Authors: Amal Dahri, Codou Badiane Mane, Abdoulaye Diaw, Bekkaoui Hassane, Isaulina Barreto, Leonel Pontes, and Ilhame Ouansafi.

Representatives from Morocco, São Tomé and Principe, and Senegal, accompanied by World Bank  staff in the country offices, attended the inaugural in-person meeting of the in Washington, DC USA from February 26-27, 2024. The meeting was attended by 20 countries from Africa, Asia, the Middle East, and South America, and was held to facilitate the sharing of experiences and lessons learned regarding climate change response and healthcare system resilience. The primary goals of the meeting were to initiate the collaborative, identify priority technical areas and key themes, share existing efforts, tools, and successes, understand and document expectations for collaborative activities, and jointly outline potential knowledge products that could be co-produced throughout the two-year collaborative period. Participants identified six workstreams for focus by the collaborative and agreed to collaboratively co-develop five knowledge products in 2024-2025 corresponding to the first three workstreams: 1) Governance, 2) Financing and Maximizing Financing, 3) Data and Accountability, 4) Multisectoral Action, 5) Engaging Communities, and 6) Service Delivery Models.

Discussions revealed that the cost of inaction on climate change, whose global impact is already evident greatly surpasses the cost of investing in mitigation efforts. These investments would benefit healthcare systems, enabling them to continue serving populations, especially the most vulnerable. This article highlights the JLN CSHS collaborative’s discussions of Morocco, São Tomé and Príncipe, and Senegal’s climate and health situations, as well as their expectations for upcoming meetings and dedication to knowledge products.

Climate and Health Landscape in Morocco, São Tomé and Príncipe, and Senegal

Morocco, São Tomé and Príncipe, and Senegal acknowledge the significant impact climate change has on health outcomes, recognizing that it threatens to undermine decades of progress in public health. While these countries are at different stages of incorporating climate considerations into public policy, all three have demonstrated a political commitment to addressing climate change.

Morocco’s CSHS Mitigation: Building Resilience to Climate Change

Morocco faces growing challenges from climate change, experiencing extreme heat waves, drought, and flooding. The nation remains committed to international climate goals for 2030 and is taking decisive action to mitigate climate change and reduce greenhouse gas (GHG) emissions across all sectors, especially healthcare.

By 2021, Morocco’s Ministry of Health and Social Protection had committed to building a sustainable and climate-resilient healthcare system. A recent assessment evaluated the environmental sustainability, climate resilience, and GHG emissions of Morocco’s public healthcare facilities. Based on the assessment’s recommendations, Morocco will develop an implementation plan to enhance the climate resilience of its healthcare facilities. These substantial measures demonstrate Morocco’s dedication to strengthening its healthcare system against climate change impacts and ensuring continued healthcare services amid climate-related disruptions. São Tomé and Príncipe, a small island developing state (SIDS), has a history of rainfall and landslides, which lead to water-borne diseases and increased cases of malaria and dengue fever. Necrotizing cellulitis, caused by microorganisms normally found on the skin, could also be linked to climate change. The northern part of the country, prone to flooding during the rainy season, has implemented simulation exercises to prepare for such events. Despite participating in the Conference of the Parties (COP), the country has not yet initiated health-related measures to adapt to climate change.

Senegal’s Proactive Approach to Integrating Climate Risks in Health Sector Planning

Senegal is taking a proactive stance against climate-related health risks by integrating climate considerations into the planning and budgeting of investment projects across all sectors, with a particular focus on health and health determinants. This approach is driven by the increased prevalence of extreme weather events such as heavy rainfall, flooding, extreme temperatures, unseasonal rainfall, dust storms, drought, and coastal erosion, which have led to the emergence of diseases like dengue fever in recent years (2017-2023). Key initiatives include strengthening the institutional framework and fostering intra- and multi-sectoral collaboration, particularly within the Health and Environment group, to ensure a comprehensive understanding and integration of climate risks in the health sector.

Senegal demonstrates its commitment to climate-conscious healthcare through several initiatives. Collaboration between the Ministry of the Environment, Sustainable Development and Ecological Transition (MEDDTE) and the Ministry of Health and Social Action (MSAS) led to the development of the national adaptation plan for the health sector (PNAS), awaiting political validation. Further, a decree mandates climate integration in all future public investment projects exceeding 500 million FCFA, and a “green national budget” will complement the 2024 finance law.

Senegal has completed gap analyses and vulnerability studies to inform these policies. The country is finalizing a concept note for a health adaptation project for the Green Climate Fund (GCF) and has integrated climate risk into health sector development policy, system structures, and procedures. Climate-sensitive health indicators are now part of the Nationally Determined Contribution (NDC) and routine health information system monitoring. Additionally, the heat wave early warning system is being strengthened.

Country Learnings and Meeting Expectations

International Collaboration to Build Climate-Resilient Healthcare Systems

The inaugural in-person meeting of the JLN-CSHS partnership fostered a valuable exchange among French-speaking participants from diverse countries. The meeting facilitated a platform to share insights on climate change impacts, discuss region-specific challenges, and learn from each other’s progress in developing healthcare systems that can withstand climate change.

Morocco, São Tomé and Príncipe, and Senegal valued the JLN knowledge exchange platform, which allowed them to expand their knowledge base and learn from the diverse approaches other countries have taken to address their unique challenges and constraints. The three countries were particularly interested in learning about initiatives undertaken by other participating countries to adapt and mitigate the adverse effects of climate change on health systems. They emphasized the importance of learning from good practices and successful initiatives in other contexts, with the goal of adapting and replicating these strategies within their own health systems.

The three countries highlighted a number of specific features they learned from these meetings, at various stages of integrating climate change considerations into their public policies.

Morocco emphasized that governance is the most important axis to ensure success in the fight against the adverse effects of climate change at both the national and international levels. They stated that governance will enable the establishment of a multi-sectoral approach to both climate change adaptation and GHG emissions reduction.

Sao Tomé and Príncipe recognized the need to conduct a health vulnerability study to enhance climate change resilience. The country also emphasized the need to prioritize the creation of a national health climate change adaptation plan, a financing plan for these activities, and the establishment of good governance and community commitment to ensure impactful outcomes.

Senegal highlighted successful initiatives from participating countries, including waste management in Morocco (utilizing shredder sterilizers and recycling instead of incinerators) and analysis for climate-resilient, low-emission health infrastructure.  Additional successes noted include Nigeria’s “health and climate” institutional framework; Fiji’s checklist for ecologically sustainable healthcare facilities; carbon footprint and vulnerability assessment toolkits in Malaysia, Colombia, Bangladesh, and India; and Malaysia’s green-certified health buildings to mitigate carbon emissions from its healthcare sector.

Morocco and Senegal have identified several actionable lessons, including strengthening climate governance in the health sector, reinforcing multi-sectoral approaches to health sector climate change adaptation, and constructing climate-resilient and low-carbon health facilities. Meanwhile, São Tomé and Príncipe focused on community involvement by leveraging the country’s health education center.

Knowledge Products: Enhancing Healthcare System Resilience to Climate Change

 The JLN CSHS meetings fostered in-depth discussions on critical strategic areas for bolstering healthcare system resilience against climate change. Governance emerged as a unanimous priority for knowledge workstreams and collaboration among Morocco, São Tomé and Príncipe, and Senegal. These countries also emphasized the need for focused attention on multi-sector collaboration and financing, to which Morocco and Senegal would like to contribute. Additionally, Senegal expressed a particular interest in community involvement to support climate-resilient healthcare strategies.

Knowledge products focused on governance, financing and maximizing financing, and data and accountability could help countries advance their climate and health work in different ways, depending on how climate change and health are currently positioned within each country. Mr. Bekkaoui (Morocco) suggested that financing for climate change adaptation could be secured through the return on investment from hospitals using renewable energy and investing in new energy-saving technologies to reduce energy consumption. He also noted that a cost-benefit analysis could help secure funding from global climate funds. Mr. Pontes and Ms. Barreto (São Tomé and Príncipe) highlighted that engaging with decision-makers could support policy and strategy development and facilitate resource mobilization. Dr. Badiane and Dr. Diaw (Senegal) emphasized that strengthening multi-sectoral guidance structures would improve the rational management of resources through synergies and complementarities of actions supported by technical and financial partners.

Furthermore, a multi-sectoral approach that considers both health and health determinants would enable a person-centered, problem-solving approach. This strategy should prioritize equity—defined here as giving everyone precisely what they need—and avoid an “arithmetical” distribution of interventions and resources between the country’s different localities. Lastly, knowledge products co-produced by countries could guide investment in climate-sensitive disease surveillance, the systematic integration of climate-related concerns into health policy to achieve Universal Health Coverage, and the engagement of communities and decision-makers for the operational implementation of the National Health Adaptation Plan (NHAP).