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Implementation science for planetary health

Remarks about implementation science for planetary health by Reda Sadki, Executive Director, The Geneva Learning Foundation at the Centre for Planetary Health’s research corner meeting, London School of Hygiene & Tropical Medicine (LSHTM) on December 17, 2025.

Pauline Paterson (LSHTM): We are really delighted to welcome Reda Sadki. Reda is the Executive Director of the Geneva Learning Foundation, a non-profit research organization developing new epistemological and methodological approaches for complex global health challenges. Welcome, Reda.

Reda Sadki (TGLF): Warm greetings from Geneva, Switzerland. I am very pleased to share with you what we have been learning about climate change and health – in particular, how we can move from ground truth to local action on a global scale.

Since 2021, we have been running an initiative called Teach to Reach, led by community-based health professionals from all over the world. It connects people across countries and job roles, supporting the journey from local insight to global health initiative.

The scale of this network has grown significantly. In March 2021, we started with 2,604 participants. By December 2024, at the eleventh meeting of Teach to Reach, we had 24,610 health workers participating.

Who are they? Most work in health facilities and districts. Half work for government and half for civil society organizations.

Where are they? They serve in the most fragile contexts: 62% work in remote rural areas; 47% with the urban poor; 25% with refugees or internally displaced populations. And one in five work in areas of active armed conflict.

Alongside these individuals, we are nurturing the REACH Network, a coalition of more than 4,000 locally-led organizations. This is the backdrop for how we think about leadership as the key to driving change in climate and health.

The “dark matter” of implementation science

As a community working on climate change and health, we are strong – and getting stronger – on diagnosis. But we must be candid: we are weak on delivery. The science keeps getting better, but there is a gap when it comes to translating science into action.

When it comes to formal research, we see what I call the ”dark matter”, a blind spot around hyperlocal adaptation and how implementation actually happens at the local level.

This dark matter includes environmental, behavioral, and systemic signals that formal research might miss: social and economic disruption, hidden mental health burdens in communities with no formal services, community coping mechanisms, and subtle changes in vector behaviors.

Now, I know that for many of you trained in epidemiology, the word “anecdote” sets off alarm bells. We are taught to devalue it for good reason: it is prone to recall bias, selection bias, and lacks denominators. A nurse in Bangladesh noticing “more heatstroke” is a signal, not a prevalence study. We are not claiming it is.

However, we have two ways to answer the questions these signals raise. We can carry out long-term, rigorous academic studies over decades. Or – given that we are past several climate tipping points – we can recognize that aggregate patterns formed by thousands of these signals offer a speed and granularity that traditional studies cannot match. This functions as a massive, distributed sentinel surveillance system. It may be “imperfect” compared to a controlled trial, but is it riskier than the alternative? The alternative is often waiting years for definitive answers while communities suffer damage that may make those findings moot.

This requires a new epistemology. Our hypothesis is that we can build a system where an anecdote becomes an eyewitness report. A health worker, traditionally seen as a “knowledge recipient” presumed ignorant of climate science, becomes a “knowledge creator”. They know things about local impacts that no one else knows, simply because they are there every day.

In July 2023, Charlotte Mbuh, TGLF’s director who started over a decade ago as a sub-national health worker from Cameroon, stood at COP28 and said:

”What we know, we know because we are here every day. We are already managing the impacts of climate change on health. We are doing the best we can, but we need your support.”

Read Charlotte Mbuh’s full statement at COP28: Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

Turning experience into evidence: the global climate change and health survey

To operationalize this, we built a living laboratory powered by a global human sensor network.

In 2025, in partnership with Grand Challenges Canada and a group of 50 global funders (including Gates, Wellcome, and Rockefeller), we conducted what I have been told is the largest-ever climate and health survey, and the one with the highest level of responses from local communities in the most climate-vulnerable regions

We received responses from 6,436 health workers, primarily from the sub-national level. Because of the trust we have built over years, the Teach to Reach network contributed over 60% of these responses, ensuring we heard from the most climate-vulnerable regions.

https://www.youtube.com/watch?v=C67nYqq-hP0

Most importantly for funders, we asked about barriers to action. The top barriers were not just resource shortages, but structural issues.

Pending their formal publications, I am not yet able to share results.

These findings are signals. They generate hypotheses. Here are three examples of hypotheses grounded in health worker experirences:

• Geh Raphaela Agwa, a midwife from Cameroon, told us: “During this unfavourable weather period, people who can paddle canoes come in and help…”. Could community-led transport solutions improve maternal health access during floods?
• Solace Jewel Morgan, a disease control officer in Ghana, told us: “The dry season… results in dust particles known as harmatan. This leads to a high incidence of respiratory illnesses… encourage… free distribution of personal protective masks.” Could prophylactic mask distribution reduces respiratory morbidity during the harmatan season?
• Victoire Odia, a nurse from the Democratic Republic of Congo (DRC), told us that during extreme weather events, maternity “stays were paid for by the women’s group solidarity fund.” Could micro-financing networks increase facility-based deliveries in climate-vulnerable areas?

Of course, we must distinguish between generating a hypothesis and validating an intervention. We do not claim every local idea is safe or effective immediately. But we do claim that listening is the prerequisite to testing them.

From insight to impact: the Accelerator model for implementation science

We do not just extract data. We give it back to the community to prompt action. Since 2016, we have developed an “Accelerator” system that moves from listening to implementation. It works on a simple rhythm: participants set a specific, practical goal on Monday, and on Friday, they report on what happened, receiving feedback from peers.

This brings us to a critical tension: the balance between context and content. Critics might argue that prioritizing “context over content” carries risks. What if health workers implement unproven or suboptimal strategies? That is a valid concern. However, we see this mechanism not as a way to bypass evidence, but as the most effective tool to operationalize it.

In The Geneva Learning Foundation’s Accelerator, every participant commits to work toward their countries’ goals, and to do so by using the best available global knowledge.

Learn more: What is The Geneva Learning Foundation’s Impact Accelerator?

This actually supports effective adoption and use of global guidelines, which otherwise may linger on shelves.

In fact, we have shown in the past that this mechanism increases adherence to proven protocols (e.g., WHO guidelines on heat stress or malaria control). That is one important reason why it is a powerful implementation science tool. It transforms adherence from a wish expressed in the capital city into a reality in local communities.

Furthermore, if national planners and international experts are willing to listen, they may hear back ways to improve and strengthen the global standards, as well as gain new insights into the “how” of local implementation that defies easy generalization.

When we compared this model to conventional technical assistance or “cascade training,” the results were stark :

1. Speed: Implementation was 7x faster.
2. Cost: The cost was 90% lower.
3. Sustainability: In a Ministry of Health initiative in Côte d’Ivoire, 82% of participants continued using the model without further support. 78% explicitly stated they needed no further external assistance.

These results give us confidence. We are not starting from zero. We are building on prior work in immunization and other areas of work where supporting implementation led to exactly these kinds of validated outcomes.

Here are two examples of local solutions in action.

• Côte d’Ivoire: Communities identified stagnant water as a malaria risk and organized youth-led cleanup committees to clear gutters. This resulted in a drastic, locally measured drop in malaria cases.
• Cameroon: In response to frequent floods, communities voluntarily cleaned gutters to ensure water did not stagnate, directly impacting disease vectors.

No one in the capital city – and certainly no one in Geneva or Seattle – knew about these initiatives.

This leads to our most ambitious projection. If we can grow this network from 80,000 to 1 million health workers by 2030, we estimate we could save 7 million lives through simple, locally resourced projects, at a cost of less than $2 per life.

I acknowledge this is an aggressive claim. It is a “back-of-the-envelope” calculation based on our pilot data. It assumes that local projects remain effective at scale and that we can attribute outcomes to the network. But I ask you: if there is even a glimmer of a chance that this is true – that we can save lives at a fraction of the cost of traditional interventions – isn’t it worth investing in the rigorous research to find out?

Discussion

Do you think MOOCs (Massive Open Online Courses) are dead?

Reda Sadki: MOOCs have become primarily marketing tools for higher education. From a pedagogical perspective, they remain transmissive, expert to learner. I do not see how that model can deliver against complex problems. We need a two-way street. We need new ways to organize the production and circulation of knowledge.

Thank you, Reda. I noticed in your results that food security is a major concern. Have you identified local actions focusing on food, given the challenges of working with healthcare workers who might not see this as their primary remit?

Reda Sadki: That is a critical question. Food insecurity is one of the most worrying consequences we are tracking. We often see a mismatch where local actors tasked with, say, immunization, do not see nutrition as their lane. However, at the community level, the approach is naturally integrated – the health worker knows the vet, who knows the farmers. Those connections exist.

We are currently preparing a major insights report that includes a specific chapter on food security. We are also designing an accelerator specifically around this topic to bring together the right set of partners, because the consequences we are documenting are dire.

You mentioned that 78% of participants eventually said “no thank you” to further support. Ideally, shouldn’t these peer networks become self-sustaining, bypassing Geneva or London entirely?

