Integrating Climate Change Into the Management of Priority Health Risks in Ghana

Project details

Climate change, including climate variability, has multiple influences on human health.  Both direct and indirect impacts are expected. These include alterations in the geographic range and intensity of transmission of vector-, tick-, and rodent-borne diseases and food- and waterborne diseases, and changes in the prevalence of diseases associated with air pollutants and aeroallergens.  Climate change could alter or disrupt natural systems, making it possible for diseases to spread or emerge in areas where they had been limited or had not existed, or for diseases to disappear by making areas less hospitable to the vector or the pathogen. The World Health Organization (WHO) estimates that climate change may already be causing over 150,000 deaths globally per year.  While direct and immediate impacts such as deaths in heat waves and floods can often be dramatic and provoke immediate policy-responses, the most important long-term influences will likely act through changes in natural ecosystems and their impacts on disease vectors, waterborne pathogens, and contaminants.  Reviewing these concerns overall, climate change has recently been identified as “the biggest global health threat of the 21st Century”. Moreover, Africa already experiences an extremely high burden of climate-sensitive diseases, including 90% of the global burden of malaria, and the highest per capita burden of malnutrition and diarrhea.

Given the significance of health-related climate change impacts, and the combination of Ghana’s vulnerability to climate change and the existing disease burden, Ghana has sought SCCF funding for the development of a Full-Size Project (FSP) to implement climate change adaptation priorities in Ghana, in order to secure the health-related Millennium Development Goals (MDGs) under changing climatic conditions. The PIF was endorsed by the GEF Operational focal Point in Ghana and approved by the GEF board in the second half of 2009. The current proposal follows GEF and SCCF guidelines to provide the additional information to be submitted to the GEF Board for approval in May 2010.

Ghana experiences a number of environmental problems that impact on the achievement of development goals, and there are indications that the country is being affected by an increasing incidence of climate-related natural disasters. The precursor study to Ghana’s Country Environmental Profile showed that the basis for Ghana’s economic growth is being achieved only at high cost to the environment, conservatively estimated at around 6% of GDP, or around $500 million annually. This estimate excludes the health and environmental costs arising from industrial and artisanal mining, inadequate urban sanitation and waste, and indoor and outdoor air pollution. It also does not include costs arising from social conflicts over access to increasingly scarce resources. Nor do these costs include the predicted impacts on these and other variables of the climate change impacts described below.

Recent examples of increasing natural disasters include the 2007 floods, which struck the three Northern regions and parts of the Western region. The major incidence of disasters in Ghana is from floods, epidemics, fire, pests and diseases and conflicts. As there is a very high reliance on rainfed agriculture for food security in Ghana, drought is a top natural disaster risk. In recent times these disasters have caused major disruptions in the economic and social development of the country, due to the inability to cope effectively with natural hazards. The main sources of vulnerability include poverty and development pressures (including rising population pressures and unplanned urbanization). Other factors include fragile and degraded environments, epidemic diseases (especially malaria and HIV/AIDS), and governance issues.  These factors can interact with climate change to exacerbate current disease burdens.

As noted in the 2006-2010 United Nations Development Assistance Framework (UNDAF), health care in Ghana remains poor with a national average of just over 50% with access to health care. The proportion of people with access to health care is far lower in the three northern regions and some of the coastal areas. The health burden in Ghana falls significantly on children under five years of age: while this age group comprises approximately 20% of the population, among this group constitutes over 50% of all recorded deaths. Neonatal mortality (death occurring among infants aged less than 28 days) is particularly significant as it contributes over 50% of all infant deaths. Under-five mortality rates are three times as high in the northern regions (at 177 per 1000) than in the Greater Accra Area.  By comparison, the mortality rate for under age five in Japan is 4 per 1000.

Like other countries in the early phases of health transition, the pattern of disease in Ghana demonstrates a preponderance of communicable diseases, under-nutrition, and poor reproductive health. Epidemics of cerebrospinal meningitis (CSM), yellow fever and diarrheal disease remain a significant threat while the effort to eradicate guinea worm is yet to be fully realized. Emerging and re-emerging diseases of increasing magnitude and threat include the HIV/AIDS menace, tuberculosis, buruli ulcer and filariasis. Malaria has been identified as one of the leading causes of death in Ghana, with diarrheal disease a major cause of childhood mortality and morbidity. Taken together, malaria, guinea worm infestation, diarrheal disease, and meningitis account for about 50% of the country’s total disease burden.  Malaria is still the leading cause of outpatient morbidity in all ages and sex groups, and the cause of 20% of all deaths in children under five. The disease is responsible for a substantial number of miscarriages among pregnant women and low birth weight babies. Malaria accounts for 13.8% of outpatient department (OPD) attendance among pregnant women, 10.6% of admissions and 9.4% of deaths.

