There’s an urgency to scale climate change solutions quickly, was the unofficial mantra at the World Health Summit, as delegates called for faster change and more funds.

NEW DELHI – It doesn’t cost much to ensure that a mother does not deliver her baby by candlelight, increasing the chances of the newborn’s and mother’s survival. 

Thousands of primary health centres (PHC) in India are benefiting from a solar project rollout that provides clean and sustainable power for around $4,000 to $5,000 per centre. This checks several sustainable development goal (SDG) boxes – for the planet, affordable and clean energy, good health and well-being and climate action. 

This was one of the few celebrated examples of climate action at scale at the World Health Summit (WHS) in New Delhi, a twice-a-year, influential gathering of health stakeholders, which ended on Sunday. 

Leading experts flagged hurdles that are slowing down such sustainable projects and programmes, ironically just as these should be accelerated, given the rapidly warming climate.

From scaling up affordable cooling, to faster funding mechanisms, to better data, experts from multilateral bodies such as the World Bank and Asian Development Bank (ADB), funders, NGOs and CSOs listed their priorities. 

Economic growth now vs net zero later

As if on cue, the WHS coincided with northern India experiencing extreme heat, southern India’s heat index topping 50°C, and Europe posting its hottest March on record.

Decarbonisation is the usual response to rising heat, but this needs to be looked at from another lens, Marion Jane Cros, the World Bank’s  (WB) Senior Economist for Health, pointed out. Decreasing the carbon footprint is important, but it’s more urgent in the short term to tackle heat and protect economic growth. 

The WB estimates that heat stress could result in 34 million job losses in India by 2030 and reduce GDP by up to 4.5%,, amounting to $150-250 billion.

It makes a case, in its AHEAD programme with the government, for action to reduce heat stress through affordable, energy-efficient cooling systems. With heat waves expected to intensify in the coming years, Cros made an argument to protect human capital.

“If you are affected by climate health-sensitive disease, by heat stroke, or different heat-related diseases, you might not be able to go to work,” said Cros.

“Then if you have to go to the health facility, you might not have health insurance. You have to pay some money. Then you might encounter a catastrophic health expenditure. So again, if you are protected against (this), it makes you more resilient, in particular for the vulnerable population.”

Nearly half of the Indian population lives below $3.65 per day, Cros says, and can’t afford many of the cooling systems currently available. 

Keeping cool on a tight budget

One of the groups rolling out affordable cooling solutions is the Mahila (women) Housing Trust (MHT).  They work with women in communities who can’t afford air coolers, let alone air conditioners, and support them to paint their roofs in white reflective paint, which has been estimated to reduce the temperature by 2°C to 6°C.

For a deeper engagement, MHT’s executive director Bijal Brahmbhat says, they explain the science to the women, install thermometers to log the temperature and ask the women to compare it with a non-cooled house or the Met department’s temperature for that day.

“They understand, and slowly they started taking it up at a settlement level and also talking to the government,” she says.

MHT’s other initiative is to cool bus stops, and it launched the first site in Ahmedabad along with the local administration in mid-March amid a heat wave warning. The low-cost tech uses a combination of curtains made of grass to block the sun and mist fans to absorb the heat. It reduces the heat by a significant 6-7°C; the city’s highest temperature has been 48°C.

The low-cost cooling solution has led to inquiries from other cities, including Delhi, Brahmbhat says. The first one was expensive at a little over $4,000. 

“The first cooling station we did was net zero, but the solar cost was around 350,000 rupees. At places where we didn’t have the funds and we couldn’t go for solar, we used energy-efficient systems which would go on for a certain time and then stop for a certain time.”

Climate vs health to climate and health

As local administrations scale up responses to climate change, an Asian Development Bank (ADB) official told the WHS how governments in the region have changed their approach to climate and health in the last few years. 

Dinesh Arora, ABD’s principal health specialist, recalls that countries used to tell the bank to go and talk to the Ministry of Environment when it wanted to discuss climate change and health.

