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Climate Integration: Why the Future of Health Systems and Global Development Depends on It

October 26, 2022

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.

Like everything—and everyone—else, health systems function at the mercy of climate change, which means climate adaptation is vital not only to local resilience, but to health systems strengthening and security. So how can we connect these programmatically? In this episode of The Intersect, Abt’s Eric Reading and Kelly Saldana explain the urgent need for climate integration in global development.

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Read the Transcript

Eric Tischler: Hi, and welcome to the Intersect. I'm Eric Tischler. Abt Global tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening and maybe even fun to pair up colleagues from different disciplines so they can share their ideas and perhaps spark new thinking of how we solve these challenges. Today, I'm joined by two of those colleagues, Kelly Saldana and Eric Reading. Kelly is Abt's Vice President of Systems Strengthening and Resilience. She came to us earlier... Over dubs. She came to us earlier this year from US AID, where she was director of the Agency's Office of Health Systems. There she incorporated concepts of resilience into the agency's understanding of what makes systems strong. Eric is Abt's First Chief Climate Officer, a role he took on the summer after leading our work with US AID, which included extensive contracts addressing health, agriculture, energy, and of course resilience. Welcome.

Kelly Saldana: Thank you.

Eric Reading: Thank you.

Eric T: At least 3.3 billion people are considered to be highly vulnerable to climate change. According to the Intergovernmental Panel on Climate Change, people are 15 times more likely to die from extreme weather than in years past. But there are less obvious threats that fall into what we might think of as more traditional health sector concerns. For example, between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year from malnutrition, malaria, diarrhea, and heat stress according to the World Health Organization. So it's not surprising that US AID is now calling itself a climate agency, but we're finally officially recognizing the intersect between climate, health, and resilience. How do we manage it? How do we find the funding we need? How do we measure the progress we're making and how do we start implementing solutions?

Eric, you recently took on a new role at Abt. You're our first chief climate Officer. You're coming from the position as head of our US AID portfolio. So what led you to embrace the new CCO role?

Eric R: Well, after working for decades in global development in various areas from urban development to water and energy and agriculture, natural resources, I really saw climate crossing into everything that we worked in in global development. I saw that the challenges that we're seeing from the changes in climate are affecting all of those, and the solutions that we need to adopt are really found in each of those areas. It made me realize I have something that I can really contribute to how do we take on these challenges of making our systems more resilient to climate change, and how do we help make adaptations of behaviors and systems that mitigate the climate change challenge?

Eric T: Great. Okay. Obviously, we're still doing a lot of work with US AID. So Kelly, I'm going to ask you, now that it's a climate agency, but without specific climate funding, bureaus aren't necessarily synchronized in their approach. You faced a similar challenge when you were there. You were leading Health Systems Strengthening. It's a crosscutting platform to achieve sustainable health outcomes. What are some lessons and solutions you see for climate integration as you're trying to solve for the same problems, maybe, or similar problems?

Kelly: Sure. I think one of the things we found working in health systems is that each of the individual programs within the global health sector worked on strengthening health systems as directly related to those programs. But what we were trying to do was to strengthen health systems in a crosscutting and comprehensive way. That really required us to make it clear that although the impacts weren't direct, that they were important because there's real opportunity costs to direct programming if you're not focusing on health systems. So, I think there's direct linkages to climate related to that based on some of the statistics you stated at the beginning. But clearly we've seen that in the event of a natural disaster, people lose access to health services. So, how do we ensure continuity of services so we don't see backsliding on issues? That's something that has to happen before the disaster occurs. There's themes of these types of adaptations that we can build into systems early so that they're available and able to withstand different types of climate stressors.

Eric T: So, this isn’t even necessarily new work for us, right? For example, in Mozambique, we were helping people get ahold of their antiretroviral therapies amidst a disaster where supplies were difficult to get ahold of. But we’re not necessarily calling this climate work, right? So, how do we highlight those linkages topically and then help coordinate that work while addressing all aspects, meaning not just the health aspect but the climate and resilience aspects?

