世界银行-马达加斯加-气候和健康脆弱性评估（英）-2024-78页_7mb

Climate and Health Vulnerability Assessment: Madagascar Summary

Introduction

Madagascar's unique geography and climate make it highly vulnerable to climate-related hazards such as cyclones, droughts, floods, landslides, and sea-level rise. This assessment highlights current and projected climate risks, their effects on public health, and gaps in the health system's adaptive capacity. The analysis, based on observed and projected climatic data, informs adaptation strategies to strengthen health resilience.

Climate-Related Hazards

• Temperature: Madagascar has experienced a 0.5°C temperature increase since the 1960s, with projections indicating further rises, particularly in southern regions. Nighttime temperatures are expected to rise significantly.
• Precipitation: Reduced rainfall (e.g., 59 mm decrease nationally over 50 years) and increased drought frequency are projected. While intense rainfall events may increase, this exacerbates flooding and landslides.
• Extreme Events: By 2070, cyclone intensity is expected to rise, though frequency may decrease. SLR projections indicate a 34 cm rise by 2059, increasing coastal risks.

Climate-Related Health Risks

• Nutrition: Stunting and malnutrition affect over 50% of children under five. Climate impacts on agriculture reduce food availability, particularly in drought-prone areas.
• Waterborne Diseases: Diarrhea prevalence varies subnationally, driven by limited access to improved water, sanitation, and hygiene (WASH), which worsens during floods or droughts.
• Vector-Borne Diseases: Malaria risk increases significantly by 2070, with rising temperatures and rainfall enabling vector proliferation.
• Air Quality: Indoor and ambient air pollution from cooking fuels, wildfires, and brick production contribute to respiratory illnesses.
• Zoonotic Diseases: Deforestation and habitat alteration increase human exposure to zoonotic infections, such as plague.

Health System Adaptive Capacity

The health system faces significant gaps, including limited budgets for climate adaptation, weak enforcement of building codes, insufficient workforce training, and fragmented cross-sectoral coordination. National and subnational coordination and monitoring mechanisms are inadequate to address timely threats.

Recommendations

To build climate-resilient health systems, key actions include:

• Strengthening intersectoral coordination, particularly the One Health approach.
• Establishing a dedicated budget line within the Ministry of Health (MoH) for climate adaptation.
• Training all levels of health workers, including community stakeholders, on climate risks and emergency preparedness.
• Expanding early warning information systems (e.g., 3-2-1 SMS) to vulnerable areas.
• Ensuring climate vulnerability considerations guide healthcare infrastructure, medicine procurement, and investments.
• Improving funding mechanisms for decentralized emergency preparedness, especially in climate-vulnerable regions.

The assessment urges immediate action to scale climate adaptation measures in health systems, ensuring universal health coverage amid intensifying climate challenges.