Table 1
Climate Change and National Health Documentation Available Online as of January 2022.
| COUNTRY | NAP ADDRESSES CC AND HEALTH | H-NAP ADDRESSES CC AND HEALTH | NATIONAL ADAPTATION POLICY THAT INCLUDES HEALTH | UNFCCC NATIONAL COMMUNICATION (NC) AND NDC | NATIONAL ADAPTATION STRATEGIES THAT INCLUDE HEALTH | ADAPTATION FINANCING MENTIONED |
|---|---|---|---|---|---|---|
| Botswana | NAP Framework (2020) | - | Draft Climate Change Response Policy (2016) | First NC (2001) Second NC (2013) Third NC (2019) NDC (2016) | National Climate Change Strategy and Action Plan (2018) | - |
| Mozambique | National Adaptation Programme of Action. (2007) | - | IP | Initial NC (2006) NDC (2021) | National Climate Change Adaptation and Mitigation Strategy 2013–2025. (2012) | - |
| Namibia | IP | - | National Climate Change Policy (2011) | First NC (2001) Second NC (2011) Third NC (2015) Fourth NC (2020) NDC (2021) | National Climate Change Strategy and Action Plan 2013–2020 | USD 82 Million needed for health |
| South Africa | National Climate Change Adaptation Strategy (2021) | National Climate Change and Health Adaptation Plan. 2014–2019 | National Climate Change Response Policy (2011) | First NC (2003) Second NC (2011) Third NC (2018) NDC (2021) | National Climate Change Adaptation Strategy (2021) | USD 4 Billion – 380 billion (scenario dependant health not defined) |
| Zimbabwe | NAP Roadmap (2019) | IP | National Climate Policy (2017) | First NC (1998) Second NC (2013) Third NC (2017) NDC (2021) | National Climate Change Response Strategy (2014) | USD 52 million needed for health |
[i] KEY: Climate change (CC); Health Adaptation Plan (H-NAP); National Communication (NC); Nationally Determined Contributions (NDC); Documentation found online (Y); Documentation in Progress (IP); No data found in documents (-).
Table 2
Overview of Included NAPs, Strategies, and Academic Studies that List Climate Change and Health Impacts.
| CLIMATE CHANGE RISK | HEALTH IMPACT | Botswana | Namibia | Mozambique | South Africa | Zimbabwe | ||||||||||
| NAP | Study Ref | National Strategy | NAP | Study Ref | National Strategy | NAP | Study Ref | National Strategy | NAP | Study Ref | National Strategy | NAP | Study Ref | National Strategy | ||
| INCREASE IN TEMPERATURE WHICH CONTRIBUTE TO DROUGHT | FOOD AND WATER SECURITY | Y | [25, 26] | Y | - | [25] | Y | Y | [27, 28] | Y | Y | [29–33] | Y | Y | [25] | Y |
| INCREASE IN PRECIPITATION WHICH CONTRIBUTE TO FLOODING | WATER AND VECTOR-BORNE DISEASES | Y | N | Y | - | N | Y | Y | [27, 28] | Y | Y | N | Y | Y | N | Y |
| INCREASE IN TEMPERATURE | HEAT RELATED DISEASES | N | N | N | - | N | Y | N | N | N | Y | [33, 24] | Y | N | N | N |
| EMISSIONS AND AIR POLLUTION | RESPIRATORY AND CARDIO DISEASE | N | N | N | - | N | N | N | N | N | Y | [33, 34] | Y | N | N | N |
| INCREASE IN PRECIPITATION WHICH CONTRIBUTE TO FLOODING | PHYSICAL INJURY AND DISPLACE-MENT | N | N | N | - | N | N | N | [27] | N | Y | [28] | Y | N | N | N |
| INDIRECT EFFECTS OF EXTREME WEATHER EVENTS | HEIGHTENED MENTAL STRESS AND DISEASE | N | N | N | - | N | N | N | [27] | N | N | [33, 34] | Y | N | N | N |
[i] KEY: Documentation found online (Y), No documentation found online (N), No data available (-).