Kelly: I think two things. What we tried to do is enable multi-month dispensing of ARVs. So rather than have to pick up your ARVs every month, clients could go and pick up a three- or six-month supply. But what you don't want to do is do that for ARVs and then recreate that for family planning commodities and then recreate it for something else. You want to make sure that the system itself has policies that enable and sort of have thought that through at the outset.

But then specifically how we adapt for climate, USAID is requiring climate risk mitigation plans in all of its designs. A lot of that is really thinking through, from the USAID perspective, what are the climate-related risks to the development activity that USAID is designing and making sure that USAID is building into its contracts and grants the ability for implementers like Abt to know what to expect and be able to quickly adapt and adjust programs. I think it's a lot of that same kind of thinking that USAID is doing specifically for the programs it funds that we want to make sure the countries that we work with are also doing for the ongoing programs that implementers like Abt are providing technical assistance for. So it's not just how do you maintain the continuity of Abt's programs, but how do you work with countries so that they're maintaining continuity of all of their programs across the board, but using a lot of the same principles?

Eric R: It's important to remember that climate exacerbates preexisting vulnerabilities. So, when you have poverty or gender that are causing vulnerability to start with, changes in climate and the stresses and shocks that come from changes in climate make those vulnerabilities even worse. It also intersects with a lot of other sectors. Obviously, climate dramatically impacts agriculture and changes in climate can very rapidly affect nutrition and incomes from agriculture. It affects malaria, for example, and Abt does a lot of work in preventing malaria vectors around the world. Those malaria seasons are extended as the climate gets warmer and the mosquitoes are able to thrive in the warmer climate.

Kelly: Yeah. I think that's a really important point, that you can't just have and build systems resilience without also creating community and individual resilience. I think a lot of times we talk about layering and sequencing different kinds of activities on top of one another in order to really build that overall resilience. So, if you think of the health system itself, it's dependent on health workers. If those workers cannot get to the facility because of a disaster or because of their own familial situation, then the health system is not going to be able to function as well without health workers.

Then, as Eric was mentioning, in the event of a disaster, there's oftentimes increases in gender-based violence and in other actions that, really, the community itself needs to have plans and abilities to deal with from a resilience perspective, which feeds into the functioning of the systems themselves.

Eric T: Right. Eric, do you want to talk a little bit about how we're already working with partners on the ground? I’m thinking of our electrification work, for example, which also has health implications, and how that might dovetail with what Kelly's talking about or be an exemplar of what Kelly's talking about?

Eric R: Yeah. Absolutely. We're just beginning some really interesting work right now that is working on the electrification of health facilities throughout Africa, 10,000 health facilities that are either unpowered or underpowered today. That not only helps to improve the quality of care that can be brought with electricity coming into those settings, but also helps to make those communities more resilient as those health facilities have their own independent sources of power. So as you see natural disasters, as you see other things happening, you've got a much, much more resilient energy system in place. As we know, in the case of disaster, losing your energy grid is a real consequence that happens very frequently. Having health facilities that have independent power in that way, through solar electrification, is a tremendously huge benefit. Even within the United States, we've seen where that independent power of health facilities can really help when the grid is stressed in the case of, for example, high heat events.

Eric T: Right. You're referring to tapping into those health facilities as a resource for the community?

Eric R: Exactly, yeah. For example, in California, recently, when the grid was really overstressed, the fact that there was backup power generation in hospitals throughout the state really allowed more power to be brought online. What would've normally been backup power could be used for primary power for that health facility, allowing other power to be used for the grid that allowed people to survive in that extreme heat event. In that particular case, because of the extreme heat, one of the challenges was keeping people from getting heat stroke and out of the emergency rooms. So, these things really interrelate with each other. These are problems that we think about today in the United States, for example. But as climate change has more and more impact around the world, that resilience of the grid is certainly going to be an issue in Africa and throughout developing countries.

