Stories

Tag: primary health care

  • How the Lancet Countdown illuminates a new path to climate-resilient health systems

    How the Lancet Countdown illuminates a new path to climate-resilient health systems

    The 2025 Lancet Countdown report has begun to acknowledge a critical, often-overlooked source of intelligence to build climate-resilient health systems: the health worker. By including testimonials from health workers alongside formal quantitative evidence, the Lancet cracks open a door, hinting at a world beyond globally standardized datasets. This is a necessary first step. However, the report’s framework for action remains a traditional, top-down model. It primarily frames the health workforce as passive recipients of knowledge—a group that must be “educated and trained” because they are “unprepared”, rather than build on existing evidence that points to health workers as leaders for climate-health resilience.

    The 2025 report confirms that climate change’s assault on human health has reached alarming new levels.

    • Thirteen of 20 indicators tracking health threats are flashing red at record highs.
    • Heat-related mortality, now estimated at 546,000 deaths annually in the 2012-21 period, has climbed 63% since the 1990s.
    • Deaths linked to wildfire smoke pollution hit a new peak in 2024, while fossil fuel combustion overall remained responsible for 2.52 million deaths in 2022 alone.
    • Extreme weather increasingly drives food insecurity.
    • This accelerating health crisis unfolds against a backdrop of faltering political will.
    • The report documents governmental retreats from climate commitments.

    Yet, within this sobering assessment lies a quiet but potentially pivotal shift.

    For the first time, the Countdown’s country profiles integrate direct testimonials from frontline health workers, explicitly acknowledging their “lived experiences as valuable evidence”.

    It is a crucial opening, recognizing that globally standardized data alone cannot capture the full picture or tell the story.

    The Countdown’s inclusion of health worker voices in its country profiles is laudable.

    It hints at bridging what philosopher Donald Schön called the divide between the “high, hard ground” of research-based theory and the “swampy lowlands” of messy, real-world practice.

    Schön argued that the problems of greatest human concern often lie in that swamp, requiring practitioners to rely on experience and intuition – what he termed “knowing-in-action”.

    This promising step creates new possibilities.

    When the reference global report on climate change and health sees the frontline, this illuminates the path to recognize those working there as agents and leaders capable of forging solutions.

    However, the report’s dominant framework still positions the health workforce primarily on the receiving end of knowledge transfer.

    Indicator 2.2.5 meticulously documents gaps in climate and health education, concluding that professionals are left “unprepared”.

    The resulting recommendation?

    Health systems must “[e]ducat[e] and train[…] the health workforce”.

    This framing, while highlighting a genuine need, implicitly casts health workers as passive vessels needing to be filled, rather than as active knowers and problem-solvers.

    This perspective misses an important dimension, one vividly apparent from our direct work at The Geneva Learning Foundation with tens of thousands of health practitioners globally.

    Frontline health workers are already responding – adapting vaccination schedules during heatwaves, managing cholera outbreaks after floods, counseling communities on new health risks – because they must.

    Their daily observations is distinct from “lived experience”, because of their formal health education. 

    The patterns that emerge could form a vital, real-time early warning system, detecting subtle shifts in disease patterns or community vulnerabilities even before formal surveillance systems register them.

    To dismiss this deep experiential knowledge as merely “anecdotal” is to ignore critical intelligence in a rapidly escalating crisis.

    Worse, it reflects an “epistemological injustice” where practical wisdom is systematically devalued.

    Here lies the crucial disconnect.

    The Lancet Countdown rightly presents evidence for “community-led action,” showcasing powerful examples in Panel 6 where farmers or local groups have driven substantial environmental and health gains.

    Yet, it fails to connect this potential explicitly to the health workers embedded within those very communities.

    What does empowering the health workforce truly mean?

    It cannot be limited to providing didactic training, such as webinar lectures about climate science.

    Drawing on our research and practice, it involves concrete actions:

    1. Recognizing health professionals as knowledge creators: Systematically capturing, validating, and integrating their “knowing-in-action” into the evidence base.
    2. Connecting them through peer learning networks: Enabling practitioners facing similar “swampy” problems across diverse contexts to share hyperlocal solutions and build collective intelligence.
    3. Supporting locally-led implementation: Equipping them to design and execute adaptation projects tailored to community needs, often leveraging existing local resources, as demonstrated in TGLF initiatives where the vast majority of participants reported sustaining action without external funding.
    4. Creating feedback loops to policy: Establishing mechanisms for this ground-level knowledge to flow upwards, informing district, national, and even global strategies.

