CLIMATE-RESILIENT HEALTH SYSTEMS IN LOW-RESOURCED SETTINGS OF GHANA: AN ASSESSMENT OF POLICY, PRACTICE AND OPPORTUNITIES IN THE UPPER EAST REGION

Abstract

Ghana’s national climate change masterplan 2015-2020 underscores the need to mainstream climate change adaptation into health systems. Ghana’s Ministry of Health mainstreamed climate change and health into its Medium-term Development Plans in 2010-2013 and 2014-2017. The study assessed how Ghana’s climate change agenda has translated into climate action within the Primary Healthcare System (PHC). The study was conducted in the Upper East Region of Ghana. Multi-stage sampling was applied to select the Binduri, Builsa North, and Talensi Districts. In this mixed method study, thematic Analysis was applied to understand how the Community-Based Health Planning and Services (CHPS) policy supports climate action because they comprise 63% of health facilities in Ghana. The study assessed the health system’s resilience to climate change via checklists based on World Health Organisation indicators. The study also assessed the vulnerability and environmental sustainability of healthcare facilities (HCF) in three low resourced Primary Health Care (PHC) settings/Districts between September 2021 to September 2022. The preparedness (risk levels) of PHCs and HCFs were categorized by calculating the average score. Key informant interviews with PHC and HCF managers were held to understand context-specific facilitators and barriers to mainstreaming climate change adaptation and mitigation into PHC operations and thematically analysed. Twenty-seven of 33 District Health Management Team members of PHCs (82%), 65 of 67 PHC facility managers (97%) participated in vulnerability assessments, and 18 managers were interviewed. The CHPS policy minimally mainstreams climate change adaptation and mitigation. Also, PHC systems show incomplete preparation due to a lack of formal plans and budgets for mainstreaming climate change adaptation and mitigation into PHC operations. Between September 2021 and September 2022, 80% of Health Care Facilities (HCFs) observed multiple climate hazards, and 80% of HCFs were found to be unprepared (higher risk) for the impacts of climate hazards. The results suggest that most PHC facilities are at high risk or are unprepared for the negative impacts of climate change. Mainstreaming climate action into PHC policy protocols and standards is an essential facilitator for climate change adaptation and mitigation by PHC, while the cost of mainstreaming is a significant barrier. The study recommends Ghana’s health system policy makers (Ministry of Health) to take steps and build capacity to mainstream Ghana’s national climate agenda into health systems and PHC policies, protocols and standards to enhance sustainable climate action