Reda Sadki: That is the goal. We have shown that more than half of each cohort stays in touch to continue leading local action. However, as long as resources and decision-making power remain concentrated in global centers, we cannot just “flip a switch”. We need to build bridges that facilitate that transformation. The goal is autonomy, but the reality requires us to actively dismantle the dependencies that current funding structures create.

Are there new capabilities that we in academia need to develop urgently to support this?

Reda Sadki: It is about moving away from being the “sage on the stage” to a “guide on the side”. For example, in our recent work, global partners and experts joined Teach to Reach sessions not to present the latest guidelines, but to listen to the challenges local practitioners faced. They then had to figure out how their expertise could be useful in response to those specific needs.

For researchers inside academic institutions, this can be difficult. It requires starting not with a research question, but with a willingness to listen to the needs of local actors and let the research questions emerge from that reality. We know this challenges the incentive structures of academia, but we are open to partnering with researchers willing to work in this emergent, demand-driven way.

It is a fascinating dilemma – we want to be guided by needs, but funding requires pre-set hypotheses. Reda, this has been truly impressive. Thank you for sharing these refreshing perspectives.

Reda Sadki: Thank you. We look forward to exploring how we can collaborate. Best wishes for the holidays and the new year.

References

1. Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
2. Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
3. Sadki, R., 2024. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
4. Sadki, R., 2024. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
5. Sanchez, J.J., Gitau, E., Sadki, R., et al., 2025. The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health 13, e199–e200. https://doi.org/10.1016/s2214-109x(25)00003-8
6. Jones I, Mbuh C, Sadki R, Eller K, Rhoda D. On the frontline of climate change and health: A health worker eyewitness report [Internet]. The Geneva Learning Foundation; 2023. https://zenodo.org/doi/10.5281/zenodo.10204660

Images: The Geneva Learning Foundation Collection © 2025

Implementation science for planetary health

Remarks about implementation science for planetary health by Reda Sadki, Executive Director, The Geneva Learning Foundation at the Centre for Planetary Health’s research corner meeting, London School of Hygiene & Tropical Medicine (LSHTM) on December 17, 2025.

Pauline Paterson (LSHTM): We are really delighted to welcome Reda Sadki. Reda is the Executive Director of the Geneva Learning Foundation, a non-profit research organization developing new epistemological and methodological approaches for complex global health challenges. Welcome, Reda.

Reda Sadki (TGLF): Warm greetings from Geneva, Switzerland. I am very pleased to share with you what we have been learning about climate change and health – in particular, how we can move from ground truth to local action on a global scale.

Since 2021, we have been running an initiative called Teach to Reach, led by community-based health professionals from all over the world. It connects people across countries and job roles, supporting the journey from local insight to global health initiative.

The scale of this network has grown significantly. In March 2021, we started with 2,604 participants. By December 2024, at the eleventh meeting of Teach to Reach, we had 24,610 health workers participating.

Who are they? Most work in health facilities and districts. Half work for government and half for civil society organizations.

Where are they? They serve in the most fragile contexts: 62% work in remote rural areas; 47% with the urban poor; 25% with refugees or internally displaced populations. And one in five work in areas of active armed conflict.

Alongside these individuals, we are nurturing the REACH Network, a coalition of more than 4,000 locally-led organizations. This is the backdrop for how we think about leadership as the key to driving change in climate and health.

The “dark matter” of implementation science

As a community working on climate change and health, we are strong – and getting stronger – on diagnosis. But we must be candid: we are weak on delivery. The science keeps getting better, but there is a gap when it comes to translating science into action.

When it comes to formal research, we see what I call the ”dark matter”, a blind spot around hyperlocal adaptation and how implementation actually happens at the local level.

This dark matter includes environmental, behavioral, and systemic signals that formal research might miss: social and economic disruption, hidden mental health burdens in communities with no formal services, community coping mechanisms, and subtle changes in vector behaviors.

Now, I know that for many of you trained in epidemiology, the word “anecdote” sets off alarm bells. We are taught to devalue it for good reason: it is prone to recall bias, selection bias, and lacks denominators. A nurse in Bangladesh noticing “more heatstroke” is a signal, not a prevalence study. We are not claiming it is.

However, we have two ways to answer the questions these signals raise. We can carry out long-term, rigorous academic studies over decades. Or – given that we are past several climate tipping points – we can recognize that aggregate patterns formed by thousands of these signals offer a speed and granularity that traditional studies cannot match. This functions as a massive, distributed sentinel surveillance system. It may be “imperfect” compared to a controlled trial, but is it riskier than the alternative? The alternative is often waiting years for definitive answers while communities suffer damage that may make those findings moot.

This requires a new epistemology. Our hypothesis is that we can build a system where an anecdote becomes an eyewitness report. A health worker, traditionally seen as a “knowledge recipient” presumed ignorant of climate science, becomes a “knowledge creator”. They know things about local impacts that no one else knows, simply because they are there every day.

In July 2023, Charlotte Mbuh, TGLF’s director who started over a decade ago as a sub-national health worker from Cameroon, stood at COP28 and said:

”What we know, we know because we are here every day. We are already managing the impacts of climate change on health. We are doing the best we can, but we need your support.”

Read Charlotte Mbuh’s full statement at COP28: Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

Turning experience into evidence: the global climate change and health survey

To operationalize this, we built a living laboratory powered by a global human sensor network.

In 2025, in partnership with Grand Challenges Canada and a group of 50 global funders (including Gates, Wellcome, and Rockefeller), we conducted what I have been told is the largest-ever climate and health survey, and the one with the highest level of responses from local communities in the most climate-vulnerable regions

We received responses from 6,436 health workers, primarily from the sub-national level. Because of the trust we have built over years, the Teach to Reach network contributed over 60% of these responses, ensuring we heard from the most climate-vulnerable regions.

https://www.youtube.com/watch?v=C67nYqq-hP0

Most importantly for funders, we asked about barriers to action. The top barriers were not just resource shortages, but structural issues.

Pending their formal publications, I am not yet able to share results.

These findings are signals. They generate hypotheses. Here are three examples of hypotheses grounded in health worker experirences:

• Geh Raphaela Agwa, a midwife from Cameroon, told us: “During this unfavourable weather period, people who can paddle canoes come in and help…”. Could community-led transport solutions improve maternal health access during floods?
• Solace Jewel Morgan, a disease control officer in Ghana, told us: “The dry season… results in dust particles known as harmatan. This leads to a high incidence of respiratory illnesses… encourage… free distribution of personal protective masks.” Could prophylactic mask distribution reduces respiratory morbidity during the harmatan season?
• Victoire Odia, a nurse from the Democratic Republic of Congo (DRC), told us that during extreme weather events, maternity “stays were paid for by the women’s group solidarity fund.” Could micro-financing networks increase facility-based deliveries in climate-vulnerable areas?

Of course, we must distinguish between generating a hypothesis and validating an intervention. We do not claim every local idea is safe or effective immediately. But we do claim that listening is the prerequisite to testing them.

From insight to impact: the Accelerator model for implementation science

We do not just extract data. We give it back to the community to prompt action. Since 2016, we have developed an “Accelerator” system that moves from listening to implementation. It works on a simple rhythm: participants set a specific, practical goal on Monday, and on Friday, they report on what happened, receiving feedback from peers.

This brings us to a critical tension: the balance between context and content. Critics might argue that prioritizing “context over content” carries risks. What if health workers implement unproven or suboptimal strategies? That is a valid concern. However, we see this mechanism not as a way to bypass evidence, but as the most effective tool to operationalize it.

In The Geneva Learning Foundation’s Accelerator, every participant commits to work toward their countries’ goals, and to do so by using the best available global knowledge.

Learn more: What is The Geneva Learning Foundation’s Impact Accelerator?

This actually supports effective adoption and use of global guidelines, which otherwise may linger on shelves.

In fact, we have shown in the past that this mechanism increases adherence to proven protocols (e.g., WHO guidelines on heat stress or malaria control). That is one important reason why it is a powerful implementation science tool. It transforms adherence from a wish expressed in the capital city into a reality in local communities.

Furthermore, if national planners and international experts are willing to listen, they may hear back ways to improve and strengthen the global standards, as well as gain new insights into the “how” of local implementation that defies easy generalization.

When we compared this model to conventional technical assistance or “cascade training,” the results were stark :

1. Speed: Implementation was 7x faster.
2. Cost: The cost was 90% lower.
3. Sustainability: In a Ministry of Health initiative in Côte d’Ivoire, 82% of participants continued using the model without further support. 78% explicitly stated they needed no further external assistance.

These results give us confidence. We are not starting from zero. We are building on prior work in immunization and other areas of work where supporting implementation led to exactly these kinds of validated outcomes.

Here are two examples of local solutions in action.

• Côte d’Ivoire: Communities identified stagnant water as a malaria risk and organized youth-led cleanup committees to clear gutters. This resulted in a drastic, locally measured drop in malaria cases.
• Cameroon: In response to frequent floods, communities voluntarily cleaned gutters to ensure water did not stagnate, directly impacting disease vectors.

No one in the capital city – and certainly no one in Geneva or Seattle – knew about these initiatives.

