Attachments
EXECUTIVE SUMMARY
Malawi faces significant climate-related challenges that directly and indirectly impact health. Coupled with human-made health stressors, climate change can exacerbate the existing health burdens while creating new health risks. Changes in the temperature and precipitation patterns affect the geographic range and burden of a variety of climate-sensitive health risks while impacting the functioning and capacity of Malawi’s health system. Climate change-related challenges that increase Malawi’s vulnerability to poor health outcomes include a wide range of climate hazards, such as extreme temperature and humidity conditions, potential changes to precipitation patterns, extreme precipitation events, seasonal aridity, droughts, and cyclones. The country is affected by these climate hazards due to its geographical position; a strong dependency on rainfed agriculture, which is susceptible to regular climatic shocks; ongoing population growth; chronic and widespread malnutrition; as well as the high prevalence rates of HIV/AIDS.
Considering Malawi’s high exposure and vulnerability to climate change, the World Bank, through the Health Climate and Environment Program (HCEP), is conducting a Climate and Health Vulnerability Assessment (CHVA). The objective of this CHVA is to assist decision-makers with planning effective adaptation measures to address climate-related health risks. This is first done by capturing the characteristics of the climatology of Malawi, with a focus on the observed and future health-related climate exposures. Further, climate-related health risks are examined by considering the projected climate variability, including identifying the vulnerable populations most at risk. Finally, the adaptive capacity of the health system to manage the current and future climate-related health risks is assessed to inform a series of recommendations that are aimed at reducing climate-related health vulnerability in Malawi. Where available, these measures are also provided at the subnational level to assist regional health planners. The recommendations of this CHVA are primarily aimed at the health sector, as well as the related sectors with influence on climate change-related health risks, such as disaster risk management (DRM).
The observed and projected climatology data, obtained from the Climate Change Knowledge Portal (CCKP) and climate hazards to inform this discussion of climate-related health risks, highlights the following:
→ The mean annual temperatures in Malawi have risen by 0.64°C over the past half century, occurring alongside increases in the minimum (0.60°C) and maximum (0.68°C) temperatures. The maximum temperature is highest during October and November, with people in the Southern Region experiencing the greatest risk of extreme heat.
→ The median average precipitation ranges from 1000 millimeters (mm) in the rainy season to 140 mm during the dry season; it has declined by 100 mm since the 1960s. The Northern Region has experienced the largest declines in annual precipitation, followed by the Southern Region.
→ Floods are among the most significant and recurring climate-related hazards in Malawi, especially for the low-lying areas along the Lake Malawi lakeshore in the Central and Southern Regions. Extreme precipitation is projected to increase for the 2030s and 2050s, exacerbating flooding risks during the rainy season, especially in the Southern Region.
→ Droughts are common in Malawi, and the projected decline in precipitation will likely increase their frequency and intensity.
Malawi faces significant health challenges from communicable diseases (CDs) and noncommunicable diseases (NCDs); climate change will worsen the severity of these health challenges. It is also important to point out that climate-related health risks are not evenly distributed within the population: some groups are at greater risk than others. This will be reflected in Malawi’s CHVA that assesses seven climate-related health risk categories: (a) nutrition risks, (b) vector-borne disease (VBD) risks, (c) waterborne disease (WBD) risks, (d) heat-related morbidity and mortality risks, (e) air quality health risks, (f) direct injuries and mortality risks, along with (g) mental health and well-being risks.
Nutrition risks: In a country that primarily practices rainfed agriculture, projected warmer temperatures and water deficits, along with the increasing frequency and intensity of climate-related hazards, are very likely to aggravate food insecurity and nutritional deficiencies, though with significant geographical variations.
Vector-borne disease (VBD) risks: Malaria is endemic in Malawi; its transmission is seasonal throughout the country, peaking during or just after the conclusion of the rainy season. The malaria transmission risk in the Southern Region will likely decline in the 2050s due to ongoing climate change, while the transmission throughout the remainder of the country is expected to remain stable.
Waterborne disease (WBD) risks: The burden of WBDs throughout Malawi is significant, characterized by high rates of morbidity and mortality across the country, especially among children under five years of age. The projected increases in the intensity of precipitation in Malawi will likely increase the occurrences of floods and droughts, with implications on the frequency of WBD outbreaks.