Kelly: I think that's a really good example of something that's both helping us to adapt and prepare for climate emergencies, but is also just helping the basic delivery of health services on an everyday basis. So I think, especially at the primary care level, there's a lot of services that are provided through outreach and community workers and that sort of thing that don't necessarily require electricity to function, but when a woman's having a baby in the middle of the night, you want to have light to be able to deliver that baby at the nearest health facility. So, it really does help the programs that US AID is implementing in the health sector today, while also helping to prepare for potential climate emergencies in the future.

Eric R: Exactly. It's much, much better than the alternative, for example, of having diesel generation or propane lamps or other things that are causing negative consequences for the environment while helping to provide that health service in the middle of the night.

Eric T: We have that stat about where if you have consistent refrigeration, the amount of health issues you can treat increase from six to 14, or even 20. So, clearly, there's a lot of benefit there. Understanding there's this intersection with resilience, moving forward, how can climate, practically speaking, be part of it? USAID's a climate agency now, but funding wise, what does that mean? What are some strategies we're going to have moving forward to really ensure that we're advancing those, like we just said, an integrated goal of resilience for health and for climate? How can we move forward, pursuing those agendas in lockstep?

Kelly: Specifically with health systems, I think there's increasing recognition within the health systems community that strong health systems have to be resilient. They have to both be able to take care of core functions on a regular basis, but also able to do so in the face of different kinds of shocks and stressors, which can be climate, but could also be infectious diseases, outbreaks, or any other sort of disruptions that happen on a regular basis.

There is an opportunity in the way that Congress appropriates legislation for health programs, which has tended to be very program specific but, starting with this year, they're actually asking USAID to use 10 percent of the funding across each of those elements and use them for crosscutting health systems activities.

So, some of the things that USAID could do in that crosscutting way that would enable health systems to be more resilient is to make sure the policies are in place to ensure continuity of services, like being able to dispense a multi-month availability, having telework options available, making sure that there's agreements between public sector and private sector to be able to share resources if one or the other is unable to continue to provide resources, loosening up some of the public financial management systems so that funding can also be more flexibly moved from one area to the other in the event of an emergency, and then having robust coordination committees that, I think, involve the community as well as the health sector and other relevant government agencies that really are stood up and able to respond in the event of emergency, to name a couple of examples.

Eric R: Yeah. I would add as well, there have been regulations in place for a long time that climate risk management is something that needs to be looked at in the context of development programs, but historically we've tended to look at that as kind of a negative, that we have to make sure that climate's not going to wipe away this investment that we've made.

I think in the world that we're in today, we have a real opportunity to think of that as a positive and really lean into that climate risk assessment and say, "Okay, we understand that this is how this system is going to be stressed by climate, and then as we make an investment to that system, how can we make that system more resilient to shocks?" Those shocks are climate shocks; those shocks are social shocks, political shocks, whatever else they might be. But investing in that system resilience that we can identify through that climate risk assessment process is really valuable and Abt has supported the agency for quite some time in working on that climate risk assessment work.

I think leaning into that and really making it part of the design rather than something that we're doing just to satisfy a regulatory requirement is really a way that we can use existing streams of investment that we're already making, whether it's in family planning and maternal health, for example, where Abt did some work in the Philippines to look at the disruptions to family planning from heat stresses and climate change and other climate disasters to understand how you can build a system that is more resilient to those shocks.

Kelly: I think that Abt example is really good because it wasn't just looking at the climate's impact on Abt's program, but because that program was working directly with the government, we really were working hand in glove with the government program and to mitigate climate, it wasn't enough that Abt had flexibility in its planning, but really trying to infuse those into local governments in the Philippines so that now the Filipino health system itself has contingency plans and climate risk mitigation plans that local health systems are able to do.

Eric R: Exactly.

Eric T: Well, this is a rare occurrence. We're talking about apocalyptic climate change and we have a happy ending. So maybe that's a good place to stop. Thank you both for joining me.

Kelly: Sure.

Eric R: Thank you, Eric.

Kelly: Thank you.

Eric T: … and thank you for joining us at The Intersect.

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