This leads to our most ambitious projection. If we can grow this network from 80,000 to 1 million health workers by 2030, we estimate we could save 7 million lives through simple, locally resourced projects, at a cost of less than $2 per life.

I acknowledge this is an aggressive claim. It is a “back-of-the-envelope” calculation based on our pilot data. It assumes that local projects remain effective at scale and that we can attribute outcomes to the network. But I ask you: if there is even a glimmer of a chance that this is true – that we can save lives at a fraction of the cost of traditional interventions – isn’t it worth investing in the rigorous research to find out?

Discussion

Do you think MOOCs (Massive Open Online Courses) are dead?

Reda Sadki: MOOCs have become primarily marketing tools for higher education. From a pedagogical perspective, they remain transmissive, expert to learner. I do not see how that model can deliver against complex problems. We need a two-way street. We need new ways to organize the production and circulation of knowledge.

Thank you, Reda. I noticed in your results that food security is a major concern. Have you identified local actions focusing on food, given the challenges of working with healthcare workers who might not see this as their primary remit?

Reda Sadki: That is a critical question. Food insecurity is one of the most worrying consequences we are tracking. We often see a mismatch where local actors tasked with, say, immunization, do not see nutrition as their lane. However, at the community level, the approach is naturally integrated – the health worker knows the vet, who knows the farmers. Those connections exist.

We are currently preparing a major insights report that includes a specific chapter on food security. We are also designing an accelerator specifically around this topic to bring together the right set of partners, because the consequences we are documenting are dire.

You mentioned that 78% of participants eventually said “no thank you” to further support. Ideally, shouldn’t these peer networks become self-sustaining, bypassing Geneva or London entirely?

Reda Sadki: That is the goal. We have shown that more than half of each cohort stays in touch to continue leading local action. However, as long as resources and decision-making power remain concentrated in global centers, we cannot just “flip a switch”. We need to build bridges that facilitate that transformation. The goal is autonomy, but the reality requires us to actively dismantle the dependencies that current funding structures create.

Are there new capabilities that we in academia need to develop urgently to support this?

Reda Sadki: It is about moving away from being the “sage on the stage” to a “guide on the side”. For example, in our recent work, global partners and experts joined Teach to Reach sessions not to present the latest guidelines, but to listen to the challenges local practitioners faced. They then had to figure out how their expertise could be useful in response to those specific needs.

For researchers inside academic institutions, this can be difficult. It requires starting not with a research question, but with a willingness to listen to the needs of local actors and let the research questions emerge from that reality. We know this challenges the incentive structures of academia, but we are open to partnering with researchers willing to work in this emergent, demand-driven way.

It is a fascinating dilemma – we want to be guided by needs, but funding requires pre-set hypotheses. Reda, this has been truly impressive. Thank you for sharing these refreshing perspectives.

Reda Sadki: Thank you. We look forward to exploring how we can collaborate. Best wishes for the holidays and the new year.

References

1. Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
2. Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
3. Sadki, R., 2024. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
4. Sadki, R., 2024. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
5. Sanchez, J.J., Gitau, E., Sadki, R., et al., 2025. The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health 13, e199–e200. https://doi.org/10.1016/s2214-109x(25)00003-8
6. Jones I, Mbuh C, Sadki R, Eller K, Rhoda D. On the frontline of climate change and health: A health worker eyewitness report [Internet]. The Geneva Learning Foundation; 2023. https://zenodo.org/doi/10.5281/zenodo.10204660

Images: The Geneva Learning Foundation Collection © 2025

Online learning completion rates in context: Rethinking success in digital learning networks

The comprehensive analysis of 221 Massive Open Online Courses (MOOCs) by Katy Jordan provides crucial insights for health professionals navigating the rapidly evolving landscape of digital learning. Her study, published in the International Review of Research in Open and Distributed Learning, examined completion rates across diverse platforms including Coursera, Open2Study, and others from 78 institutions. 

• With median completion rates of just 12.6% (ranging from 0.7% to 52.1%), traditional metrics may suggest disappointment. Jordan’s multiple regression analysis revealed that while total enrollments have decreased over time, completion rates have actually increased. 
• The data showed striking patterns in how participants engage, with the first and second weeks proving critical, after which the proportion of active students and those submitting assessments remains remarkably stable, with less than 3% difference between them. 
• The research challenges common assumptions about “lurking” as a participation strategy and provides compelling evidence that course design factors significantly impact learning outcomes. 

These findings reveal important patterns that can transform how we approach professional learning in global health contexts.

Beyond traditional completion metrics

For global health epidemiologists accustomed to face-to-face training with financial incentives and dedicated time away from work, these completion rates might initially appear appalling. In traditional capacity building programs, participants receive per diems, travel stipends, and paid time away from work. They are removed from their work environment, and their presence in the activities is often assumed to be evidence of both participation (often without any actual process metrics) and learning (with measurement often limited to “smile sheets” that measure sentiment or intent, not learning). Outcomes such as “completion” are rarely measured. Instead, attendance remains the key metric. In fact, completion rates are often confused with attendance. From this perspective, even the highest reported MOOC completion rate of 52.1% could be interpreted as a dismal failure.

However, this interpretation fundamentally misunderstands the different dynamics at play in digital learning environments. Unlike traditional training where external incentives and protected time create artificial conditions for participation, MOOCs operate in the reality of participants’ everyday professional lives. They typically do not require participants to stop work in order to learn, for example. The fact that up to half of enrollees in some courses complete them despite competing priorities, no financial incentives, and no dedicated work time represents remarkable commitment rather than failure.

What drives completion?

The accumulating evidence from MOOCs reveals three significant factors affecting completion:

1. Course length: Shorter courses consistently achieved higher completion rates.
2. Assessment type: Auto-grading showed better completion than peer assessment.
3. Start date: More recent courses demonstrated higher completion rates.

The critical engagement period occurs within the first two weeks, after which participant behavior stabilizes.

This insight aligns with what emerging networked learning approaches have demonstrated in practice.

Rather than judging digital learning by metrics designed for classroom settings, we must recognize that participation patterns may reflect authentic integration with professional practice.

The measure of success should not necessarily be focused solely on how many complete the formal course. Rather, we should be considering how learning connects to real-world problem-solving and contributes to sustained professional networks.

Moving beyond MOOCs: peer learning networks

The Geneva Learning Foundation’s learning-to-action model offers a distinctly different model from conventional MOOCs. While MOOCs typically deliver standardized content to individual learners who progress independently, the Foundation’s digital learning initiatives are fundamentally network-based and practice-oriented. Rather than focusing on content consumption, their approach creates structured environments where health professionals connect, collaborate, and co-create knowledge while addressing real challenges in their work.

These learning networks differ from MOOCs in several key ways:

1. Participants engage primarily with peers rather than pre-recorded content.
2. Learning is organized around actual workplace challenges rather than abstract concepts.
3. The experience builds sustainable professional relationships rather than one-time course completion.
4. Assessment occurs through peer review and real-world application rather than quizzes or assignments.
5. Structure is provided through facilitation and process rather than predetermined pathways.

The Foundation’s experience with over 60,000 health professionals across 137 countries demonstrates that when learning is connected to practice through networked approaches, different metrics of success emerge:

• Knowledge application: Practitioners implement solutions directly in their contexts
• Network formation: Sustainable learning relationships develop beyond formal “courses”
• Knowledge creation: Participants contribute to collective understanding
• System impact: Changes cascade through health systems

Implications for global health training and learning

For epidemiologists and health professionals designing learning initiatives, these findings suggest several strategic shifts:

1. Modular design: Create shorter, more connected learning units rather than lengthy courses.
2. Real-world integration: Link learning directly to participants’ practice contexts.
3. Peer engagement: Provide structured opportunities for health workers to learn from each other.
4. Network building: Focus on creating sustainable learning communities rather than isolated training events.

The future of professional learning, beyond completion rates

The research and practice point to a fundamental evolution in how we approach professional learning in global health. Rather than replicating traditional per diem-driven training models online, the most effective approaches harness the power of networks, enabling health professionals to learn continuously through structured peer interaction.

This perspective helps explain why seemingly low completion rates should not necessarily be viewed as failure. When digital learning is designed to create lasting networks of practice, knowledge emerges through collaborative action. Completion metrics therefore capture only a fraction of the impact.

For health systems facing complex challenges that include climate change, pandemic response, and health workforce shortages, this networked approach to learning offers a promising path forward—one that transforms how knowledge is created, shared, and applied to improve health outcomes globally.

Reference

• Jordan, K., 2015. Massive open online course completion rates revisited: Assessment, length and attrition. IRRODL 16. https://doi.org/10.19173/irrodl.v16i3.2112

Sculpture: The Geneva Learning Foundation Collection © 2025

#climateAndHealth #completionRates #learningMetrics #MOOCs #networkedLearning #onlineEducation #onlineLearning #professionalLearning

Online learning completion rates in context: Rethinking success in digital learning networks

The comprehensive analysis of 221 Massive Open Online Courses (MOOCs) by Katy Jordan provides crucial insights for health professionals navigating the rapidly evolving landscape of digital learning. Her study, published in the International Review of Research in Open and Distributed Learning, examined completion rates across diverse platforms including Coursera, Open2Study, and others from 78 institutions. 

