Dr Githinji Gitahi_Amref Health Africa Group CEO

By Dr Githinji Gitahi
Nov 14 2024 (IPS)

Global warming is no longer just an issue for the environment but a crisis of life itself. Yet, African governments’ climate action strategies, specifically those submitted under the Nationally Determined Contributions (NDCs), remain disproportionately focused on emission reductions—an approach that fails to address the most pressing health needs of African communities. For many Africans, it’s hard to explain why their leaders prioritize reducing emissions, which are rather low and insignificant when the immediate threat of climate change is not their carbon footprint but their vulnerability to its effects.

Consider the Democratic Republic of Congo (DRC). With a per capita carbon emission of just 0.04 metric tons, it would take an average Congolese citizen over 400 years to match the emissions of a citizen in a high-income country like the U.S., Canada, or Australia. However, DRC’s NDC includes an unconditional commitment to reduce emissions by 2%, with a conditional target of 21% by 2030. This ambitious reduction, aimed at emissions that are already minuscule, would come at a cost of $25.6 billion for mitigation compared to the $23 billion allocated for adaptation actions.

This isn’t an argument against the DRC’s commitment, but an example of the absurdity that is replicated across most of the African climate action strategies as stated in their NDCs. Across the continent, mitigation costs consistently overshadow adaptation investments, even though Africa’s contribution to global emissions is minimal. What impact would DRC’s 21% reduction from 0.04 to 0.0316 metric tons per capita emissions have on the global climate at a cost of $25.6 billion?

Ethiopia provides another example. With per capita emissions of 0.2 metric tons, Ethiopia aims to cut emissions by 68.8% by 2030. However, of its $316 billion climate action budget, $275.5 billion is dedicated to mitigation, while only $40.5 billion is allocated to adaptation. This imbalance overlooks Ethiopia’s pressing need for climate resilient infrastructure in health, water, and sanitation to protect millions from climate-induced floods and droughts.

The story continues in Malawi, where per capita emissions are only 0.1 metric tons. Malawi’s NDC targets a 6% unconditional reduction and a 51% conditional reduction by 2040, with $41.8 billion allocated for mitigation but only $4.5 billion for adaptation. This focus on mitigation underfunds Malawi’s immediate vulnerabilities, such as water scarcity, food insecurity, and a fragile agricultural sector.

Zimbabwe and Uganda follow similar patterns. Zimbabwe, with per capita emissions of 0.9 metric tons, aims to reduce emissions by 40% by 2030, budgeting $4.83 billion for mitigation compared to just $2.35 billion for adaptation. Uganda, with emissions at 0.1 metric tons per capita, commits to a 24.7% reduction by 2030, with $16.7 billion allocated for mitigation and $11.4 billion for adaptation, despite recurring droughts that jeopardise agriculture and health systems.

A more people-centered approach would give precedence to climate-resilient crops, effective water management, and adaptable healthcare systems that directly address the immediate needs of vulnerable populations.

This fixation on mitigation in countries with negligible emissions reveals what I call “distributed carbon guilt”—a shared sense of responsibility for a problem these countries did not create. African nations seem trapped in a “copy-paste” climate agenda that mirrors the priorities of high-emission countries rather than building strategies rooted in local needs.

It’s time for African leaders to rethink their climate strategies and make a decisive shift away from carbon metrics toward a people-centred approach. This human life crisis demands a bottom-up strategy focused on protecting lives and livelihoods, prioritising the safety and resilience of vulnerable communities facing growing health risks, water and food scarcity, and the loss of jobs and incomes.

Achieving this scale of change requires harnessing the power of citizen engagement to build a groundswell of advocacy that places people at the heart of climate negotiations. Empowered African voices—from grassroots activists to government representatives—are essential in holding wealthier nations accountable, demanding they honour their commitments for a just energy transition and provide the financial and technological support necessary to safeguard lives and strengthen the resilience of African communities.