Source: UNDP Ghana Project Document (August 12, 2010)

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Key results & output

• Outcome 1: Improved national and local health technical sector capacity to plan for and manage climate change related alterations in the geographic range and/or incidence of climate-sensitive health outcomes, including malaria, diarrheal diseases and meningococcal meningitis
  • Output 1.1: A national climate change and health inter-ministerial committee is established that includes key representatives from relevant programmes in the Ministry of Health, Ghana Health Service, WHO country office, Ministry of Environment Science and Technology, the National Climate Change Committee, the National Development and Planning Commission, and others
  • Output 1.2: Regional and district coordinating mechanisms strengthened for enhanced management of climate change-related health risks
  • Output 1.3: Training materials developed and delivered for health workers at the national, regional, district and sub-district levels to identify and respond to the current and likely future health risks of climate change on relevant diseases, including the differential impact on women and children
  • Output 1.4: Sub-national level climate change health risk maps developed that depict current and likely future areas vulnerable to diarrheal disease, malaria, and CSM.
• Outcome 2: Mechanisms established for cross-sectoral coordination to support climate change-resilient health policy formulation and implementation at national and local policy-making levels.
  • Output 2.1: A strategy for mainstreaming climate change risks into health sector policies and measures is developed and implemented in collaboration with the Ministry of Health, Ghana Health Services, the Environmental Protection Agency and development partners in the Health and environment sector.
  • Output 2.2: Health Sector Medium Term Development Plan specifies gender-sensitive actions to address the health risks of climate change, and mechanisms for implementation.
  • Output 2.3: A gender-sensitive climate risk-screening tool for the heath sector is developed
  • Output 2.4: Methods and Indicators are identified to measure climate change resilience in the health sector.
  • Output 2.5: Disease surveillance systems are strengthened to better avoid, prepare for, and effectively respond to climate change-related health risks, to ensure coherent responses to emergencies and changing disease patterns; using CSM, diarrheal disease, and malaria as entry points.
• Outcome 3: 'Lessons learned' collected and knowledge management components established
  • Output 3.1: Data on climate change-related risks from surveillance systems integrated into health information management systems to facilitate regular evaluation of the distribution and patterns of climate sensitive health outcomes.
  • Output 3.2: Based on pilot studies, sub-national climate risk maps updated and disseminated.
  • Output 3.3: Best practices and lessons learned are recorded and disseminated, and the information is incorporated into national and local climate change and health action plans
  • Output 3.4: Gender-sensitive information, education, and communication materials are created and disseminated to health and other stakeholders at different levels.

Source: UNDP Ghana Project Document (August 12, 2010)

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Monitoring & evaluation

Project Start:

Project Inception Workshop: will be held within the first 2 months of project start with those with assigned roles in the project organization structure, UNDP country office and where appropriate/feasible regional technical policy and programme advisors as well as other stakeholders.  The Inception Workshop is crucial to building ownership for the project results and to plan the first year annual work plan. 

Daily:

Day to day monitoring of implementation progress: will be the responsibility of the Project Manager, based on the project's Annual Work Plan and its indicators, with overall guidance from the Project Director. The Project Team will inform the UNDP-CO of any delays or difficulties faced during implementation so that the appropriate support or corrective measures can be adopted in a timely and remedial fashion.

Quarterly:

Project Progress Reports (PPR): quarterly reports will be assembled based on the information recorded and monitored in the UNDP Enhanced Results Based Management Platform. Risk analysis will be logged and regularly updated in ATLAS.

Annually:

Annual Project Review/Project Implementation Reports (APR/PIR): This key report is prepared to monitor progress made since project start and in particular for the previous reporting period (30 June to 1 July).  The APR/PIR combines both UNDP and GEF reporting requirements.  

Periodic Monitoring through Site Visits: 

UNDP CO and the UNDP RCU will conduct visits to project sites based on the agreed schedule in the project's Inception Report/Annual Work Plan to assess first hand project progress.  Other members of the Project Board may also join these visits.  A Field Visit Report/BTOR will be prepared by the CO and UNDP RCU and will be circulated no less than one month after the visit to the project team and Project Board members.

Mid-Term of Project Cycle:

Mid-Term Evaluation: will determine progress being made toward the achievement of outcomes and will identify course correction if needed.  It will focus on the effectiveness, efficiency and timeliness of project implementation; will highlight issues requiring decisions and actions; and will present initial lessons learned about project design, implementation and management.  Findings of this review will be incorporated as recommendations for enhanced implementation during the final half of the project's term.  

End of Project:  

Final Evaluation: will take place three months prior to the final Project Board meeting and will be undertaken in accordance with UNDP and GEF guidance.  The final evaluation will focus on the delivery of the project’s results as initially planned (and as corrected after the mid-term evaluation, if any such correction took place).  The final evaluation will look at impact and sustainability of results, including the contribution to capacity development and the achievement of global environmental benefits/goals.  The Terminal Evaluation should also provide recommendations for follow-up activities.

Project Terminal Report: This comprehensive report will summarize the results achieved (objectives, outcomes, outputs), lessons learned, problems met and areas where results may not have been achieved.  It will also lie out recommendations for any further steps that may need to be taken to ensure sustainability and replicability of the project's results.

Learning and Knowledge Sharing:

Results from the project will be disseminated within and beyond the project intervention zone through existing information sharing networks and forums. 

The project will identify and participate, as relevant and appropriate, in scientific, policy-based and/or any other networks, which may be of benefit to project implementation though lessons learned. The project will identify, analyze, and share lessons learned that might be beneficial in the design and implementation of similar future projects.

Establish a two-way flow of information between this project and other projects of a similar focus. 

Source: UNDP Ghana Project Document (August 12, 2010)

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