focusing on indigenous conceptualisations of well-being, prioritising Indigenous knowledge and understanding the broader agenda of decolonisation, health and human rights ( ''high confidence)'' ( [[#Ford--2015|Ford and King, 2015]] ; [[#Green--2014|Green and Minchin, 2014]] ; [[#Hoy--2014|Hoy et al., 2014]] ; [[#Jones--2019|Jones, 2019]] ; [[#Jones--2014|Jones et al., 2014]] ; [[#Mugambiwa--2018|Mugambiwa, 2018]] ; [[#Nursey-Bray--2018|Nursey-Bray and Palmer, 2018]] ).

Indicators should capture measures of processes that drive adaptation readiness, including leadership, institutional learning and inter-sectoral collaboration ( [[#Boyer--2020|Boyer et al., 2020]] ; [[#Ford--2015|Ford and King, 2015]] ) as well as outcome measures such as the presence of programming known to reduce risks ( [[#Ebi--2018a|Ebi et al., 2018a]] ). Additionally, indicators related to scaling up of effective interventions and relying on the implementation of science frameworks are important ( [[#Damschroder--2009|Damschroder et al., 2009]] ; [[#Theobald--2018|Theobald et al., 2018]] , 2020; [[#Ebi--2018a|Ebi et al., 2018a]] ; [[#Fox--2019|Fox et al., 2019]] ). Measuring impacts attributable to climate change could be addressed with a combination of indicators related to overall health system performance and population vulnerability ( [[#Ebi--2017|Ebi et al., 2017]] ; [[#Ebi--2018a|Ebi et al., 2018a]] ).

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