Table 3
Country-Level Data for Botswana Collated from the Full Data-Extraction Table [20].
| CLIMATE RISK | HEALTH IMPACT | NAP ADDRESSES HEALTH EXPOSURE | H-NAP ADDRESSES HEALTH EXPOSURE | IMPLEMENTATION PLANS AND MONITORING MENTIONED | INTERSECTORAL POLICY AND IMPLEMENTATION |
|---|---|---|---|---|---|
| Botswana is a water scarce country and is already facing the negative impacts of climate change as evidenced by the endemic droughts, heavy rainfall, heat waves, and severe thunderstorms. | Impacts of climate change on health will exacerbate the incidence of malaria, cholera and an increase in malnutrition. The diseases Dengue Fever, Rickettsia, Cholera, Yellow Fever, and Bilharzia may potentially be affected by changes in temperature and water availability, as may be respiratory diseases (such as asthma) and heat stress (NC3) | NAP Framework 2020. Key sectors consulted in national consultation (Health Department not included p 10) Intention to conduct national health impact assessments to provide valuable information on population vulnerability Plan to establish District Climate Change Committees that will link the subnational with the national level (p 13) Botswana’s Ministry of Health and Wellness is currently not implementing projects or programmes on health adaptation to climate change (NC3) | Need for Botswana National Health Adaptation Strategy and Action Plan as adjunct to National Climate Change Strategy to be adopted and implemented as a public health approach to adaptation to climate change (NC3) | 2018 National Climate Change Strategy and Action Plan completed and awaiting approval (emphasizes the use of Indigenous and Traditional Knowledge and practice p 14). Assess the status of health facilities preparedness in handling casualties from climate change events including the ability to collaborate with local community structures and groups to enable protection of the severely injured and disabled by mental disorder Integrated environment and health surveillance Revise Public Health Act and National Health Plan to include climate change The implementation of a voluntary community-based monitoring and response system to identify community members most vulnerable to health impacts from climate change [26] National Monitoring and Evaluation System (NMES): monitor and evaluate National Development Plan 11. | Botswana Climate Change Response Policy draft 2016 Botswana Vision 2036 National Development Plan 11 include climate change threat. National Health Policy 2011 identifies climate change as a real threat to population well-being (no implementation) Revised Rural Development Policy 2002 National Disaster Risk Reduction Policy Community based Natural Resources Management policy 2007 National Conservation Strategy 2019 draft Policies on energy, climate change, waste management, and Integrated Transport Policy |
| Botswana is a water scarce country. The national cattle herd has suffered mortalities of one-third at least four times in the past 70 years because of drought Crop agriculture is a marginal activity but could become more precarious, particularly for subsistence farmers who are reliant on the land (NC3) | Food and water security as a risk to nutrition, sanitation, and hygiene | Establish water sanitation and hygiene committees in the Districts, Sub-districts, and Villages. Guided by the local DHMTs to plan and coordinate key activities related to the prevention and control sanitation/hygiene and water-related diseases (p 146) Develop a set of interventions required to protect nutrition from climate related risks | A number of adaptation strategies to address impacts of climate change on health are focused on agriculture and food security; maternal and child-care and feeding practices; environmental health, water, and sanitation (NC2019) | It is important that a national vulnerability assessment and adaptation process is undertaken in order to identify high risk health districts and locations and vulnerable groups | |
| Impacts of extreme weather events and related increase in water- and vector-borne diseases | The population exposed to malaria is projected to double, and increases in a variety of other climatically linked diseases are possible | For malaria, a variety of vector control techniques are being used and may need to be expanded For diarrhoea, the strategy could include upgrading of drinking water supplies and sanitation, improved drainage and poverty alleviation | Education and awareness around health and climate change The integration of climate change related surveillance and tracking Water quality surveillance – Rolling out water sampling plans to district and villages to trace and detect early contaminants |
Table 4
Country-Level Data for Mozambique Collated from the Full Data-Extraction Table [20].