Heat-related morbidity and mortality risks: Health effects caused by heat include the direct effect of heat stress, heat rash, cramps, exhaustion, and dehydration, as well as the acute exacerbation of pre-existing conditions. Extreme heat and its impact on excess heat-related morbidity and mortality is very likely to increase under the high- and low-emissions scenarios in Malawi. Air quality health risks: The high levels of pollution from harmful airborne particulates have led to increased incidences of illness and deaths stemming from chronic lung diseases and acute respiratory infections among the population.
Direct injuries and mortality risks: Mortalities and direct injuries, associated with heavy rains-induced flash floods, mudslides, and landslides, are becoming a serious threat to life and human health in Malawi. The Central and Southern Regions, particularly the districts of Chikwawa, Phalombe, Nsanje, and Zombe, are more susceptible to flooding than other parts of the country.
Mental health & well-being risks: Impacts of extreme weather events, such as droughts, floods and cyclones on agriculture and other sources of livelihoods affect mental health and well-being of Malawians. Rural farming communities are more vulnerable to mental health impacts triggered by climate change-related hazards due to their dependence on agriculture and the environment for sustenance. The extent to which the health system in Malawi is prepared for the changes in hazards, exposures, and susceptibility, and its capacity for managing them will determine its resilience in the coming decades.
In this CHVA, Malawi’s adaptive capacity to prevent and manage climate-related health risks is examined according to the six health system building blocks143.
→ The Government of the Republic of Malawi recognizes climate change and its impacts on the country’s development. It ratified the Paris Agreement in 2015. Furthermore, the government has developed several policy frameworks that aim to reduce the country’s vulnerability to climate change-related impacts, including human health outcomes.
→ Malawi’s health sector is heavily donor-dependent and the government’s low public financing on health has worsened healthcare access and widened health inequality gaps. Although health has been incorporated into national policies, gaps remain at the subnational level, and there is no precise strategic planning for climate-health finance, nor are there any resource allocations for climate-related health risks and vulnerabilities.
→ Malawi faces numerous health workforce challenges that are likely to be exacerbated by climate change. There are significant staffing gaps in the number of skilled health workers, which is further affected by their geographical distribution throughout the country; the health workforce is relatively limited in the rural areas. Climate health impacts will likely exacerbate these inequalities.
→ Health information systems (HIS) are incorporated as a key pillar into the government’s Health Sector Strategic Planning II (HSSP II). The information, monitoring, and surveillance systems in Malawi are identified as an area to be strengthened.
→ Malawi has historically experienced regular shortages of essential medical products. Furthermore, weak quality assurance and accreditation, coupled with inadequate biosafety and biosecurity mechanisms, significantly affect the availability of laboratory and imaging services throughout the country.
→ Inequalities in the accessibility of healthcare persist due to poor transport and a lack of ambulances for emergencies, which will likely be exacerbated by climate hazards. The country has a weak health infrastructure that is unable to withstand climate change shocks, which will affect healthcare service delivery.
Recommendations to reduce climate-related health risks could include the following activities:
→ Enhance the coordination mechanisms for climate action and articulate climate action in subnational plans. The progress on climate change commitments and objectives in development plans should be monitored and should address the rural-urban disparities in climate-health risks. Specific strategic planning should also account for subnational differences.
→ Articulate climate-health actions in subnational plans.
→ Create and promote health workforce retention packages, including risk reduction and emergency protocols, to ensure that there are sufficient skilled health workers for the areas at the highest risk of climate-related hazards.
→ Scale up the formal training that was developed by Malawi’s Health and Climate Change Core Team (HCCT) on climate and health and incorporate it into the medical and paramedical as well as the refresher courses for continued learning and on-the-job training opportunities.
→ Strengthen communication networks between the Department of Climate Change and Meteorological Services (DoCCMS) and the communities at risk of extreme weather events.
→ Support community-led efforts to improve sanitation practices and controls to prevent WBDs and foodborne illnesses and diseases, including the generation of educational materials and public communication. Focus should be placed in particular on rural communities and temporary disaster shelters.
→ Engage medical colleges and the Ministry of Education (MoE) to integrate with district-level community groups in developing and implementing health promotion programs that are focused on climate-related health risks.
→ Ensure that strategic purchasing is guided by detailed, subnational climate information on population needs and supported by a provider mechanism that incentivizes providers.