The Pathway to Resilience

Climate adaptation and mitigation are not opposing approaches but mutually reinforcing strategies to tackle climate change and its impacts.  Each should be applied based on the specific needs of communities. For example, investing in adaptation in Africa provides immediate protection and reduces future risks, avoiding the escalating costs of inaction. According to the Global Commission on Adaptation, an investment of $1.8 trillion in areas like early warning systems, climate-resilient infrastructure, sustainable agriculture, and water resources could yield $7.1 trillion in benefits. If African farmers adopted solar-powered irrigation, resilient crop varieties, and weather alert systems, global agricultural yields could avoid a 30% decline by 2050. Clearly, investing in adaptation delivers significant co-benefits for both resilience and mitigation.

African governments should therefore refocus on five key areas: strengthening climate-resilient health systems, offering reliable, safe water and sanitation services, supporting sustainable agriculture, mitigation, especially where there are direct co-benefits and implementing social protection programmes. Climate-resilient health systems are vital to managing climate-driven pressures, including rising disease burdens from malaria, dengue, and respiratory illnesses linked to pollution and extreme temperatures. They are also critical for responding to health impacts from extreme weather events like droughts and floods.

Reliable water and sanitation infrastructure that can withstand prolonged droughts and unpredictable rainfall is essential for tackling Africa’s growing water scarcity. This is directly linked to health, as failing and overwhelmed sanitation systems increase the risk of diseases like cholera.

In agriculture, climate-smart practices—such as resilient crop varieties, agroforestry, improved irrigation, and early warning systems—are crucial for food security. Meanwhile, government-led people-centric social protection programmes offer a safety net for communities facing the economic impacts of climate shocks.

These priorities will form a central part of discussions at next year’s Africa Health Agenda International Conference (AHAIC25) in Kigali, where African leaders will host global health and development stakeholders to exchange best practices and innovative solutions for tackling these urgent challenges.

Calling for Accountability from High-Income Countries

Based on the widely accepted principle of ‘common but differentiated responsibilities and respective capabilities,’ Africa should not bear this financial burden of adaptation alone. High-income countries, whose emissions have driven this crisis, have a moral obligation to compensate for the damage affecting developing nations. The Climate Convention mandates developed countries to provide this support, but funding is still not flowing at the scale or speed required. At COP29 in Baku, African leaders must stand united in demanding substantial, immediate financial support from wealthier nations to fund adaptation efforts across the continent as the world jointly works to slow down the global warming catastrophe.

As the next round of NDCs is due in early 2025, African policymakers must shift the focus to address their countries’ most pressing priorities.  Adaptation should be the primary consideration, guided by available data that highlights Africa’s urgent need for resilience. Mitigation should be pursued selectively where it offers direct benefits, such as reducing indoor air pollution. Meanwhile, G20 countries, especially the highest emitters, must lead on global mitigation efforts. Continuing to prioritize emission reductions in low-emission African nations is effectively adopting someone else’s agenda and diverts attention from Africa’s critical needs.

Africa’s climate commitments must prioritize lives, livelihoods, and resilience. The continent’s leaders must champion a strategy that safeguards its people, builds robust systems, and prepares for the climate impacts already upon us. In this crisis of life, Africa needs a climate action strategy centered on people—not carbon.

IPS UN Bureau Report

Follow @IPSNewsUNBureau
  

Nearly one million Kenyans are pushed below the poverty line and remain poor as a result of healthcare expenses. Credit: Paul Nevin

By Siddharth Chatterjee and Dr Githinji Gitahi
NAIROBI, Kenya, Dec 12 2017 (IPS)

Today is 12 December 2017 is an auspicious day, as it marks Kenya’s independence from colonial rule in 1963. Today is also Universal Health Coverage Day. It is the anniversary of the first unanimous United Nations resolution calling for countries to provide affordable, quality health care to every person, everywhere.

In Kenya illness can mean financial ruin.

Every day families are forced to sell their assets, rely on community support or see their modest life savings wiped out by medical bills.

Ill-health is a substantial burden not only on Kenyan families, but also on the country’s economic growth. Every year, nearly one million Kenyans are pushed below the poverty line and remain poor as a result of healthcare expenses.

Out-of-pocket expenses at point of treatment in Kenya make up a third of the country’s total health expenditure, far above the World Health Organization’s suggested 15 or 20%.

“Universal health coverage should be [viewed] as a rights issue,” said Dr. Tedros Adhanom Ghebreyesus, the director general of the World Health Organization (WHO). “Many families are getting into poverty because they are spending their savings for health care services.”

