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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Paul Belcher FRCP MFPH Hon 🇪🇺🇬🇧
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Reda Sadki