2024-04-29-世界银行-加纳气候和健康脆弱性评估（英）_105页_22mb

Climate and Health Vulnerability Assessment for Ghana

Core Content

This report presents the findings of the Climate and Health Vulnerability Assessment (CHVA) for Ghana, conducted by a team of experts and supported by the World Bank Health, Nutrition and Population team. It aims to evaluate the impact of climate change on health outcomes and the health system, identify adaptive capacities, and recommend strategies to reduce climate-related health vulnerabilities.

Main Objectives and Methodology

• Objective: To assess the vulnerability of Ghana's health system to climate change and identify gaps in adaptive capacity.
• Conceptual Framework: Based on the World Health Organization (WHO) Operational Framework for Building Climate-Resilient Health Systems.
• Methodology: A multi-pronged approach including desk reviews, quantitative analysis of secondary data, and qualitative data collection and analysis.

Country Context

• Geography: Ghana is divided into 16 administrative regions, with the Northern region experiencing higher temperatures and lower rainfall.
• Climate Trends:
  • Observed: Unimodal rainfall in the north, bimodal in the south; increasing temperatures with latitude.
  • Projected: Declining rainfall magnitude, bimodal temperature patterns, and earlier monthly temperature peaks (March-April).
• Sea-Level Rise:
  • Observed: An average increase of 3.44 mm/year from 1993 to 2016.
  • Projected: Rise of 6-7 mm/year (2020-2039) and 8.5-9.7 mm/year (2040-2059) under extreme emission scenarios. Under mitigation, rise is expected to be about 5.3 mm/year (2020-2039) and 5.5 mm/year (2040-2059).
• Population:
  • Total population growth from 1960 to 2021.
  • Unbalanced distribution across regions.
  • Higher vulnerability in rural and northern areas due to poverty and subsistence farming.
• Economic Development:
  • GDP growth from 2014 to 2022.
  • Key sectors contributing to GDP.
• Health System:
  • Overview of health infrastructure, workforce, and financing.
  • Challenges include insufficient facilities, lack of preventive services, and weak referral systems.

Climate Exposures and Hazards

• Observed and Projected Climatology:
  • Temperature and precipitation trends show increasing temperatures and declining rainfall.
  • Rainfall peaks between June and September.
• Sea-Level Rise:
  • Expected to cause coastal erosion and flooding, particularly along the Volta delta.
• Extreme Events:
  • 22 major hydrometeorological events in the last 50 years, affecting 16 million people and causing over 400 deaths.
  • Key hazards: Droughts, floods, wildfires, storms, earthquakes, and epidemics.
  • Floods and droughts threaten agriculture and livelihoods, especially in the Northern region.

Health Risks

Vulnerable Population Groups

• The elderly, women, children, the chronically ill, and socially isolated groups (e.g., disabled, ethnic minorities, migrants) are particularly vulnerable.
• Women are disproportionately affected by food and water insecurity.
• Farmers and miners face high heat stress and physical labor burdens.

Direct Health Risks

• Heat Waves: Associated with heat strokes, organ damage, and increased mortality, especially among the elderly and those with respiratory or renal diseases.
• Air Pollution: High mortality and treatment costs; linked to the use of solid fuels in households.
• Mental Health: Climate change impacts mental health through stress, anxiety, depression, and PTSD. Limited data exists in the Ghanaian context.

Indirect Health Risks

• Climate-Sensitive Infectious Diseases:
  • Malaria: Highest in the Northern region, with a declining trend nationally but marginal increases in some regions.
  • Diarrhea: High in northern regions; linked to temperature and precipitation.
  • Meningitis: Declining in northern regions, but marginal increases in middle belt and southern regions.
  • Schistosomiasis: Cases increased with temperature, though not significantly linked to precipitation.

Health System Risks

• Primary Health Care (PHC): Insufficient facilities and health posts per capita; only half of CHPS Zones meet infrastructure and transport standards.
• Workforce: Disparities in distribution and training; shortages in some cadres.
• Health Information Systems: Limited capacity for monitoring and responding to climate-related health risks.
• Financing: Inadequate funding for preventive services and climate resilience initiatives.

Adaptive Capacity and Gaps

• Leadership and Governance: Policies exist, but implementation and integration with health sectors are lacking.
• Health Workforce: Inequities in distribution and training; poor working conditions.
• Health Information Systems: Gaps in data collection and early warning systems.
• Medical Infrastructure: Insufficient equipment and resources, especially in rural areas.
• Service Delivery: Weak referral systems and limited access to PHC services for vulnerable groups.
• Health System Financing: Limited inclusion of preventive and climate adaptation measures in funding allocations.

Key Recommendations

1. Leadership and Governance: Strengthen policy integration and implementation across sectors.
2. Health Workforce: Address shortages and improve training and working conditions.
3. Vulnerability and Capacity Assessment: Conduct regular assessments to identify and address gaps.
4. Integrated Risk Monitoring and Early Warning: Develop and implement early warning systems for climate-related health risks.
5. Health and Climate Research: Support research to better understand and predict climate health impacts.
6. Climate Resilient Technologies and Infrastructure: Invest in infrastructure and technologies that withstand climate impacts.
7. Environmental Determinants Management: Address air and water pollution, vector control, and sanitation.
8. Climate-Informed Health Programs: Integrate climate considerations into public health initiatives.
9. Emergency Preparedness and Management: Enhance readiness for extreme weather events and health emergencies.
10. Climate and Health Financing: Allocate sufficient funds for climate adaptation and health resilience.

Conclusion

The report underscores the significant vulnerability of Ghana's health system and population to climate change, emphasizing the need for a comprehensive, integrated, and adaptive approach to mitigate these risks. It highlights the importance of strengthening primary health care, improving workforce capacity, and enhancing monitoring and early warning systems to build a climate-resilient health sector.