    This approach offers concrete pathways for the academic research community.

    These networks function as distributed, real-world laboratories.

    They generate rich qualitative and quantitative data on context-specific climate impacts, the practicalities of implementing adaptation strategies, barriers encountered, and observed outcomes.

    They offer fertile ground for implementation science, participatory action research, and validating citizen science methodologies at scale.

    Rigorous study of these networks themselves – how knowledge flows, how solutions spread, how collective capacity builds – can advance our understanding of learning and adaptation in complex systems.

    This vision of an empowered, networked health workforce directly supports emerging global policy.

    WHO’s Global Plan of Action on Climate Change and Health, and the Belém Health Action Plan (BHAP) under development for COP30, both stress social participation, capacity building, and the integration of local knowledge.

    Peer learning networks provide a practical, field-tested engine to translate these principles into action, connecting the ambitions of Belém with the realities faced by a nurse in Bangladesh, a community health worker in Kenya, or a community health doctor in India.

    Furthermore, this approach may represent one of the most effective investments available.

    Preliminary analysis by The Geneva Learning Foundation suggests that supporting local action health workers through networked peer learning could yield substantial health gains.

    With a critical mass of one million health workers connected to learn from and support each other, the potential is to save seven million lives, at a cost lower than that of immunization.

    This is not just about doing good.

    It is about smart investment in resilience.

    The 2025 Lancet Countdown acknowledges the view from the ground.

    The challenge now is to fully integrate that perspective into research and policy, by supporting and amplifying existing, community-led local action.

    We must move beyond framing health workers as recipients of knowledge or vulnerable populations needing protection, and recognize their indispensable role as knowledgeable, capable leaders.

    Harnessing their “knowing-in-action” through structured, networked peer support is not merely an alternative approach. 

    It is essential for building the adaptive, equitable, and effective health responses this escalating climate crisis demands.

    The wisdom needed to navigate the swamp often resides within it.

    References

    1. Romanello M, Walawender M, Hsu S-C, et al. The 2025 report of the Lancet Countdown on health and climate change. Lancet 2025; published online Oct 29. https://doi.org/10.1016/S0140-6736(25)01919-1.
    2. Sadki, R., 2025a. 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
    3. Sadki, R., 2025b. 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
    4. Sadki, R., 2024a. Critical evidence gaps in the Lancet Countdown on health and climate change. https://doi.org/10.59350/nv6f2-svp12
    5. Sadki, R., 2024b. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98
    6. Sadki, R., 2024c. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879
    7. Sadki, R., 2024d. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34
    8. Sadki, R., 2024e. Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems. https://stories.learning.foundation/2024/11/26/why-guidelines-fail-on-consequences-of-the-false-dichotomy-between-global-and-local-knowledge-in-health-systems/
    9. Sadki, R., 2024f. Anecdote or lived experience: reimagining knowledge for climate-resilient health systems. https://stories.learning.foundation/2024/11/11/anecdote-or-lived-experience-reimagining-knowledge-for-climate-resilient-health-systems/
    10. Sadki, R., 2024g. Knowing-in-action: Bridging the theory-practice divide in global health. https://stories.learning.foundation/2024/12/14/knowing-in-action-bridging-the-theory-practice-divide-in-global-health/
    11. Sadki, R., 2023a. Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline. https://doi.org/10.59350/3kkfc-9rb27
    12. Sadki, R., 2023b. Climate change is a threat to the health of the communities we serve: health workers speak out at COP28. https://stories.learning.foundation/2023/12/11/climate-and-health-health-workers-trust/
    13. Sanchez, J.J., Gitau, E., Sadki, R., Mbuh, C., Silver, K., Berry, P., Bhutta, Z., Bogard, K., Collman, G., Dey, S., Dinku, T., Dwipayanti, N.M.U., Ebi, K., Felts La Roca Soares, M., Gudoshava, M., Hashizume, M., Lichtveld, M., Lowe, R., Mateen, B., Muchangi, M., Ndiaye, O., Omay, P., Pinheiro dos Santos, W., Ruiz-Carrascal, D., Shumake-Guillemot, J., Stewart-Ibarra, A., Tiwari, S., 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
    14. Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673
    15. The Geneva Learning Foundation, 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

    Image: The Geneva Learning Foundation Collection © 2025

  • Strengthening primary health care in a changing climate

    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