Description
Introduction: The Sahel region faces worsening climate change impacts, including high temperatures and water scarcity which amplify ongoing health risks such as malnutrition and malaria outbreaks. Ngouri Hospital in Chad, which is run by the Ministry of Health (MoH) and supported by the international NGO ALIMA and its local affiliate Alerte Sante, has launched a project to strengthen its climate resilience to ensure access to care, workforce protection, and effective emergency response, using low-carbon sustainable approaches. This descriptive study outlines the application of a facility-adapted Vulnerability and Adaptative Capacity (VCA) assessment, developed by the Climate Action Accelerator (CAA), to provide actionable information for Ngouri Hospital to increase its climate resilience and environmental sustainability.
Methods: We used WHO guidance to create a participatory VCA process, which was implemented in Ngouri hospital by a multi-disciplinary team from MoH, ALIMA, Alerte Sante and CAA. The methodology included: (1) targeted literature review synthesizing climate hazards and population vulnerabilities; (2) facility audit, highlighting infrastructural weaknesses and healthcare delivery gaps; (3) qualitative focus groups to add depth to the identified vulnerabilities and capacities and to generate a summary of the risks; (4) elaboration of a matrix of solutions with cost estimates, feasibility, and other decision-making parameters; (5) a participatory prioritisation process to identify a shortlist of high priority solutions, to enable development of the multi-year improvement plan.
Results: The Ngouri climate VCA produced a comprehensive climate change risk register, categorizing hazards, exposures, vulnerabilities, and adaptive capacities. The main climate change-related hazards identified were found to result in direct health risks (e.g. increased malarial mortality due to changing malarial epidemiology and exacerbated by increasing food insecurity) and indirect health risks (e.g. power outages causing breaks in Oxygen supply due to inadequate bridging systems). A list of 36 mitigation solutions was generated and reduced to nine structural solutions, and eleven health-programming and workforce solutions. The final prioritised solution list included anticipatory planning, community sensitization, supplementary feeding programs, and improved waste management.
Lessons learnt regarding the VCA process included the importance of community engagement, multidisciplinary collaboration, and the value of the overall process to increase staff agency and motivation regarding environmentally sustainable care. To overcome barriers to engagement with traditional focus group discussions, alternative methods including facilitated discussions with pictorial data capture were employed.
Conclusion: The facility-adapted climate VCA provides a practical and replicable approach to assess climate vulnerabilities and capacities in similar settings.
The results of the VCA emphasized the significant health risks posed by climate change, including increased risk of infectious disease mortality, and underscore the importance of sustainable solutions. The identified solutions enable a strategic approach for building climate resilience in Ngouri Hospital and provide a blueprint that could be adapted to similar healthcare facilities.
The lessons learnt from the VCA process on participatory modalities and data capture are also generalisable to other settings where such assessments are undertaken.
This descriptive study contributes to the broader goal of aligning healthcare systems with global sustainability objectives while ensuring their quality in the face of a changing climate.
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