| CLIMATE | HEALTH | NAP ADDRESSES HEALTH EXPOSURE | H-NAP ADDRESSES HEALTH EXPOSURE | IMPLEMENTATION PLANS AND MONITORING MENTIONED | INTERSECTORAL POLICY AND IMPLEMENTATION |
|---|---|---|---|---|---|
| The country is exposed to a wide range of hazards such as droughts, floods, and tropical cyclones | Direct risks to health posed by Climate change include risks with physical security; the potential exacerbation of the spread of diseases (such as malaria and cholera), and changes in patterns of respiratory and occupational diseases. Health impacts include under nutrition, trauma of displacement, water-borne diseases, and malaria (Arnall). | NAPA. 2007 No direct health specific initiatives included (Early warning; Strengthening agricultural production; impacts on coastal zones; water resources) Criteria used in prioritising NAPA and adaptation actions included Human health as a bullet in the “Poverty reduction and the increase of adaptation capacity”. This document identified that adaptation to climate change required a cross-sectoral approach, with the Ministry for the Coordination of Environmental Affairs responsible for coordinating climate change-related activities | H-NAP study conducted in 2019. This was a WHO assisted assessment of vulnerability and adaptation to climate change of the health sector in Mozambique. Health Sector Climate Change Adaptation Plan and finalization (expected November 2021). | National Climate Change Adaptation and Mitigation Strategy 2013–2025. Health 1 of 8 strategic areas. Includes the establishment of disease surveillance, food and water support programmes and increasing vulnerable people’s adaptive capacity through social protection systems. Mentioned the inclusion of a national level plan to implement the strategy and Local Adaptation Plans to support action at district level. By 2020, 86 local plans have been approved and 21 are under implementation (INDC 2020) | Adapting to Climate Change, GIZ 2012–2020 Mozambique Coastal City Adaptation Project, USAID 2014–2019 Cities and Climate Change–Pilot Program for Climate Resilience of Mozambique, World Bank. 2012–2019 |
| Around a third of the Mozambican population live in coastal zones, with the low-lying human settlements and associated developments, as well as fishing activities, further vulnerable to severe flooding, sea-level rise, and associated stresses. | Changes in the geographic distribution and the prevalence in vector-borne diseases such as malaria Increased prevalence of water-borne diseases during flooding events, including diarrheal disease Less predictable disease transmission owing to the combination of variable rainfall and complex temperature changes (ADB/ACDI) | Developed National Health Observatory dashboard for climate sensitive diseases (Malaria, Dengue, Chikungunya, cholera, and diarrhoea) (WHO) The pilot for integration of climate and epidemiological information and development of early warning system in 4 provinces (Nampula, Sofala, Inhambane, and Maputo) is underway (no date). | Strengthen Reduce exposure to climate change vector disease. Strengthening capacity to prevent and control the spread of disease, including mapping of vector distribution and spatial mobility Establishing surveillance systems and control measures for specific diseases exacerbated by Climate Change | Climate Resilience: Transforming Hydro-Meteorological Services Project for Mozambique, World Bank. 2013–2019 | |
| Food security | Health not specifically mentioned, but nutrition and food production noted | No mention of health intervention, but inclusion of agricultural resilience, agriculture, fisheries, food security and nutrition |
Table 5
Country-Level Data for Namibia Collated from the Full Data-Extraction Table [20].
