Adaptation in the health sector


Despite increased investment in public health spending and significant advances in health outcomes in recent years, indicators of public health in Madagascar remain low when compared to other countries in the region. Public spending in the health sector increased to 3.2% of GDP in 2006 and health is a key goal of the national poverty reduction and development strategies. Nonetheless, significant challenges remain. More than one third of the population is under-nourished and life expectancy remains low at 57 years. Access to health services is limited, particularly in rural areas where more than 65% of the rural population lives more than 10km from a health care facility. Malaria remains a significant risk to public health, particularly on the east coast. Other diseases affecting the population include schistosomiasis, TB and leprosy. The health of the community is an important element of adaptative capacity and increased resilience of the health sector will be an essential component of the national adaptation response to climate change.

Potential Impacts

Climate change impacts on the health sector are likely to occur as a result of both climate variability and extreme climate events. Impacts are likely to include both direct impacts, caused by primary effects of climate change, and indirect impacts, caused by secondary effects of climate change. Potential impacts include:
• Increased incidence or changes in geographical distribution of vector borne, waterborne or respiratory diseases including malaria, diarrhea, schistosomiasis, and dengue fever. WHO has identified malaria as the disease most likely to be affected by climate change. While research on the exact relationship of the links between climate change and malaria has not been conclusive, there is evidence that changes in temperature and rainfall patterns may lengthen the transmission season and facilitate the introduction of malaria into previously unaffected areas including the highlands of Madagascar where local populations have limited immunity and malaria control programs are weak.

• Injuries, fatalities or loss of assets from cyclones or flooding with coastal and poor populations being the most at risk. Illness or loss of assets can cause major setbacks for poor households and tip near poor households into poverty as these households lack the resources or safety nets to re-establish their livelihoods and recover following major economic or social shocks.

• Illnesses caused by exposure to polluted water following flooding which can facilitate entry of pathogens from human waste, animal waste or landfill sites into the water supply, or resulting from damage to water supply infrastructure.

• Malnutrition linked to food insecurity resulting from crop failure or reduced yields during droughts, flooding or changes in agriculture climatic cycles.

• Mental health diseases resulting from stress caused by loss of assets, injuries, illness, fatalities or climate induced migration.

• Health impacts of climate migration including increase in the incidence of transmissible diseases as migration between populations occurs, and increase in social conflict as access to resources (e.g. water, food, housing) becomes more competitive.

Priority Actions

Climate change adaptation measures will be required to increase the resilience of both the structural components of the health sector (e.g. hospitals and health clinics) and institutional systems, and to protect the health of the population. Examples of adaptation approaches that should be considered for implementation in the health sector in Madagascar include:
Institutional capacity and training of health workers and public to increase understanding of the physical and mental health care risks of climate change.

Increased access to health care for vulnerable populations through development and staffing of new health care facilities or improvements in means of physical access to existing facilities.

Development or expansion of infectious disease control programs to respond to new health risks. For example, increase in access to anti-malarial drugs and mosquito nets n newly affected regions.

Improved disease monitoring and early warning systems to allow early response to disease outbreaks. Contingency plans for disease outbreaks should also be developed.

Climate proofing of health facilities and appropriate planning of new infrastructure to protect existing facilities against flooding or storm damage and to ensure new facilities are not built in high-risk areas.

Improved access to safe water and sanitation through development of new infrastructure or protection of water quality to increase overall resilience of populations to health risks.

Implementation of ecosystem based or structural protective measures to protect coastal communities from extreme climate events.

Improved disaster preparedness, warning and response mechanisms to allow early warning and effective response to natural disasters.

Implementation of adaptation measures to enhance food security for vulnerable populations. Examples include agricultural extension services and training, dissemination drought and salt resistant crops and development of alternative livelihood strategies.

National planning for climate migration to minimize social disruption and conflict and facilitate equitable access to resources and services.