“I’m seeing a sea-change. Indonesia is talking about a full climate and health directorate within the health systems,” said Arora.

The ADB is working to see how the infrastructure of public health hospitals can be more resilient and withstand, say, a flood or an earthquake or how quickly it can resume functions.

Funding challenges

The WHS brought health and climate together in a way that the UN’s Conference of the Parties (COP) gathering has rarely done. But funding is a challenge for health projects. 

“There’s an urgency here. We need to scale solutions quickly,” says Neeraj Jain, of the global health non-profit, PATH. The challenge described by several speakers was a chicken-and-egg situation: funders need data on the possible impact, but collecting the data needs funds. This creates delays in launching new solutions for climate change adaptation and mitigation.

A popular proposal for a way forward is for funders to start a climate action project, monitor its operational impact and course correct as needed. But this approach makes it easier for adaptation funding over mitigation, where the impact can be seen relatively quickly, for instance, greening of urban spaces to reduce the urban heat island effect, compared to setting up a wind power project.

The focus of funders is on real impact, not policy and narrative, says Jain, who is PATH’s Director of Growth Operations, Asia, Middle East and Europe at PATH. This is particularly the case in low and middle-income (LMICs) countries where the effects of climate change on health are most visible. 

“We as practitioners need to move into action mode and roll out solutions that have real, measurable impact. The impact has to be at scale and sustainable for the support from government, private, as well as philanthropic financing to flow in.”

Governments chase win-win climate solutions.

One of the largest examples of a decentralised decarbonisation and, so far, successful projects is the one by SELCO Foundation to solarise primary health centres (PHCS) in India. 

It began with 15 PHCs in 2016, and aims to cover 25,000 by 2026 at a cost of about $117 million (₹1,000 crores). So far, it has installed solar power in 10,000 PHCs for lights, fans, baby warming equipment, foetal monitoring systems, oxygen concentrators, vaccine and medicine storage refrigerators, diagnostics and so on. 

Twelve state governments have signed up for this, and SELCO’s director, Huda Jaffer explains that there are benefits in savings and health outcomes, including no deliveries by candlelight. 

“The way the program is packaged, they’re able to see a very tangible saturation based on a scale program for the state itself. Helping the fact is some catalytic capital, and systems in place for them to show that it has been rolled out, implemented and owned within a certain time frame at a certain saturation scale.”

But this demonstrable success comes with underlying constraints. India has well over 200,000 PHCs and sub-centres, many of which do not have reliable power from the grid or need diesel generators. 

The SELCO project only covers 12.5% of PHCs, costing about $4,000 to provide solar power per PHCs. It’s a model that could be scaled to Africa, where the electrification of health centres is low. 

Another issue is that several funders for such projects support the initial setting up of the systems (capex) but leave the running and maintenance (opex) to local communities and administrations that are usually understaffed, untrained, and have tight budgets. 

In India, there needs to be a dedicated government team to scale this from 25,000 PHCs to 200,000 plus, and ensure the solar set-up is maintained, Jaffer said, adding that SELCO is playing the role of a dedicated secretariat.

“But in Africa it has to be donor monies, and donor design is always capex-based systems, which typically leads to opex issues as there is no long-term ownership that is built in from the program design team.”

Equity: The same victims again and again

In the end, strip away the layers, and climate action is ultimately about equity.  Speaking at WHS, Dr Soumya Swaminathan, the former WHO Chief Scientist, said that every time we plan something, we must address where there are equity issues that we are forgetting about. 

Sustained heat exposure poses health risks like dehydration and cardiovascular diseases, especially for India’s informal workforce (85% of workers) and women engaged in household chores in poorly ventilated spaces, for example.

“Ultimately, those same people get left out of all programs, whether they are the elderly, the disabled or the very poor or women who have multiple of these risk factors,” said Swaminathan.

Image Credits: Selco Foundation, Mahila Housing Trust.