Building climate-resilient health systems in Zambia

For Masauso Mbewe, a 42-year-old community health worker (CHW) from Chitela village in Lusangazi District, the effects of climate change have hit close to home.

"The drought that we experienced during the 2023/2024 farming season has brought a lot of hardship upon my life," he said. "This year I only harvested seven bags of maize, one bag of soya beans, and nothing from the ground nuts."

Just a few hundred kilometers away, in Chipala village of Petauke District, Anne Mwale's story echoes Masauso's. On the cusp of her thirtieth birthday, this single mother of five faces an even more dire situation.

"This year, everything we planted dried in the field. We got nothing," she said. "So, we scrounge."

Masauso's and Anne's stories are not unique. Across Zambia, climate change is wreaking havoc on agriculture and, by extension, public health. In February 2024, Zambian President Hakainde Hichilema declared a national disaster after a drought brought on by El Niño devastated agriculture, affecting more than one million households.

The crisis came after Zambia went without rain for an uninterrupted five weeks when farmers needed it the most. Worse still, the drought only compounded the effects of another dry spell and flooding that hit the nation in 2023. Exacerbated by climate change and the El Niño weather phenomenon, the crisis threatens national food security and water and energy supplies, and it has the potential to have a longstanding impact on the Zambian population’s health outcomes.

Climate change is not a new concern in southern Africa. The rate of temperature increase in Africa has accelerated in recent decades, with weather- and climate-related hazards like El Niño becoming more frequent and more severe. The 2023/24 El Niño season inflicted extreme dry conditions on the southern region, which recorded the driest February in over 40 years. This resulted in widespread crop failure leading to food shortages, water scarcity, and the proliferation of diseases. It is expected that several sectors will be disrupted, including health care.

Climate variability has already begun to affect health outcomes in Zambia, and climate change—particularly warmer temperatures, droughts, and floods—will exacerbate current effects. Climate-sensitive diseases that have persistently increased mortality and morbidity rates in urban and rural Zambia include malaria, diarrhea, cholera, and respiratory infections, with malaria having the highest rate of incidence.

For Masauso and Anne, who have been working as CHWs since 2019, the impact is twofold. Not only have their families' food security been compromised, but their ability to provide essential health services has also been affected.

"This has made my work as a CHW to be very difficult because I cannot stay home and see my children starving. Therefore, I have to travel away from my community to find [temporary] jobs outside my village that can pay me money so that I am able to provide food for my children," says Masauso.

For Anne, who serves as one of two data coordinators among her 11 CHW peers, pressing challenges include balancing her voluntary work with securing a livelihood; enduring hunger, which affects her ability to work; and providing for her family when her income is insufficient and the costs of food, energy, and other essentials have increased.

Because of increases in heavy rainfall and temperatures, both of which facilitate mosquito breeding, the spread of malaria, a leading cause of death in Zambia, is of particular concern. Increases and changes in geographic coverage and survival of mosquito populations could be exposing more Zambians to the disease, including some that previously may not have been exposed. Malaria incidence saw a rise from 444 cases per 1,000 people in 2020 to 565 cases per 1,000 in 2023.

A recent situation report on cholera in Southeast Africa found that outbreaks were strongly associated with heavy rainfall, with increased precipitation linked to more cases of cholera. Poor drainage systems, contaminated water, and lack of access to potable water also contribute to cholera and diarrhea outbreaks.

In general, climate hazards are predicted to increase deaths associated with climate-sensitive conditions and diseases, such as heat stress caused by rising temperatures, waterborne diseases, and malnutrition due to insufficient agricultural production and food availability.

For more than 20 years, PATH has been working to accelerate health equity in Zambia through partnerships, innovation, and technology, while aligning with the shifting needs of Zambia’s people and government.

With the understanding that climate change presents a pressing global challenge with profound implications for public health, this year PATH and the Ministry of Health established a Technical Working Group (TWG) on Climate Change and Health. The TWG operates under the umbrella of the Ministry of Health and the World Health Organization.

As TWG secretariat and facilitator, PATH supported a thorough review of existing research and data to establish a robust understanding of the health impacts of climate change, as well as emerging trends and challenges. The working group identified key health vulnerabilities and risks related to climate change in Zambia, considering local, regional, and global contexts. The group is also developing evidence-based recommendations and strategies for addressing climate change-related health challenges, spanning mitigation and adaptation measures that the Ministry of Health and the Zambian government can implement.

For example, through the TWG, PATH supported the Ministry of Health in developing a plan to mitigate the effects of the recent drought. The group also facilitates collaboration and knowledge exchange among multidisciplinary experts in the fields of climate science, public health, health care delivery, environmental science, policy, and advocacy. Additionally, the group supports local capacity-building efforts and is involved in communications and public awareness initiatives aimed not only at catalyzing crucial conversations on building climate-resilient health care systems but also at turning this conversation into action.

Across Africa, PATH enhances partnerships and collaboration to accelerate climate-responsive solutions in public health. Through Zambia’s Climate and Health TWG, PATH is building on its experience in other countries to spotlight innovations for climate-resilience and community action.

For instance, PAMO Plus, funded by the US President’s Malaria Initiative, has trained and deployed about 10,000 CHWs in Zambia’s four provinces with the highest burden of malaria—Eastern, Luapula, Muchinga, and Northern. These CHWs, like Masauso and Anne, are on the front lines of identifying, testing for, and treating malaria cases within their communities. Alongside CHWs are community change agents—trained volunteers who use dialogues and household visits to engage, educate, and influence community members to use malaria services.

For example, the agents teach people how to control vector breeding sites, such as by disturbing pools of water where mosquitoes could breed. By equipping communities for diagnosis, treatment, and behavior change at the most localized level, PAMO Plus’s support has built resilience within the health system, helping to prevent interruption of services in the face of climate disasters.

As Masauso Mbewe and Anne Mwale's experiences show, climate change is not just an abstract threat—it's a daily reality affecting the lives and livelihoods of Zambians, including those serving their communities as health workers.

Robust and resilient health systems are the primary line of defense against climate-related shocks and stressors. Functioning health facilities and health care workers provide much-needed care to the communities affected by climate-sensitive diseases, such as vector-borne and diarrheal diseases. During extreme climate events, such as flash floods, heat waves, droughts, and landslides, they are critical to ensure timely treatment and care for the people affected and to monitor diseases.

Our collaboration with partners in Zambia represents a small fraction of our preparedness work. As we advance the Climate and Health TWG’s agenda, we remain steadfast in knowing the best way to adapt to climate change is to ensure everyone, everywhere has access to the care it takes to live healthy lives free of crushing financial burdens.

For Masauso, Anne, and countless others across Zambia, this means a future where they can focus on their vital work without worrying about their next meal or their children's education.