• With median completion rates of just 12.6% (ranging from 0.7% to 52.1%), traditional metrics may suggest disappointment. Jordan’s multiple regression analysis revealed that while total enrollments have decreased over time, completion rates have actually increased. 
• The data showed striking patterns in how participants engage, with the first and second weeks proving critical, after which the proportion of active students and those submitting assessments remains remarkably stable, with less than 3% difference between them. 
• The research challenges common assumptions about “lurking” as a participation strategy and provides compelling evidence that course design factors significantly impact learning outcomes. 

These findings reveal important patterns that can transform how we approach professional learning in global health contexts.

Beyond traditional completion metrics

For global health epidemiologists accustomed to face-to-face training with financial incentives and dedicated time away from work, these completion rates might initially appear appalling. In traditional capacity building programs, participants receive per diems, travel stipends, and paid time away from work. They are removed from their work environment, and their presence in the activities is often assumed to be evidence of both participation (often without any actual process metrics) and learning (with measurement often limited to “smile sheets” that measure sentiment or intent, not learning). Outcomes such as “completion” are rarely measured. Instead, attendance remains the key metric. In fact, completion rates are often confused with attendance. From this perspective, even the highest reported MOOC completion rate of 52.1% could be interpreted as a dismal failure.

However, this interpretation fundamentally misunderstands the different dynamics at play in digital learning environments. Unlike traditional training where external incentives and protected time create artificial conditions for participation, MOOCs operate in the reality of participants’ everyday professional lives. They typically do not require participants to stop work in order to learn, for example. The fact that up to half of enrollees in some courses complete them despite competing priorities, no financial incentives, and no dedicated work time represents remarkable commitment rather than failure.

What drives completion?

The accumulating evidence from MOOCs reveals three significant factors affecting completion:

1. Course length: Shorter courses consistently achieved higher completion rates.
2. Assessment type: Auto-grading showed better completion than peer assessment.
3. Start date: More recent courses demonstrated higher completion rates.

The critical engagement period occurs within the first two weeks, after which participant behavior stabilizes.

This insight aligns with what emerging networked learning approaches have demonstrated in practice.

Rather than judging digital learning by metrics designed for classroom settings, we must recognize that participation patterns may reflect authentic integration with professional practice.

The measure of success should not necessarily be focused solely on how many complete the formal course. Rather, we should be considering how learning connects to real-world problem-solving and contributes to sustained professional networks.

Moving beyond MOOCs: peer learning networks

The Geneva Learning Foundation’s learning-to-action model offers a distinctly different model from conventional MOOCs. While MOOCs typically deliver standardized content to individual learners who progress independently, the Foundation’s digital learning initiatives are fundamentally network-based and practice-oriented. Rather than focusing on content consumption, their approach creates structured environments where health professionals connect, collaborate, and co-create knowledge while addressing real challenges in their work.

These learning networks differ from MOOCs in several key ways:

1. Participants engage primarily with peers rather than pre-recorded content.
2. Learning is organized around actual workplace challenges rather than abstract concepts.
3. The experience builds sustainable professional relationships rather than one-time course completion.
4. Assessment occurs through peer review and real-world application rather than quizzes or assignments.
5. Structure is provided through facilitation and process rather than predetermined pathways.

The Foundation’s experience with over 60,000 health professionals across 137 countries demonstrates that when learning is connected to practice through networked approaches, different metrics of success emerge:

• Knowledge application: Practitioners implement solutions directly in their contexts
• Network formation: Sustainable learning relationships develop beyond formal “courses”
• Knowledge creation: Participants contribute to collective understanding
• System impact: Changes cascade through health systems

Implications for global health training and learning

For epidemiologists and health professionals designing learning initiatives, these findings suggest several strategic shifts:

1. Modular design: Create shorter, more connected learning units rather than lengthy courses.
2. Real-world integration: Link learning directly to participants’ practice contexts.
3. Peer engagement: Provide structured opportunities for health workers to learn from each other.
4. Network building: Focus on creating sustainable learning communities rather than isolated training events.

The future of professional learning, beyond completion rates

The research and practice point to a fundamental evolution in how we approach professional learning in global health. Rather than replicating traditional per diem-driven training models online, the most effective approaches harness the power of networks, enabling health professionals to learn continuously through structured peer interaction.

This perspective helps explain why seemingly low completion rates should not necessarily be viewed as failure. When digital learning is designed to create lasting networks of practice, knowledge emerges through collaborative action. Completion metrics therefore capture only a fraction of the impact.

For health systems facing complex challenges that include climate change, pandemic response, and health workforce shortages, this networked approach to learning offers a promising path forward—one that transforms how knowledge is created, shared, and applied to improve health outcomes globally.

Reference

• Jordan, K., 2015. Massive open online course completion rates revisited: Assessment, length and attrition. IRRODL 16. https://doi.org/10.19173/irrodl.v16i3.2112

Sculpture: The Geneva Learning Foundation Collection © 2025

#climateAndHealth #completionRates #learningMetrics #MOOCs #networkedLearning #onlineEducation #onlineLearning #professionalLearning

Health at COP29: Workforce crisis meets climate crisis

Health workers are already being transformed by climate change. COP29 stakeholders can either support this transformation to strengthen health systems, or risk watching the health workforce collapse under mounting pressures.

The World Health Organization’s “COP29 Special Report on Climate Change and Health: Health is the Argument for Climate Action“ highlights the health sector’s role in climate action.

Health professionals are eyewitnesses and first responders to climate impacts on people and communities firsthand – from escalating respiratory diseases to spreading infections and increasing humanitarian disasters.

The report positions health workers as “trusted members of society” who are “uniquely positioned” to champion climate action.

The context is stark: WHO projects a global shortage of 10 million health workers by 2030, with six million in climate-vulnerable sub-Saharan Africa. Meanwhile, our communities and healthcare systems already bear the costs of climate change through increasing disease burdens and system strain.

Health workers are responding, because they have to. Their daily engagement with climate-affected communities offers insights that can strengthen both health systems and climate response – if we learn to listen.

A “fit-for-purpose” workforce requires rethinking learning and leadership

WHO’s report acknowledges that “scale-up and increased investments are necessary to build a well-distributed, fit-for-purpose workforce that can meet accelerating needs, especially in already vulnerable settings.” The report emphasizes that “governments and partners must prioritize access to decent jobs, resources, and support to deliver high-quality, climate-resilient health services.” This includes ensuring “essential protective equipment, supplies, fair compensation, and safe working conditions such as adequate personnel numbers, skills mix, and supervisory capacity.”

Resources, skills, and supervision are building blocks of every health system.

They are necessary but likely to be insufficient.

Such investments could be maximized through cost-effective, scalable peer learning networks that enable rapid knowledge sharing and solution development – as well as their locally-led implementation.

The WHO report calls for “community-led initiatives that harness local knowledge and practices.”

Our analyses – formed by listening to and learning from thousands of health professionals participating in the Teach to Reach peer learning platform – suggest that the expertise developed by health professionals through daily engagement with communities facing climate impacts is key to problem-solving, to implementing local solutions, and to ensure that communities are part and parcel of such solutions.

Why move beyond seeing health workers as implementers of policies or recipients of training?

We stand to gain much more if their leadership is recognized, nurtured, and supported.

This is a notion of leadership that diverges from convention: if health workers have leadership potential, it is because they are uniquely positioned to turn what they know – because they are there every day – into action.

Peer learning has the potential to significantly accelerate progress toward country and global goals for climate change and health.

By making connections, a health professional expands the horizon of what they are able to know.

At the Geneva Learning Foundation, we have seen that such leadership emerges when health workers are empowered to:

• share and validate their experiential knowledge;
• develop, test, and implement solutions with the communities they serve, using local resources;
• connect with peers facing similar challenges; and
• inform policy based on ground-level realities.

Working with a global community of community-based health workers, we co-developed the Teach to Reach platform, community, and network to listen and learn at scale. Unlike traditional training programs, Teach to Reach creates a peer learning ecosystem where:

• Health workers from over 70 countries connect directly to share experiences.
• Solutions are crowdsourced from those closest to the challenges.
• Knowledge flows horizontally rather than just vertically.
• Local innovations are rapidly shared and adapted across contexts.

For example, in June 2024, over 21,000 health professionals participated in Teach to Reach 10, generating hundreds of real-world stories and insights about climate change impacts on health.

The platform has proven particularly valuable in fragile contexts and resource-limited settings, where traditional capacity building approaches often struggle to reach or engage health workers effectively.

This approach does not replace formal institutions or traditional scientific methods – instead, it creates new pathways for knowledge to flow rapidly between communities, while building the collective capacity needed to respond to accelerating climate impacts on health.

Already, this demonstrates the untapped potential for health workers to contribute to our collective understanding and response.

But we do not stop there.

As we count down to Teach to Reach 11, participants are now sharing how they have actually used and applied this peer knowledge to make progress against their local challenges.