| CLIMATE | HEALTH | NAP ADDRESSES HEALTH EXPOSURE | H-NAP ADDRESSES HEALTH EXPOSURE | IMPLEMENTATION PLANS AND MONITORING MENTIONED | INTERSECTORAL POLICY AND FINANCING |
|---|---|---|---|---|---|
| Namibia has frequent dry-spells and droughts with sporadic occurrences of flooding in water basins. [Cuvelai drainage, Cubango-Okavango, Zambezi, Kunene, and Orange-Senqu rivers]. About 62% of Namibians live in rural areas and depend heavily on rain-fed agriculture, high number of female-headed households make Namibia even more vulnerable to impacts of climate change (NPCC) | Poor sanitary conditions due to floods in some areas, malnutrition due to reduced crop yields, and livestock productivity will increase illness and child mortality (NPCC) Increased prevalence of vector-borne diseases such as malaria and sleeping sickness, owing to better breeding conditions of mosquitoes and Tsetse flies, increased prevalence of water-borne diseases, such as cholera, increased potential for malnutrition and stunting owing to increased crop failure, increased number of people at risk of heat-stress (ADB) | - | - | The Namibia Vulnerability and Adaptation (V&A) Assessment report. 2008 Nominal mention of health (one paragraph in a p 167 document) National Policy on Climate Change 2011 Mention of heatstroke, respiratory disease, water- and vector-borne diseases amongst others. Health 1 of 19 strategies a) provision of safe water and sanitation facilities for the public (b) Provide medical assistance to the citizens of Namibia affected by climate change-induced diseases as well as malnutrition Mainstream climate change into the formal education system, at all levels Develop regional cooperation in order to deal properly with transboundary issues related to climate change (such as transboundary surface and ground water, transboundary disasters as well as regional climate change models) National Climate Change Strategy and Action Plan 2013–2020 created to implement Policy. (Support from UNDP, Gov of Japan, German Ministry of Econ Dev (GIZ) Development was a two-year process with multiple stakeholders and a focus on grassroots level to raise awareness and garner ideas from our local communities, who are most at risk to the impacts from climate change Health one of 4 priorities: (p 45) Strategic Aim 1: Health sector climate change strategy in place. | National Land Policy National Drought Policy Agriculture Policy SCORE Project (Scaling Up Community Resilience to Climate Variability and Climate Change) (2015–2019): climate-smart agriculture through micro-drip irrigation gardens and conservation agriculture through the enhancement of rain-fed crops. Most of the adaptation projects and programmes in Namibia are in the areas of energy, ecosystems, and agriculture. They focus on capacity-building, knowledge communication, field implementation, and policy formation and integration, with all nationally implemented projects supporting community-based adaptation. Africa Adaptation Programme in Namibia (2010–2012) Harambee Prosperity Plan |
| Increased prevalence of vector-borne diseases such as malaria and sleeping sickness, owing to better breeding conditions of mosquitoes and tsetse flies Increased prevalence of water-borne diseases, such as cholera (ACDI) | - | - | Strategic Aim 2: Strengthen disease prevention and treatment for climate sensitive diseases. Adaptation strategies tailored to regions or communities based upon their risks and vulnerability Measuring and monitoring the effects of climate change on health will be very important. TARGET: By 2020 access to adequate health services specifically addressing climate related diseases increased by 80% (p 46) | 75 million USD for the first three years: On-going improvement of sanitation done in conjunction with sanitation policy and strategy–more than half of the population in all towns have access to sanitation (NCCSAP) | |
| It has been predicted with a high degree of certainty, that Namibia will become hotter throughout the year (NCCSAP) | Increased number of people at risk of heat-stress (ACDI) Increase in temperature will lead to heat-related illness and put to risk the already vulnerable groups such as the old, already sick people (e.g., with HIV/AIDS) and children (NCCSAP) | - | - | Strategic Aim 3: Develop adaptation mechanisms to climate change related health risks and disseminate information for effective preparedness. TARGET: Prevention and treatment measures strengthened, contingency plans developed and in place (p 46) | - |
| Maximum temperatures have been getting hotter over the past 40 years, as observed in the frequency of days exceeding 35°C, suggesting an overall warming (NCCSAP) | Increased potential for malnutrition and stunting owing to increased crop failure | - | - | Strategic Aim 4: Strengthen the existing mechanisms for the vulnerable groups to access basic services and health facilities during climate related emergencies. TARGET: (2014–2017)Put in place contingency plan to all vulnerable groups to access basic services during flood disaster periods b) Develop measures to safeguard vulnerable groups with emphasis on the special needs of women and children from flood and drought | - |
| - | - | - | - | Health impacts from Uranium dust (Erongo region) | - |
Table 6
Country-Level Data for South Africa Collated from the Full Data-Extraction Table [20].
