Policy Tracker: Medical rules shift to climate focus

In Nigeria and South Africa, funding reallocations are being implemented to counteract cuts in US aid, ensuring a robust response to epidemics and enhancing healthcare resilience in the face of climate threats.

Sierra Leone’s Heat Action Plan incorporates early warning systems, cooling strategies, and adaptation measures, focusing on vulnerable communities and establishing a link between climate change and health.

At the Fifth Clim-HEALTH Africa meeting in Senegal, over 80 experts agreed on a five-year strategic plan aimed at strengthening Africa’s health resilience to climate change. In 2023, extreme weather events resulted in 15,000 deaths and impacted 88 million people due to droughts. However, only 22 African countries currently have health adaptation plans in place. The initiative seeks to improve early warning systems, climate-health indicators, and elevate Africa’s representation in global climate negotiations.

The Harare Declaration, adopted during the Climate and Health Africa Conference, focuses on enhancing climate resilience within health systems. In 2023–2024, there were 836,600 reported cholera cases and a 14% increase in malaria cases linked to climate-related disasters. The declaration emphasises the importance of early warning systems, policy integration, and research funding. To date, 29 African countries have joined the Alliance for Transformative Action on Climate and Health, a WHO-led initiative aimed at strengthening climate-resilient health systems.

In South Africa, the government is increasing health and defence spending to offset cuts in U.S. aid, particularly from the PEPFAR programme, which previously funded HIV treatment for over 5.5 million patients. Finance Minister Enoch Godongwana announced an additional 28.9 billion rand ($1.5 billion) for health, increasing the budget from 277 billion rand in 2024/25 to 329 billion rand by 2027/28. This funding will allow for the hiring of 9,300 medical personnel, including 800 doctors, to mitigate the impact of USAID reductions.

To finance these allocations, the government plans to raise the value-added tax (VAT) by 0.5% in both 2025–26 and 2026–27, bringing the total to 16%. This increase, which affects essential goods, has elicited political backlash. Additionally, 5 billion rand ($271 million) will be allocated to bolster the military, particularly for peacekeeping missions in eastern Congo. Ongoing budget discussions will culminate in a parliamentary vote on the final allocations in the coming weeks.

Nigeria has approved $200 million to counterbalance reductions in U.S. health aid, as disease control efforts struggle against increasing challenges. Malaria, which caused 200,000 deaths in 2023, and meningitis, which killed 26 people in early 2025, are worsening due to climate-related factors such as rising temperatures. The funds, part of a $36.6 billion budget, will support vaccine distribution and epidemic response, addressing gaps left by USAID’s $600 million freeze on health investments.

The $1.07 billion HOPE programme, supported by two $500 million World Bank loans and $70 million in grants, aims to strengthen Nigeria’s healthcare system. It allocates $500 million for primary healthcare, $4.8 billion for HIV treatment, and resources to train thousands of health workers. The need for these investments is underscored by climate-related disease outbreaks exacerbated by floods that displaced over 2.4 million people in 2023, highlighting the critical importance of enhancing Nigeria’s health resilience.

In Kenya, the 2025 Budget Policy Statement prioritises preventive healthcare under the Bottom-Up Economic Transformation Agenda for Inclusive Green Growth. The Universal Health Coverage (UHC) initiative, aligned with Vision 2030 and the Kenya Health Policy Framework 2014–2030, focuses on disease prevention, digital health, and waste management. With 17.8 million registered under the Social Health Account (SHA) and a 93% immunisation coverage rate, these policies are designed to enhance climate-resilient healthcare and ensure sustainable health financing.

Sierra Leone’s Heat Action Plan tackles rising temperatures by integrating early warning systems, urban cooling strategies, and equitable heat adaptation measures. With 35% of residents in informal settlements, initiatives like reflective roofing, tree planting, and cooling zones target the most vulnerable. A multi-sectoral heat task force and $10 million financing plan aim to strengthen resilience.

African nations must prioritise climate-health policies that reduce emissions while enhancing public health. Investing in clean energy, integrating health into climate strategies, and mobilising health experts will accelerate mitigation efforts and drive policy change.

Building climate-resilient health systems is essential. Countries should embed sustainability in universal healthcare, adopt cleaner solutions, and decarbonise high-emitting health facilities. Strengthening workforce capacity will ensure long-term environmental and health security.

Protecting health from climate threats requires proactive measures. Governments must assess vulnerabilities, integrate climate risk into surveillance, and invest in adaptation, including water and food security. Closing the financing gap is critical for resilience.