Lobbying for resilience to climate change in Burundi’s health sector: how a communication project targeting political and religious leaders, the media and the general public, led to integrating climate change into the official national health policy.
Malaria has become Burundi’s first cause of ill health
With its cool, lofty hills and plateaus, Burundi seems far removed from tropical diseases such as malaria. Indeed, at the turn of the twentieth century malaria was a rare disease confined to the low-lying river valleys and plains with little human habitation. Today, however, malaria has become the foremost cause of ill health in the tiny East African nation, accounting for 50% of consultations in the country’s health facilities and fully 48% of deaths of children under five. Just in the seven years between 1993 and 2000 the number of malaria cases almost quadrupled from 800,000 to 3,000,000. Even though climate change is neither mentioned in Burundi’s current National Health Development Plan nor in its malaria-related policy documents, this dramatic rise in a previously nearly unknown disease may be directly linked to it.
More and more communities are affected and fail to adapt to the new threat
With rising temperatures, increased rainfall and demographic pressure on the environment, the habitat for malaria-transmitting mosquitos has been creeping steadily upwards, and could well reach even the highest elevations by the end of the century. Meanwhile the population concentrated at the higher altitudes, who were previously unexposed to malaria and therefore lack immunity, easily fall prey to the dangerous disease.
The impact of this epidemiological development on affected communities depends on their ability to adapt to the new threat. How well they can cope with it depends, for example, on their use of mosquito nets, their access to a health facility and their knowledge about malaria, including its transmission, ways to prevent it, its symptoms and effective treatment. Currently, the population of only two out of 18 provinces is estimated to have the adaptive capacities to reduce their vulnerability to malaria.
Time to ensure high-level political awareness for the topic
Keenly aware of the growing impact of climate change on health, and of many communities’ failure to cope and adapt, the civil society organisation ALUMA (Action de Lutte contre la Malaria) saw the need for greater high-level commitment to promote resilience against climate change in Burundi’s health system. ALUMA’s proposal “Lobbying for integration of the relationship between climate change and health in the relevant policy instruments” attracted the support of the GIZ Global Programme on Climate Change and Health. From February 2014 to April 2015 it supported ALUMA’s initiative to focus decision-makers‘ attention on the possible impacts of climate change on health, as exemplified by the rapid expansion of the country’s number one disease.
Burundi’s Ministry of Health through its Department of Health Promotion and Hygiene was the third member in what became known as the Climate-Health Project. A close partner was the bilateral German-Burundian project ‘Adapting to Climate Change in the Water and Soil Sectors’ (ACCES). Its climate change vulnerability analyses, for example, provided clear evidence for health impacts, particularly the spread of malaria.
Key individuals become advocates for climate change adaptation in the health sector
The project’s objective was to ensure that Burundi’s Ministry of Health would recognize the importance of the climate change-health linkage and its impacts, and that this would be reflected in its relevant policy documents. As a first step specific groups of people were identified who could be effective advocates toward the government on this topic: judiciously selected leaders of political parties, civil society organisations, religious leaders, and members of the parliamentary commissions on health, the environment, and the budget were sensitised in 1.5-day retreats facilitated by national and international experts on the climate-health link.
In addition, In-depth trainings were held for journalists, who then reported on the retreats and interviewed participants in their respective media. Both in 2014 and in 2015, around World Malaria Day, the project organised widely publicised contests for the best journalistic spots and articles on climate change and health, with a particular focus on malaria. In this way, in the course of only 15 months nearly 300 key individuals received intensive exposure to the issues of climate change and health.
When the project ended prematurely due to Burundi’s political crisis of April 2015, two important planned activities had to be abandoned: a retreat for high-level members of government, and a local malaria vulnerability analysis that was expected to generate convincing data on the impact of climate change on health.
Impressive results in a very short time
Despite its briefer than planned existence (15 months rather than 23) the Climate-Health Project attained important results:
- ALUMA became an active member in the post-Libreville Declaration committees working on Burundi’s Situational Analysis and Needs Assessment and on its National Health Sector Adaptation Plan, promoting coherence with the Ministry of Health’s policy documents.
- The project contributed to revising the Public Health Law in 2014 to include the impact of natural catastrophes on health and their mitigation.
- ALUMA, as a member of the committee developing Burundi’s new National Health Policy 2016-25, contributed to integrating the impact of climate change in this fundamental document.
- As a consequence, the impact of climate change is expected to be an integral aspect of Burundi’s third National Health Development Plan, currently in preparation.
While the existence of an official document or even a law cannot guarantee that the proposed measures are put into practice, the fact that climate change is now taken into account in important policy documents provides the legal and administrative framework that is prerequisite for making Burundi’s health sector more climate-resilient.
What made this project work?
Targeting the highest-level governmental decision-makers made it possible to contribute to the formulation of these policy documents. The fact that the Ministry of Health was not just an audience for, but also an active participant in the lobbying, multiplied the effectiveness of the project’s approach. Getting political and religious opinion leaders involved in spreading the wake-up call concerning the health impacts of climate change lent further credibility to this message, which was broadly disseminated by the dozens of journalists trained and inspired by the project. This cohort of media professionals, knowledgeable and convinced about the link between climate change and health, remain a major resource for maintaining the topic – particularly on Burundi’s key issue of malaria – in the public eye.