They cannot do it alone.

This is why we ask global partners to join and contribute to this emergent, locally-led leadership for change.

How different is this ‘ask’ from that of global partners asking health workers to contribute to the climate change and health agenda?

WHO’s COP29 report makes a powerful case that “community-led initiatives that harness local knowledge and practices in both climate action and health strategies are fundamental for creating interventions that are both culturally appropriate and effective.”

Furthermore, it recognizes that “these initiatives ensure that climate and health solutions are tailored to the specific needs and realities of those most impacted by climate change but also grounded in their lived realities.”

What framework for collaboration?

The path forward requires what the report describes as “cooperation across sectors, stakeholders and rights-holders – governmental institutions, local authorities, local leaders including religious authorities and traditional medicine practitioners, NGOs, businesses, the health community, Indigenous Peoples as well as local communities.”

Our experience with Teach to Reach demonstrates how such cooperation can be facilitated at scale through digital platforms that enable peer learning and knowledge sharing. Key elements include:

• a structured yet flexible framework for sharing experiences and insights;
• direct connections between health workers at all levels of the system;
• rapid feedback loops between local implementation and broader learning;
• support for health workers to document and share their innovations; and
• mechanisms to validate and spread effective local solutions.

WHO’s recognition that health workers have “a moral, professional and public responsibility to protect and promote health, which includes advocating for climate action, leveraging prevention for climate mitigation and cost savings, and safeguarding healthy environments” sets a clear mandate.

This WHO report highlights the need for new ways of supporting community-led learning and action to:

1. support the rapid sharing of local solutions;
2. build health worker capacity through peer learning;
3. connect communities facing similar challenges; and
4. enable health workers to lead change in their communities

Reference

Neira, M. et al. (2024) COP 29 Special Report on Climate Change and Health: Health is the Argument for Climate Action. Geneva, Switzerland: World Health Organization.

Image: The Geneva Learning Foundation Collection © 2024

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#climateAction #climateAndHealth #COP29 #COP29SpecialReportOnClimateChangeAndHealthHealthIsTheArgumentForClimateAction #healthWorkers #HRH #leadership #localAction #MariaNeira #resilience #WorldHealthOrganization

Health at COP29: Workforce crisis meets climate crisis

Health workers are already being transformed by climate change. COP29 stakeholders can either support this transformation to strengthen health systems, or risk watching the health workforce collapse under mounting pressures.

The World Health Organization’s “COP29 Special Report on Climate Change and Health: Health is the Argument for Climate Action“ highlights the health sector’s role in climate action.

Health professionals are eyewitnesses and first responders to climate impacts on people and communities firsthand – from escalating respiratory diseases to spreading infections and increasing humanitarian disasters.

The report positions health workers as “trusted members of society” who are “uniquely positioned” to champion climate action.

The context is stark: WHO projects a global shortage of 10 million health workers by 2030, with six million in climate-vulnerable sub-Saharan Africa. Meanwhile, our communities and healthcare systems already bear the costs of climate change through increasing disease burdens and system strain.

Health workers are responding, because they have to. Their daily engagement with climate-affected communities offers insights that can strengthen both health systems and climate response – if we learn to listen.

A “fit-for-purpose” workforce requires rethinking learning and leadership

WHO’s report acknowledges that “scale-up and increased investments are necessary to build a well-distributed, fit-for-purpose workforce that can meet accelerating needs, especially in already vulnerable settings.” The report emphasizes that “governments and partners must prioritize access to decent jobs, resources, and support to deliver high-quality, climate-resilient health services.” This includes ensuring “essential protective equipment, supplies, fair compensation, and safe working conditions such as adequate personnel numbers, skills mix, and supervisory capacity.”

Resources, skills, and supervision are building blocks of every health system.

They are necessary but likely to be insufficient.

Such investments could be maximized through cost-effective, scalable peer learning networks that enable rapid knowledge sharing and solution development – as well as their locally-led implementation.

The WHO report calls for “community-led initiatives that harness local knowledge and practices.”

Our analyses – formed by listening to and learning from thousands of health professionals participating in the Teach to Reach peer learning platform – suggest that the expertise developed by health professionals through daily engagement with communities facing climate impacts is key to problem-solving, to implementing local solutions, and to ensure that communities are part and parcel of such solutions.

Why move beyond seeing health workers as implementers of policies or recipients of training?

We stand to gain much more if their leadership is recognized, nurtured, and supported.

This is a notion of leadership that diverges from convention: if health workers have leadership potential, it is because they are uniquely positioned to turn what they know – because they are there every day – into action.

Peer learning has the potential to significantly accelerate progress toward country and global goals for climate change and health.

By making connections, a health professional expands the horizon of what they are able to know.

At the Geneva Learning Foundation, we have seen that such leadership emerges when health workers are empowered to:

• share and validate their experiential knowledge;
• develop, test, and implement solutions with the communities they serve, using local resources;
• connect with peers facing similar challenges; and
• inform policy based on ground-level realities.

Working with a global community of community-based health workers, we co-developed the Teach to Reach platform, community, and network to listen and learn at scale. Unlike traditional training programs, Teach to Reach creates a peer learning ecosystem where:

• Health workers from over 70 countries connect directly to share experiences.
• Solutions are crowdsourced from those closest to the challenges.
• Knowledge flows horizontally rather than just vertically.
• Local innovations are rapidly shared and adapted across contexts.

For example, in June 2024, over 21,000 health professionals participated in Teach to Reach 10, generating hundreds of real-world stories and insights about climate change impacts on health.

The platform has proven particularly valuable in fragile contexts and resource-limited settings, where traditional capacity building approaches often struggle to reach or engage health workers effectively.

This approach does not replace formal institutions or traditional scientific methods – instead, it creates new pathways for knowledge to flow rapidly between communities, while building the collective capacity needed to respond to accelerating climate impacts on health.

Already, this demonstrates the untapped potential for health workers to contribute to our collective understanding and response.

But we do not stop there.

As we count down to Teach to Reach 11, participants are now sharing how they have actually used and applied this peer knowledge to make progress against their local challenges.

They cannot do it alone.

This is why we ask global partners to join and contribute to this emergent, locally-led leadership for change.

How different is this ‘ask’ from that of global partners asking health workers to contribute to the climate change and health agenda?

WHO’s COP29 report makes a powerful case that “community-led initiatives that harness local knowledge and practices in both climate action and health strategies are fundamental for creating interventions that are both culturally appropriate and effective.”

Furthermore, it recognizes that “these initiatives ensure that climate and health solutions are tailored to the specific needs and realities of those most impacted by climate change but also grounded in their lived realities.”

What framework for collaboration?

The path forward requires what the report describes as “cooperation across sectors, stakeholders and rights-holders – governmental institutions, local authorities, local leaders including religious authorities and traditional medicine practitioners, NGOs, businesses, the health community, Indigenous Peoples as well as local communities.”

Our experience with Teach to Reach demonstrates how such cooperation can be facilitated at scale through digital platforms that enable peer learning and knowledge sharing. Key elements include:

• a structured yet flexible framework for sharing experiences and insights;
• direct connections between health workers at all levels of the system;
• rapid feedback loops between local implementation and broader learning;
• support for health workers to document and share their innovations; and
• mechanisms to validate and spread effective local solutions.

WHO’s recognition that health workers have “a moral, professional and public responsibility to protect and promote health, which includes advocating for climate action, leveraging prevention for climate mitigation and cost savings, and safeguarding healthy environments” sets a clear mandate.

This WHO report highlights the need for new ways of supporting community-led learning and action to:

1. support the rapid sharing of local solutions;
2. build health worker capacity through peer learning;
3. connect communities facing similar challenges; and
4. enable health workers to lead change in their communities

Reference

Neira, M. et al. (2024) COP 29 Special Report on Climate Change and Health: Health is the Argument for Climate Action. Geneva, Switzerland: World Health Organization.

Image: The Geneva Learning Foundation Collection © 2024

Share this:

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• Email
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• Facebook
• Twitter
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#climateAction #climateAndHealth #COP29 #COP29SpecialReportOnClimateChangeAndHealthHealthIsTheArgumentForClimateAction #healthWorkers #HRH #leadership #localAction #MariaNeira #resilience #WorldHealthOrganization

Critical evidence gaps in the Lancet Countdown on health and climate change

The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”.

Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing.

The fundamental tension appears right at the start.

The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.”

This framing privileges standardized, quantifiable data over other forms of knowledge.

Yet paradoxically, the report recognizes that “health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.”

This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.

Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.

When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.

Can we afford to wait?

As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?

Explore the value of health workers’ experiential knowledge: Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.

This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”

The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.

The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.

A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”

More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”

However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”

This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.

A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”

This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.

Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.

This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.

Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.

It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.

For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.

The seeds of this transformation are present in the 2024 report.

Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.

References

1. Romanello, M., et al., 2024. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
2. Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
3. Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
4. Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
5. Sadki, R., 2025. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
6. Sadki, R., 2024. Knowing-in-action: Bridging the theory-practice divide in global health. https://doi.org/10.59350/4evj5-vm802
7. Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
8. Sadki, R., 2024. World Health Summit: to rebuild trust in global health, invest in health workers as community leaders. https://doi.org/10.59350/343na-80712
9. Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
10. Sanchez, J.J. et al. (2025) ‘The climate crisis and human health: identifying grand challenges through participatory research’, The Lancet Global Health, p. S2214109X25000038. Available at: https://doi.org/10.1016/S2214-109X(25)00003-8.

Image: The Geneva Learning Foundation Collection © 2024

#climateAndHealth #COP29 #CriticalEvidenceGapsInTheLancetCountdownOnHealthAndClimateChange #epistemology #experientialKnowledge #IndigenousKnowledge #localKnowledge #quantitativeData

Critical evidence gaps in the Lancet Countdown on health and climate change

The 2024 report of the Lancet Countdown on health and climate change “reveals the health threats of climate change have reached record-breaking levels” and provides “the most up-to-date assessment of the links between health and climate change”.

Yet its treatment of experiential knowledge – particularly the direct observations and understanding developed by frontline health workers and communities – reveals both progress and persistent gaps in how major global health assessments value different forms of knowing.

The fundamental tension appears right at the start.

The report notes a significant challenge: “A global scarcity of internationally standardised data hinders the capacity to optimally monitor the observed health impacts of climate change and evaluate the health-protective effect of implemented interventions.”

This framing privileges standardized, quantifiable data over other forms of knowledge.

Yet paradoxically, the report recognizes that “health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.”

This recognition of frontline experience as a valid source of knowledge is significant, even if not fully integrated into the report’s methodology.

Health workers’ experiences are not merely anecdotal but represent a crucial form of evidence gathering and early warning that conventional research methods cannot match.

When a nurse in Bangladesh notices changing patterns of heat-related illness in specific neighborhoods, or when a community health worker in Kenya observes shifts in disease transmission seasons, they are detecting signals that might take epidemiological studies decades to formally document.

Can we afford to wait?

As the report acknowledges that we face “record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate,” why wait for traditional longitudinal studies to validate what health workers are already seeing?

Explore the value of health workers’ experiential knowledge: Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

Their observations, if their significance and value were fully recognized, could provide vital early insights into emerging health threats and guide rapid, life-saving adaptations.

This is especially critical given the report’s call to alarm that climate change impacts are “increasingly claiming lives and livelihoods worldwide” and that “delays in climate change mitigation and adaptation have intensified these impacts.”

The humanitarian imperative to act quickly makes health workers’ experiential knowledge not just valuable but essential – they are the canaries in the coal mine of our climate crisis, and their insights could help bridge critical evidence gaps while more traditional research catches up.

The report’s most thoughtful engagement with alternative forms of knowledge comes in its treatment of Indigenous knowledge systems.

A panel titled “Indigenous knowledge for a healthy future” explicitly acknowledges that “Indigenous peoples maintain deep connections with the natural environment that are important for the social, livelihood, cultural, and spiritual practices that underpin their health and wellbeing.”

More importantly, it recognizes that “Indigenous knowledge has been shown to be the key to protect Indigenous health in times of health emergencies when official health systems and governments are unable to provide assistance to Indigenous communities.”

However, the report also acknowledges that “Indigenous medicine and worldviews are rarely considered within health care or health risk preparedness and response.”

This gap between recognizing the value of Indigenous knowledge and actually incorporating it into health systems and policies reflects a broader challenge.

A crucial observation comes in the report’s data discussion: available data are “rarely disaggregated by relevant groups (eg, gender, age, indigeneity, ethnicity, and socioeconomic level)” and “Indigenous knowledge is often overlooked, and Indigenous populations are seldom taken into consideration in the production and reporting of evidence and data.”

This gap in representation means that crucial experiential knowledge is systematically excluded from our understanding of climate change’s health impacts.

Perhaps most tellingly, while the report calls for “improved data” to evaluate progress on international commitments, it focuses primarily on standardized quantitative metrics rather than developing new frameworks that could better integrate experiential knowledge.

This reveals an underlying epistemological bias – while experiential knowledge is acknowledged as valuable, the report’s methodology remains firmly grounded in traditional scientific approaches.

Looking forward, truly leveraging experiential knowledge in understanding climate change’s health impacts will require more than just acknowledgment.

It will require developing new methodological frameworks that can systematically incorporate and validate different forms of knowing, while ensuring that frontline voices – whether from health workers, Indigenous communities, or other groups with direct experience – are centered rather than marginalized in our understanding of this global crisis.

For the Lancet Countdown to fully live up to its mission of tracking progress on health and climate change, future reports will need to more fundamentally rethink how they recognize, validate, and incorporate experiential knowledge.

The seeds of this transformation are present in the 2024 report.

Doing so is both necessary to improve science and consistent with The Lancet Countdown’s commitment to “operate an open and iterative process of indicator improvement, welcoming proposals for new indicators… from the world’s most vulnerable countries”.

References

1. Romanello, M., et al., 2024. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1
2. Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660
3. Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
4. Sadki, R., 2025. WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action. https://doi.org/10.59350/redasadki.21322
5. Sadki, R., 2025. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries. https://doi.org/10.59350/redasadki.21339
6. Sadki, R., 2024. Knowing-in-action: Bridging the theory-practice divide in global health. https://doi.org/10.59350/4evj5-vm802
7. Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
8. Sadki, R., 2024. World Health Summit: to rebuild trust in global health, invest in health workers as community leaders. https://doi.org/10.59350/343na-80712
9. Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
10. Sanchez, J.J. et al. (2025) ‘The climate crisis and human health: identifying grand challenges through participatory research’, The Lancet Global Health, p. S2214109X25000038. Available at: https://doi.org/10.1016/S2214-109X(25)00003-8.

Image: The Geneva Learning Foundation Collection © 2024

#climateAndHealth #COP29 #CriticalEvidenceGapsInTheLancetCountdownOnHealthAndClimateChange #epistemology #experientialKnowledge #IndigenousKnowledge #localKnowledge #quantitativeData

Strengthening primary health care in a changing climate

A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.

Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.

First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.

This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.

Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.

They must manage both the immediate health impacts and the longer-term consequences of these events.

This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.

The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.

In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”

They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”

The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”

They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.

Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.

This is what they know because they are there every day.

Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.

While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.

The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.

This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.

Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.

It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.

Our research has documented how health workers are already responding to climate-related health challenges.

For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions

Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.

Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.

However, these perspectives need not be mutually exclusive.

TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.

New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.

This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.

Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.

When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.

A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.

Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.

Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.

TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.

This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.

Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.

While formal research and policy development necessarily take time, climate impacts are already affecting communities.

TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.

The model also addresses the issue of trust.

Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.

Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.

By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.

Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.

References

Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7

Image: The Geneva Learning Foundation Collection © 2024

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#AndyHaines #AnyaGopfert #climateAndHealth #ElizabethWambuiKimaniMurage #epistemology #globalHealth #healthWorkforce #HumanResourcesForHealth #PHC #phronesis #primaryHealthCare #situatedKnowledge

Strengthening primary health care in a changing climate

A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.

Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.

First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.

This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.

Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.

They must manage both the immediate health impacts and the longer-term consequences of these events.

This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.

The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.

In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”

They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”

The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”

They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.

Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.

This is what they know because they are there every day.

Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.

While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.

The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.

This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.

Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.

It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.

Our research has documented how health workers are already responding to climate-related health challenges.

For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions

Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.

Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.

However, these perspectives need not be mutually exclusive.

TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.

New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.

This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.

Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.

When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.

A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.

Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.

Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.

TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.

This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.

Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.

While formal research and policy development necessarily take time, climate impacts are already affecting communities.

TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.

The model also addresses the issue of trust.

Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.

Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.

By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.

Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.

References

Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7

Image: The Geneva Learning Foundation Collection © 2024

Share this:

• WhatsApp
• Email
• LinkedIn
• Facebook
• Twitter
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#AndyHaines #AnyaGopfert #climateAndHealth #ElizabethWambuiKimaniMurage #epistemology #globalHealth #healthWorkforce #HumanResourcesForHealth #PHC #phronesis #primaryHealthCare #situatedKnowledge

The Geneva Learning Foundation (TGLF) has created a platform enabling health workers to describe the impacts of climate change on their local communities. Here are ten of the most striking reports.

Published on 30 November 2023 on the Gavi #VaccinesWork blog

In July 2023, more than 1,200 health workers from 68 countries shared their experiences of changes in climate and health at a unique Geneva Learning Foundation event designed to shed light on the realities of climate impacts on the health of the communities they serve.

A special TGLF report – On the frontline of climate change and health: A health worker eyewitness report – includes a compendium and analysis of these 1,200 health workers’ observations and insights. Here are ten of the most striking.

Samuel Chukwuemeka Obasi, who works for the Ministry of Health in Abuja, Nigeria, has noticed big changes to the environment.

“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow, so that you can easily walk through a river you required a boat to cross in years past.”

Iruoma Chinedu Ofortube, who works at the district level in Lagos State, Nigeria, recounts two stories that illustrate the lethal impact of extreme weather.

“A family embarked on a journey without potentially expecting any danger. Sadly, on their way, heavy rainfall started. The family was oblivious to the reality that the rain started ahead of them while they were en route to their destination. Unfortunately, they ran into a massive flood near a river. The force and the current from the flood swept their vehicle down the river, and before help could come for them, they drowned helplessly alongside other victims of the same circumstances.

“There was also a pregnant woman in labour. Unfortunately, they couldn’t get a strong boat or canoe that could stand the high current and waves coming from the seaside. In the process of searching for a better means of taking her to the nearest health centre, she got exhausted and died.”

Assoumane Mahamadou Issifou, who works for an NGO in Agadez, Niger, points out how food shortages are leading to malnutrition and anaemia, particularly in women and children.

“During the five years that I served in the health service in the Agadez region, I observed significant changes, particularly in the occurrence of heavy rains, which were uncommon in the past. These heavy rains have led to flooding and the displacement of populations, often forcing them to settle wherever they can. Due to their vulnerability during these challenging times, children and women suffer greatly.

“This situation, especially prevalent among newborns and children under five, contributes to malnutrition. The challenges persist because the Agadez region is situated in a desert area with very low rainfall.

“However, even with minimal rain, the region faces immense difficulties. Nutritional foods are insufficient, and environmental degradation compounds the issue. As a result, the population struggles to access daily sustenance. Pregnant women and children lack foods rich in vitamins, leading to undernourishment and subsequent diseases such as malnutrition and anaemia.

“Historically, Agadez was known for its scarcity of rain. With the recent climate change-induced increase in rainfall, few people have come to accept and understand this phenomenon. The region’s architecture is outdated, and the city has transformed into a migratory hub where diverse behaviours converge. New diseases emerge, and the indigenous population is grappling with illnesses that were previously unknown to them.”

A woman working for the Ministry of Health in the DRC, based in Kinshasa, describes how water level changes are affecting insect proliferation and leading to changing patterns of malaria and other diseases.

“A drought, characterised by a drop in rainfall during recent rainy seasons, has affected the City Province of Kinshasa, particularly in the Makelele District (located in the Bandalungwa commune) where I live.

“This area is bordered by two rivers, Mâkelele 1 and 2. The scarcity of rain in the region during the past rainy seasons has led to a significant reduction in water flow within these two rivers. Consequently, rubbish and debris have accumulated along the riverbanks.

“This situation has resulted in the proliferation of mosquitoes and other unidentified insects. This increase in insect activity has not only led to a rise in malaria cases, but has also given rise to a newly emerging form of dermatosis, the exact nature of which is yet to be determined. It is suspected that these skin lesions develop due to scratching after insect bites. Disturbingly, over 10% of the population within the municipality has been affected by this condition.”

Dieudonne Tanasngar, who works for the Ministry of Health in Chad, explains how displacement contributes to poor sanitation practices, leading to increased spread of water-borne diseases.

“In Lake Chad, during the rainy season, the various arms of the lake expand, causing flooding that affects the villages situated along its shores. This flooding often forces the inhabitants to relocate to higher ground.

“However, a significant portion of the population around the lake lacks proper sanitation facilities, leading to open defecation near the water’s edge. As the water levels rise, this practice contributes to the spread of diseases, particularly when access to health care facilities becomes challenging.

“Access to health care centres is hindered by the need to cross one or two bodies of water before reaching the nearest facility. This geographical challenge adds to the difficulties faced by the affected population. Consequently, a range of diseases can emerge and afflict the community due to these conditions.

“The combination of poor sanitation practices, flooding, and limited access to health care facilities creates a complex situation that requires concerted efforts to improve living conditions, sanitation infrastructure, and health care access for the people living around Lake Chad.”

Coulibaly Seydou, who works for the Ministry of Health in Boussé District, Burkina Faso, has noted how changing dietary habits, alongside declining mental wellbeing, is leading to an increased risk of non-communicable diseases such as high blood pressure and diabetes.

“For several years, the pattern of rainfall has been becoming increasingly irregular. The duration of the rainy season is progressively getting shorter, interspersed with periods of drought. This unpredictability makes it challenging for farmers to adjust their crop choices according to the rainfall pattern, leading to growing concerns. Discussions about the upcoming rainy season can induce anxiety and worry among rural communities.

“When it comes to the impact of climate change on mental health, we can observe a significant disturbance in the well-being of farmers. Even just a couple of days without rainfall can trigger a sense of sadness among them. Instances of minor depression have been noted among household heads who helplessly witness their crops withering due to inadequate moisture.

“In terms of physical health, there has been an uptick in the prevalence of diseases and conditions that can be attributed to changes in dietary habits. Conditions such as hypertension, diabetes and obesity are on the rise. This can be linked to the shift towards consuming industrially processed foods that are low in nutritional value and high in chemical additives.”

A man working for the Ministry of Health in Beni in the DRC describes the tragic case of a family driven into poverty and unable to afford health care for the children.

“As a result of the disruption in the seasonal shifts, a modest family reliant solely on agriculture experienced the tragic death of their young son within their community.

“The critical factors involved were as follows: their crop yield plummeted to zero due to their inability to manage the erratic changes in the seasons, and malnutrition, likely compounded by other illnesses, afflicted the family. Faced with financial constraints stemming from the complete failure of their agricultural efforts, they resorted to providing home-based care for their family.

“Tragically, their youngest son paid the ultimate price with his life. In summary, the ever-changing climate dynamics have left us disoriented and uncertain about the future.”

Fokzia Elijah, who works for the Ministry of Health in the Province of Batha, Chad, highlights how climate change is having multiple health and social impacts, particularly on pastoralists.

“Batha is the first pastoral province, often experiencing prolonged droughts followed by irregular and sometimes excessive rainfall. These climatic variations lead to challenges in cattle herding, house collapses, and difficulties in sustaining pastoralism, which typically lasts only two to three months.

“Pastoralists often migrate southward with women and children following them. Consequently, malnutrition prevails, affecting over 14% of the population, with women and children being the most vulnerable. Women who remain in the villages demonstrate resilience by engaging in limited market gardening and gathering wild oilseeds to produce sweet syrup for porridge.

“A significant issue is the death of animals between March and June due to inadequate pasture and water. This impacts the most vulnerable, particularly women and children. Batha Province, once renowned for its diverse flora and fauna, has seen the disappearance of most animals except for birds. Hyena attacks have become frequent as they search for food in communities, often targeting domestic pets.”

Linda Raji, who works for an NGO in the Kaida and Waru communities in Nigeria, highlights the implication of enviornmental change for young women – one of a range of gender-specific impacts of climate change.

“Prolonged drought dries up the dirty community stream that serves both livestock and residents. This makes it difficult for community members to access water and much harder for menstrual hygiene management for teenage girls leading to an increase in infections in the unbearable heat.

“Due to the difficulty in managing the monthly menstrual cycle due to limited access to water sanitation hygiene and period poverty, many teenage girls prefer to get pregnant to save them the worry of menstruating monthly for nine months.”

Dr Chinedu Anthony Iwu, who works at a health facility in Orlu Local Government Area in Nigeria, describes how working with communities can build resilience to climate change impacts.

“The changing climate has brought about an increase in the prevalence of vector-borne diseases. Mosquitoes are now breeding and transmitting diseases like malaria more intensely. The community lacked proper health care facilities and resources to effectively combat these diseases, leading to a rise in illness and mortality rates. Mothers’ means of livelihood were usually disrupted due to the time and effort spent in caring for their sick children with a significant impact on household welfare.

“Recognising the urgent need to address these climate-related health challenges, we engaged in community-led initiatives that included comprehensive health awareness campaigns to provide education on sanitation and hygiene practices, and education of residents about preventive measures against vector-borne diseases. By engaging our community health extension workers, we were able to organise regular health check-ups in the communities, focusing on early detection and treatment of illnesses.

“Over time, these collective efforts began to yield positive results. The mothers in the communities witnessed improvements in income as they progressively began to spend less time pursuing children’s health care challenges due to the adoption of preventive measures, thereby becoming more resilient to the changing climate.

This experience highlights the challenges faced by rural communities in Nigeria due to climate change. It demonstrates the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate-health nexus and building resilience in the face of a changing climate.”

Written by Ian Jones for Gavi. Photo credit: Aerial view of a flooded urban residential area of Dera Allah yar city in Jaffarabad District, Baluchistan Province, Pakistan. Credit: Gavi/2022/Asad Zaidi

https://redasadki.me/2023/11/30/ten-eyewitness-reports-from-the-frontline-of-climate-change-and-health/

#climateAndHealth #climateChange #Gavi #immunization #TheGenevaLearningFoundation #VaccinesWork

The Geneva Learning Foundation (TGLF) has created a platform enabling health workers to describe the impacts of climate change on their local communities. Here are ten of the most striking reports.

Published on 30 November 2023 on the Gavi #VaccinesWork blog

In July 2023, more than 1,200 health workers from 68 countries shared their experiences of changes in climate and health at a unique Geneva Learning Foundation event designed to shed light on the realities of climate impacts on the health of the communities they serve.