Table 7
Country-Level Data for Zimbabwe Collated from the Full Data-Extraction Table [20].
| CLIMATE | HEALTH | NAP ADDRESSES HEALTH EXPOSURE | H-NAP ADDRESSES HEALTH EXPOSURE | IMPLEMENTATION PLANS AND MONITORING MENTIONED | INTERSECTORAL POLICY AND FINANCING |
|---|---|---|---|---|---|
| The country is witnessing increased intensity of severe weather events, particularly droughts, prolonged intra-sessional dry spells, extreme storms associated with widespread hail and flash flooding, increasing incidences of heatwaves, and related health challenges These have disrupted the agricultural economy, hydroelectricity production, human settlements while also affecting critical communications and social infrastructure (NAP 2019) The economy of Zimbabwe is agro-based contributing about 15% each year to the GDP (NC3). | Highest mortality rates: HIV, TB, malaria, diarrhoea, child mortality and maternal health The major health issues in Zimbabwe relate to: Nutrition, water, sanitation and hygiene, health care services and facilities ante-natal and post-natal care. The country has a robust health information and surveillance report system. | NAP Roadmap, 2019 (Mentions National Strategy where health is one of 12 priorities) Climate Change Working Group: NAP working groups (3 pilot project areas) INC: Human health, vector-borne disease particularly malaria (will require investments in education and prevention techniques such as netting, repellents, and low-cost anti-malarial drugs.) Development of health care (NC3) | H-NAP exists but needs major revision for endorsement and implementation (WHO) | National Climate Policy 2017 1–6 adaptation areas Strengthen surveillance programmes for monitoring human health under a changing climate, particularly operational knowledge on climate-disease relationships Understand the impacts of climate change on women, children, youth, and people living with disabilities in Zimbabwe Undertake appropriate measures to fully realise the children’s rights to health in light of climate change Inclusion of Gender, Social Inclusion, and Climate Change National Climate Change Response Strategy 2014 Health one of 12 strategic areas Climate change education and training | Constrained by its limited ability to put in place appropriate measures to respond to climate change requirements because of lack of human, institutional, and financial resources GCF Readiness project, 2018. Climate-Smart Agricultural Investment Plan (CASAIP) The Response Policy has action plans and strategies which will require close to US 10 billion for implementation in the next 5 years, with 50% of the budget going toward water and agriculture related strategies National Gender response Plan (Health budget estimated 52 million USD) |
| The country relies on surface water resources for 90% of its requirements. In the urban areas, as much as 40% of water is lost during treatment and distribution | Increased prevalence of water-borne diseases, such as cholera, typhoid, and bilharzia, owing to intensified flooding (ACDI) | Develop and promote resilient water resources management Build resilience against diseases that occur because of impacts of climate change | |||
| - | Changes in the geographic distribution of vector-borne diseases such as malaria, owing to changes in temperatures and precipitation (ACDI) | - | - | Enhance early warning and climate-related disaster risk reduction systems (including information management systems) a) Strengthen surveillance programmes for monitoring human health under a changing climate | Roll Back Malaria Campaign (WHO) |
| 69% of the population are rural and reliant on smallholder subsistence farming and livestock. With a heavy reliance on rainfed agriculture and natural resources | The common nutritional deficiencies conditions were kwashiorkor, severe acute malnutrition, and pellagra | - | - | Develop, implement, and scale-up climate smart agriculture solutions and strengthen the resilience of agricultural value chains and markets | Food and Nutrition Security policy (2013) Considers risk reduction from climate change impacts. Now supported by the National Nutrition Strategy (2015) |