This article was co-authored by Africa Health Business and Nigeria Health Watch as part of our advocacy efforts to raise awareness and drive action on Universal Health Coverage.
“Not only are we more at risk of climate disaster and harm, but we also have less adaptive capacity and preparedness to respond to these threats, making us highly vulnerable. The stakes could not be higher, and the way out of this crisis is to prioritise Universal Health Coverage.”
— Desta Lakew, Group Director of Partnerships and External Affairs, Amref Health Africa, speaking at the 2024 Nigeria Health Watch, Future of Health Conference, Climate-Health Conference
As the climate crisis escalates into a record-breaking global public health emergency, African countries like Nigeria and Kenya are reimagining their health systems for a warming world. Nigeria, the continent’s most populous nation, recently launched its Health National Adaptation Plan (HNAP), while Kenya unveiled its National Climate Change and Health Strategy, both reflecting the kind of country-led action envisioned by the World Health Organization (WHO) in the Global Action Plan on Climate Change and Health launched at the 78th World Health Assembly.
But turning these bold commitments into real-world impact will require unlocking sustainable financing and forging strong, multisectoral partnerships, offering lessons for the continent and the world.
According to the latest State of the Climate in Africa Report by the World Meteorological Organisation (WMO), 2024 was the warmest year on record, marking a decade of unprecedented heat. The continent is now grappling with a pattern of extreme weather events, marine heatwaves, flooding, and prolonged droughts, that is burdening already fragile health systems and threatening hard-won progress toward Universal Health Coverage (UHC). In this context, the call for climate-resilient health systems is no longer aspirational, it is essential.
Increasing evidence on the intersection between climate and health highlighted the need to align climate and health agendas. Dr. Olumide Okunola, Senior Health Specialist at The World Bank, reinforced this point during a World Bank session at the 2024 Future of Health Conference hosted by Nigeria Health Watch.
“Addressing climate change in health is not just about policy — it’s about developing concrete interventions that strengthen health systems while recognising how climate change magnifies existing vulnerabilities,” he said.
Climate policy and financing landscape in Nigeria and Kenya
In Nigeria, climate considerations are recognised as part of a broader shift in the Health Sector Renewal and Investment Initiative (NHSRII), President Tinubu’s bold health reform agenda as well as Nigeria’s Nationally Determined Contributions (NDCs), the country’s formal commitment under the Paris Agreement to reduce emissions and build resilience across sectors.
Grounded on evidence from Nigeria’s Climate and Health Vulnerability and Adaptation Assessment, the recently launched HNAP, backed by a $570 million investment through the World Bank’s HOPE‑PHC programme is regarded as “the first real opportunity to operationalise climate adaptation across the health system.”
The plan uses performance-based Disbursement‐Linked Indicators (DLIs) to reward achievement of measurable milestones in climate change adaptation, including developing and implementing context-specific climate-health plans, retrofitting health facilities, and advancing emergency preparedness.
According to Dr. Okunola, the DLIs provide a $1 million incentive once the HNAP moves from design to adoption by the National Council on Health, Nigeria’s highest policy-making and advisory body on health matters. To ensure nationwide ownership and implementation, states receive $500,000 in performance-based funding by localising the HNAP into tailored, costed plans. Dr. Okunola described these incentives as only the beginning of a journey towards integrating climate resilience in health.
In contrast, Kenya has long embedded climate-health objectives within national strategies like the National Climate Change Response Strategy and Kenya Health Policy (2014–2030). Devolved governance in counties like Makueni and Nairobi has fostered local innovation in resilience planning, community engagement, and early warning, while Kenya’s ambition to co-develop a net-zero healthcare system by 2030, part of its commitments at COP26, is reinforced by the country’s Climate Change and Health Strategic Working Group setup in 2017.
We need to be clear about what climate resilience in health really means. At a side event titled “Foundations for Sustainable Health: A Blueprint for Epidemic-Ready Primary Health Care” hosted by Resolve to Save Lives and Jacobs, during the 78th World Health Assembly, Dr Tom Frieden, CEO of Resolve to Save Lives put it plainly “we can build primary health care systems that are prepared, equitable and resilient.” He noted that embedding resilience into health infrastructure planning should not be an afterthought, but a foundation. “Infrastructure isn’t just about concrete…” he said. The design of health facilities must reflect community needs and values of the people they serve and be both durable and adaptable to “evolving health needs.”
Key challenges and opportunities
During his keynote address at the 2024 Future of Health Conference, Professor Muhammad Ali Pate, Nigeria’s Honourable Minister of Health and Social Welfare, said there is an urgent need for financing that matches Africa’s vulnerability.
Indeed, Africa is home to nine of the ten countries most vulnerable to climate change, yet receives only about 2% of global climate finance, despite contributing the least greenhouse gas emissions. African countries secured only $30 billion in climate finance between 2021 and 2022, representing a mere 11% of the estimated $277 billion needed annually to implement their NDCs between 2020 and 2030, undermining efforts to move from well-intentioned plans to sustainable, aligned, scalable interventions.
While Nigeria and Kenya rank among the top climate-finance recipients in the region, their domestic allocations have shrunk: Nigeria’s funds dropped from US $1.6 billion to US $1 billion, and Kenya has funded only a third of its US $62 billion climate plan, with adaptation receiving merely 12%. This shortfall is further compounded by the foreign aid decline, worsened by recent geopolitical shifts including the U.S. withdrawal from the Paris Agreement under President Trump. The long-promised $100 billion per year in global climate financing also remains unfulfilled, undermining confidence and stalling progress where it is most urgently needed.
Moreover, financing is only one piece of the puzzle. Limited institutional capacity remains a pressing challenge. As reinforced by Dr. Tamer Rabie, World Bank’s Global Programme Lead for Climate and Health at Future of Health Conference. He emphasised that meaningful climate-health action must be underpinned by investments in capacity at all levels. “This is all about bringing technical assistance to develop capacity at the policy-making level to drive climate and health action, while ensuring there’s a human resource for health capacity plan that we can finance,” he said.
Dr Rabie also highlighted the importance of structured peer learning and knowledge exchange, underscoring how lessons from countries like Nigeria can, and should, inform global efforts through the Joint Learning Network and Climate-Smart Health System Collaborative.
Despite these challenges, significant opportunities are emerging, such as the collaborative momentum from development banks through the Joint Roadmap for Climate‑Health Finance and Action. This unified strategy aligned with country priorities and health reform agendas provides a mechanism to strengthen technical capacity across all levels, streamline data integration, and sustain long-term investment.
Reimagining resilient health systems for a changing climate
Now imagine it’s 2050, Nigeria and Kenya have transformed their health systems, fully aligned with WHO’s climate-health strategy, both at the national and sub-national level, fully anticipating and adapting to climate shocks, while delivering uninterrupted, equitable healthcare. Health facilities run on renewable energy, frontline workers use climate-informed protocols, and early-warning systems trigger timely, coordinated responses. Data flows seamlessly across sectors, and national plans fully reflect climate risks. Most importantly, as Minister Pate noted, these systems are community-driven protecting the most vulnerable while advancing health equity and resilience. This future is possible, however, to achieve our ambitions for UHC, today’s decisions must be bold, integrated, and most importantly urgent.