A special TGLF report – On the frontline of climate change and health: A health worker eyewitness report – includes a compendium and analysis of these 1,200 health workers’ observations and insights. Here are ten of the most striking.

Samuel Chukwuemeka Obasi, who works for the Ministry of Health in Abuja, Nigeria, has noticed big changes to the environment.

“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow, so that you can easily walk through a river you required a boat to cross in years past.”

Iruoma Chinedu Ofortube, who works at the district level in Lagos State, Nigeria, recounts two stories that illustrate the lethal impact of extreme weather.

“A family embarked on a journey without potentially expecting any danger. Sadly, on their way, heavy rainfall started. The family was oblivious to the reality that the rain started ahead of them while they were en route to their destination. Unfortunately, they ran into a massive flood near a river. The force and the current from the flood swept their vehicle down the river, and before help could come for them, they drowned helplessly alongside other victims of the same circumstances.

“There was also a pregnant woman in labour. Unfortunately, they couldn’t get a strong boat or canoe that could stand the high current and waves coming from the seaside. In the process of searching for a better means of taking her to the nearest health centre, she got exhausted and died.”

Assoumane Mahamadou Issifou, who works for an NGO in Agadez, Niger, points out how food shortages are leading to malnutrition and anaemia, particularly in women and children.

“During the five years that I served in the health service in the Agadez region, I observed significant changes, particularly in the occurrence of heavy rains, which were uncommon in the past. These heavy rains have led to flooding and the displacement of populations, often forcing them to settle wherever they can. Due to their vulnerability during these challenging times, children and women suffer greatly.

“This situation, especially prevalent among newborns and children under five, contributes to malnutrition. The challenges persist because the Agadez region is situated in a desert area with very low rainfall.

“However, even with minimal rain, the region faces immense difficulties. Nutritional foods are insufficient, and environmental degradation compounds the issue. As a result, the population struggles to access daily sustenance. Pregnant women and children lack foods rich in vitamins, leading to undernourishment and subsequent diseases such as malnutrition and anaemia.

“Historically, Agadez was known for its scarcity of rain. With the recent climate change-induced increase in rainfall, few people have come to accept and understand this phenomenon. The region’s architecture is outdated, and the city has transformed into a migratory hub where diverse behaviours converge. New diseases emerge, and the indigenous population is grappling with illnesses that were previously unknown to them.”

A woman working for the Ministry of Health in the DRC, based in Kinshasa, describes how water level changes are affecting insect proliferation and leading to changing patterns of malaria and other diseases.

“A drought, characterised by a drop in rainfall during recent rainy seasons, has affected the City Province of Kinshasa, particularly in the Makelele District (located in the Bandalungwa commune) where I live.

“This area is bordered by two rivers, Mâkelele 1 and 2. The scarcity of rain in the region during the past rainy seasons has led to a significant reduction in water flow within these two rivers. Consequently, rubbish and debris have accumulated along the riverbanks.

“This situation has resulted in the proliferation of mosquitoes and other unidentified insects. This increase in insect activity has not only led to a rise in malaria cases, but has also given rise to a newly emerging form of dermatosis, the exact nature of which is yet to be determined. It is suspected that these skin lesions develop due to scratching after insect bites. Disturbingly, over 10% of the population within the municipality has been affected by this condition.”

Dieudonne Tanasngar, who works for the Ministry of Health in Chad, explains how displacement contributes to poor sanitation practices, leading to increased spread of water-borne diseases.

“In Lake Chad, during the rainy season, the various arms of the lake expand, causing flooding that affects the villages situated along its shores. This flooding often forces the inhabitants to relocate to higher ground.

“However, a significant portion of the population around the lake lacks proper sanitation facilities, leading to open defecation near the water’s edge. As the water levels rise, this practice contributes to the spread of diseases, particularly when access to health care facilities becomes challenging.

“Access to health care centres is hindered by the need to cross one or two bodies of water before reaching the nearest facility. This geographical challenge adds to the difficulties faced by the affected population. Consequently, a range of diseases can emerge and afflict the community due to these conditions.

“The combination of poor sanitation practices, flooding, and limited access to health care facilities creates a complex situation that requires concerted efforts to improve living conditions, sanitation infrastructure, and health care access for the people living around Lake Chad.”

Coulibaly Seydou, who works for the Ministry of Health in Boussé District, Burkina Faso, has noted how changing dietary habits, alongside declining mental wellbeing, is leading to an increased risk of non-communicable diseases such as high blood pressure and diabetes.

“For several years, the pattern of rainfall has been becoming increasingly irregular. The duration of the rainy season is progressively getting shorter, interspersed with periods of drought. This unpredictability makes it challenging for farmers to adjust their crop choices according to the rainfall pattern, leading to growing concerns. Discussions about the upcoming rainy season can induce anxiety and worry among rural communities.

“When it comes to the impact of climate change on mental health, we can observe a significant disturbance in the well-being of farmers. Even just a couple of days without rainfall can trigger a sense of sadness among them. Instances of minor depression have been noted among household heads who helplessly witness their crops withering due to inadequate moisture.

“In terms of physical health, there has been an uptick in the prevalence of diseases and conditions that can be attributed to changes in dietary habits. Conditions such as hypertension, diabetes and obesity are on the rise. This can be linked to the shift towards consuming industrially processed foods that are low in nutritional value and high in chemical additives.”

A man working for the Ministry of Health in Beni in the DRC describes the tragic case of a family driven into poverty and unable to afford health care for the children.

“As a result of the disruption in the seasonal shifts, a modest family reliant solely on agriculture experienced the tragic death of their young son within their community.

“The critical factors involved were as follows: their crop yield plummeted to zero due to their inability to manage the erratic changes in the seasons, and malnutrition, likely compounded by other illnesses, afflicted the family. Faced with financial constraints stemming from the complete failure of their agricultural efforts, they resorted to providing home-based care for their family.

“Tragically, their youngest son paid the ultimate price with his life. In summary, the ever-changing climate dynamics have left us disoriented and uncertain about the future.”

Fokzia Elijah, who works for the Ministry of Health in the Province of Batha, Chad, highlights how climate change is having multiple health and social impacts, particularly on pastoralists.

“Batha is the first pastoral province, often experiencing prolonged droughts followed by irregular and sometimes excessive rainfall. These climatic variations lead to challenges in cattle herding, house collapses, and difficulties in sustaining pastoralism, which typically lasts only two to three months.

“Pastoralists often migrate southward with women and children following them. Consequently, malnutrition prevails, affecting over 14% of the population, with women and children being the most vulnerable. Women who remain in the villages demonstrate resilience by engaging in limited market gardening and gathering wild oilseeds to produce sweet syrup for porridge.

“A significant issue is the death of animals between March and June due to inadequate pasture and water. This impacts the most vulnerable, particularly women and children. Batha Province, once renowned for its diverse flora and fauna, has seen the disappearance of most animals except for birds. Hyena attacks have become frequent as they search for food in communities, often targeting domestic pets.”

Linda Raji, who works for an NGO in the Kaida and Waru communities in Nigeria, highlights the implication of enviornmental change for young women – one of a range of gender-specific impacts of climate change.

“Prolonged drought dries up the dirty community stream that serves both livestock and residents. This makes it difficult for community members to access water and much harder for menstrual hygiene management for teenage girls leading to an increase in infections in the unbearable heat.

“Due to the difficulty in managing the monthly menstrual cycle due to limited access to water sanitation hygiene and period poverty, many teenage girls prefer to get pregnant to save them the worry of menstruating monthly for nine months.”

Dr Chinedu Anthony Iwu, who works at a health facility in Orlu Local Government Area in Nigeria, describes how working with communities can build resilience to climate change impacts.

“The changing climate has brought about an increase in the prevalence of vector-borne diseases. Mosquitoes are now breeding and transmitting diseases like malaria more intensely. The community lacked proper health care facilities and resources to effectively combat these diseases, leading to a rise in illness and mortality rates. Mothers’ means of livelihood were usually disrupted due to the time and effort spent in caring for their sick children with a significant impact on household welfare.

“Recognising the urgent need to address these climate-related health challenges, we engaged in community-led initiatives that included comprehensive health awareness campaigns to provide education on sanitation and hygiene practices, and education of residents about preventive measures against vector-borne diseases. By engaging our community health extension workers, we were able to organise regular health check-ups in the communities, focusing on early detection and treatment of illnesses.

“Over time, these collective efforts began to yield positive results. The mothers in the communities witnessed improvements in income as they progressively began to spend less time pursuing children’s health care challenges due to the adoption of preventive measures, thereby becoming more resilient to the changing climate.

This experience highlights the challenges faced by rural communities in Nigeria due to climate change. It demonstrates the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate-health nexus and building resilience in the face of a changing climate.”

Written by Ian Jones for Gavi. Photo credit: Aerial view of a flooded urban residential area of Dera Allah yar city in Jaffarabad District, Baluchistan Province, Pakistan. Credit: Gavi/2022/Asad Zaidi

https://redasadki.me/2023/11/30/ten-eyewitness-reports-from-the-frontline-of-climate-change-and-health/

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