Across the globe there is a strong correlation between high rates of out-of-pocket expenses and catastrophic and impoverishing health expenditure. It is a powerful factor in inequality of access to healthcare, often forcing the poor to forgo medical treatment. It also increases costs, because when poor people finally seek treatment it’s either too late or else complications caused by delay have worsened their condition.

Approximately four out of every five Kenyans have no access to medical insurance, so the cruel reality is that most are just an accident or illness away from destitution. Among the poorest quintile a mere 3% have health insurance, this provided by the government’s National Hospital Insurance Fund (NHIF). This rises to 42% of the wealthiest fifth where private cover is also more common. Additionally, there are stark disparities between rural and urban populations, where rates of coverage are an average of 12% and 27% respectively.

“Over the next 5 years, my Administration will target 100% Universal Healthcare coverage for all households”. Credit: State House

To its credit, the Kenyan government is taking steps towards reducing these inequalities. Payments for primary and maternal health services in public facilities have been abolished, resulting in increased utilization and improved outcomes, particularly among the poorest. President Uhuru Kenyatta at his inaugural speech emphasized, “Over the next 5 years, my Administration will target 100% Universal Healthcare coverage for all households”.

Devolution of health care provision to county governments should also ensure more efficient resource distribution, accountable health services and improvements in equity that will eventually help decongest the overstretched Referral Hospitals.

Recent initiatives by the NHIF–such as inclusion of outpatient care and introduction of health insurance subsidies for the poor–are helping to expand coverage beyond those in formal employment. As a result, roughly 88.4% of households with health insurance are covered through the NHIF.

But as long as 33.6% of Kenyans survive on less than US$1.90 per day, there are still millions who cannot access quality healthcare.

Affordability is not the only barrier. Lack of public awareness, high loss ratios due to fraud, and reluctance among insurers to underwrite cover for the poor are also important.

Health insurance contributes only about 13% to national health expenditure, with the balance made up of out-of-pocket expenses at point of treatment, government and tax revenues, and donor funding. Such statistics undermine Kenya’s ability to achieve universal health coverage, enshrined in Kenya’s Vision 2030 and Sustainable Development Goal 3.

There is a clear need to develop low-cost, innovative solutions for expanding insurance coverage and technology must form part of such solutions. Technology-backed automation can improve efficiency and enhance transparency, both key requirements.

Mobile money can perform faster, more transparent and targeted health payments through health e-vouchers. Technology can process claims and enable healthcare consumers and providers to interact more efficiently, while offering more customized products to people of all incomes.

Efficient storage and sharing of patient data could reduce the cost of care by, for instance, tracing false claims, preventing repeat tests, or avoiding misdiagnosis.

Technology can also offer substantial savings in administration costs, which currently swallow a staggering 40% of the NHIF’s revenue, far in excess of the industry norm of 3-4%. Effective IT systems would help to reduce this astonishing disparity, as would improved governance and transparency. A lack of analytical capacity hobbles the NHIF’s ability to forecast and respond to increasing costs, hindering strategic planning and development. Better technology can address this.

However, such innovation must be accompanied by increased efficiency in health spending, through partnerships with institutions working to improving access to healthcare for the poor, and through policy dialogue between government and other stakeholders.

First Lady Margaret Kenyatta holds a new born baby when she visited Makueni County Referral Hospital during the handing over of the 30th Beyond Zero mobile clinic. Credit: State House

Ultimately, sustainability demands increased investment in preventive care and primary health. Diverting cash away from the 60% of the health budget that currently goes to curative care will pay dividends. Better primary care reduces ill-health and catches disease at an earlier stage, when treatment is cheaper and more effective. It also frees up resources to expand insurance coverage for the poor.

Launching the country’s SDG Platform with the United Nations in New York during the UN General Assembly in 2017, Kenya’s Cabinet Secretary for Foreign Affairs Dr. Amina Mohamed remarked, “As a government we have clearly prioritized the Universal Health Coverage agenda because it is one of the ways to protect our people from the consequences of out-of-pocket health expenditure which in Kenya forms about a fifth of family spending”.

This Independence Day, let us join hands to free every Kenyan from the tyranny of poverty by achieving universal health coverage. It is the foundation for economic development and prosperity.

Excerpt: