Primary health care systems must become more resilient as the effects of climate change worsen.
Devastating weather events seem to make the news every day. African countries are not spared. A "downpour" in South Africa. Of the flooding in Nigeria.cyclones in Mozambique, Malawi, Zimbabwe and Madagascar. Drought in Kenya.
These events have enormous health and social effects, including death, injury, malnutrition and disease (infectious and non-communicable). All of this puts enormous pressure on countries' health systems, both in terms of caring for those affected and infrastructure such as hospitals and clinics that are vulnerable to damage and destruction.
Extreme weather events, for example in the South African provinces of KwaZulu-Natal and Eastern Cape, also disrupt energy supplies, communications, supply chains, the workforce and the provision of essential services such as maternity care and care for the chronically ill.
So how can African countries build more resilient primary health care systems as the effects of climate change worsen? We recently performed an exploratory scoping study on primary health care and climate change in Africa and we found very little to guide health systems in answering this question.
We searched for all studies on primary health care and climate change in the African context. The analysis made it possible to map all the available data according to the various components the World Health Organization (WHO) health system: leadership and governance; personal health ; health information system; infrastructure and technology; service provision; and health financing.
We have identified five key questions that health systems must answer to develop more resilient primary health care.
1. What training do health professionals need?
In most African countries, health professionals barely receive training on the health and social effects of dramatic climate change.
Initiatives have been taken to remedy this situation. The Association of Health Educators of Southern Africa recently published a Document synthesis calling for the integration of planetary health and environmental sustainability into the curricula of health professions in Africa. The World Organization of Family Doctors has also launched a global online training program on planetary health.
This type of training should focus on how different health services – eg nutrition, HIV, TB, malaria, vaccinations, maternity – should adapt to the effects of climate change. It should also make it possible to better prepare establishments for emergency situations and extreme events.
But it is not enough to train new health professionals. Continuous professional development and internal training are also essential.
2. What are the main vulnerabilities of the community?
The primary health care system in Africa should be community oriented, focusing on the health needs of the whole community, not just those who use a particular facility. This type of primary care has become a policy in some health systems, for example in the Western Cape Province of South Africa.
The community approach has generally focused on social determinants poor health, such as early childhood development or education. From now on, the environmental determinants of health and the main climate-related vulnerabilities must also be taken into account.
For example, the air pollution from coal-fired power plants is a major cause of non-communicable diseases such as ischemic heart disease, stroke, asthma, chronic obstructive pulmonary disease and lung cancer.
The construction of informal settlements in floodplains or the absence of trees in urban slums can increase vulnerability to flooding and high temperatures. Floods can displace people and cause injuries as well as water-borne diseases such as cholera. High temperatures can lead to dehydration, heat exhaustion and even death from heat stroke.
3. How can the health system track environmental changes?
Health information systems traditionally collect data on the health services and health needs of a population. For example, these systems can identify outbreaks of notifiable infectious diseases in order to provide a rapid response.
But they rarely include indicators to detect environmental problems.
Primary health care facilities and services should identify the particular climatic events they are likely to face. For some, it may be extreme temperatures or drought. For others, it may be severe storms or cyclones, or sea level rise and storm surges.
They should also identify the most likely changes in disease burden related to these events. For example, will they face an increase in climate migrants, heat-related conditions, water-borne or vector-borne infectious diseases, mental health issues or malnutrition?
Our exploratory study did not find African examples of health information systems to track changes or provide early warnings of climate-related events.
4. How can health systems build climate resilience?
Primary health care facilities and services must continue to function in the face of environmental challenges, such as cyclones, and provide safe health care, for example in extreme heat. Institutions need robust infrastructure, lighting, water, heating and cooling, and energy supply. Services need health workers, equipment, drugs, supplies and communications.
For example, one hybrid energy system can improve resilience and reduce the carbon footprint of the healthcare system. These systems can also help withstand power outages. Health systems need to think about how they can design facilities and systems that can withstand environmental challenges, respond to emergencies, and continue to deliver essential services.
5. What are the next steps?
The scoping study reveals a general lack of evidence on how to address climate change in primary health care in Africa. Further research is needed.
The University of Stellenbosch in South Africa and the Primary Care and Family Medicine Network (PRIMAFAMED) in sub-Saharan Africa are studying the impact of climate change on primary health care, developing tools for facilities to identify their risks and vulnerabilities, and identifying the learning needs of primary health care providers.
Health systems must also explicitly take into account the risks associated with climate change. There are examples that others can learn from: for example, the Department of Health and Welfare in South Africa's Western Cape Province has set up a climate change forum to develop climate change policy. mitigation (becoming carbon neutral by 2030) and adaptation (preparing for climate-related events and challenges).
Bob Mash, Distinguished Professor, Division of Family Medicine and Primary Care, Stellenbosch University et Christian Lueme Lokotola, Lecturer in Planetary Health, Division of Family Medicine and Primary Care, Stellenbosch University