This article presents 14 practical recommendations for action on climate change and health.

The recommendations are grounded in the experiences shared by thousands of health workers and documented in the Teach to Reach 11 report “Local action to mitigate the impact of the climate crisis on health”

The recommendations below are what we conclude when we read those accounts together and ask what should change.

They are a working analysis from The Geneva Learning Foundation, written for three audiences: community health staff and volunteers, managers and planners, and global partners.

They appear here, in this article, for the first time.

A separate companion article, Eight things health workers taught us about climate change and health, presents key findings on which these recommendations are based, with the Contributor accounts that support them.

Read that piece first if the recommendations below feel abstract.

Read this one if you have already read the findings and want to know what to do.

Why these recommendations and not others

Three principles run through what follows.

1. Solutions are already in the field. The accounts describe pirogues, drones, mobile clinics, mutual-aid funds, community-built health centres, and WhatsApp antenatal care. The job of policy is to recognise, fund, and protect what already works.
2. Cost of climate adaptation is currently being paid by frontline health workers and the communities they serve, in money and in injuries. Any recommendation that ignores this transfers more cost to people who already cannot afford it.
3. Climate change is a threat multiplier on familiar diseases. Recommendations that aim at exotic new programmes will miss the ground where the problem actually lives, which is in the malaria, cholera, malnutrition, and maternal mortality that workers have been tracking for decades.

Recommendations for community health staff and volunteers

The contributors are themselves community health staff and volunteers. The recommendations here are what their accounts suggest to peers in similar settings.

1. Map your district before the next rainy season, not during it. Several accounts make clear that the difference between a successful response and a lost patient is whether the alternative route, the higher-ground building, the canoe operator, and the women’s group are known by name before the road floods. Make the map. Keep it on paper. Update it once a year.
2. Document the protocol changes you make under climate stress. Several contributors describe adapting reporting cadences, outreach schedules, and clinical protocols in real time during climate events. That kind of adaptation is the most useful evidence the system has, and it disappears if it is not written down. Write a short note each time you change a protocol because of weather. Share it with peers.
3. Build relationships with women’s groups, traditional birth attendants, youth groups, and faith leaders before any emergency. The communities that responded best to the floods in the report were the ones where these relationships already existed. They cannot be built in the week of an emergency.
4. Record what you spend out of pocket. The midwife in Tarime hires motorbikes. Keku Evans De-Clerk in Ho West spends four days travelling between communities. These costs are invisible to managers and donors unless someone counts them. Counting them is the first step to having them reimbursed.

Recommendations for managers and planners

The contributors describe a system in which the formal health service runs on the unrecorded labour and unrecorded spending of frontline staff and the unrecorded financing of community groups.

The recommendations here are about giving formal recognition and resources to what is already happening.

1. Rewrite district emergency plans around the hazards the district actually faces, in the order they arrive. The same district will see drought, then flood, then harmattan, then heatwave. A single integrated plan that names canoe operators, higher-ground sites, and outreach schedules adjusted for the local climate calendar reaches zero-dose children and high-risk pregnancies before access closes.
2. Authorise improvised responses in advance, so workers do not have to seek approval during a crisis. Mobile clinics, drone deliveries, telemedicine on WhatsApp, community-built facilities, daily surveillance reporting. These are happening anyway. Pre-authorisation removes the legal and procedural risk that workers currently carry alone.
3. Create a reimbursement line for climate-related transport, equipment, and weather-related sick days. Health worker dedication is a subsidy. Make it visible in the budget. The amounts involved are small. The signal to the workforce is large.
4. Recognise community financial mechanisms as health system infrastructure. Women’s solidarity funds, mutual-aid groups, and savings groups already pay for hospital stays and emergency transport in the accounts. District plans that ignore them duplicate effort. District plans that include them work with the grain of the community.
5. Make community trust a measurable indicator, with a budget line and a person responsible. Habila Christiana Habu in Taraba State and several other contributors describe trust as the binding constraint on emergency response. It is measurable. It can be funded. It is currently neither in most plans.

Recommendations for global partners

The Belem Health Action Plan adopted after COP30 placed adaptation and community resilience at the centre of the global response. The 2025 Lancet Countdown opened a path to climate-resilient health systems that recognises frontline knowledge. The recommendations here are about closing the gap between those framings and what is actually funded.

1. Shift climate-health portfolios from generating new knowledge to amplifying knowledge that already exists. Implementation science for planetary health begins with what frontline workers have already tested. Fund the documentation, peer learning, and protocol development that turns those tests into evidence the global system can use. Funding more research from the outside, on conditions that workers in nineteen countries have already described, is the wrong instrument.
2. Fund frontline workers directly through mechanisms that match the timeline of an extreme weather event. Reconstruction funding that arrives in months arrives after the community has already moved on. Rapid response mechanisms that can reach community-led action in weeks match the timeline that floods, droughts, and cyclones actually run on.
3. Make worker protection a required line in every emergency response grant. Reimbursement for transport, airtime, equipment, and weather-related injuries is small money and large signal. It is also the one variable in the report that no contributor reported being addressed.
4. Treat community trust and community-built infrastructure as fundable outcomes. The current grant cycle is shorter than the time it takes to build trust in a community that has been let down before, and shorter than the time it takes to build a health centre with local labour. Multi-year, presence-based funding is what these accounts call for.
5. Reframe climate-health investment around familiar diseases at altered scale. The signal is in malaria caseloads in Kinshasa during the dry season, dengue in Cote d’Ivoire, cholera in N’Djamena, malnutrition in Tiassale, and respiratory illness from harmattan dust in Transua. Funding instruments that look for new disease categories will miss it. Funding instruments that strengthen basic public health, sanitation, water security, and surveillance for these familiar diseases will reach it.

What success looks like 

Three years from now, what does success look like, if these recommendations are implemented? Here are six examples of potential outcomes:

1. A district plan in DRC that lists the women’s solidarity fund of Ngandajika as a partner organisation, with a contact name and a budget for joint activity.
2. A national malaria control programme in Niger that reimburses Sidikou Issaka Maiga and his colleagues for the pirogue hire, the long detours, and the supervision time that the seasonal chemoprevention campaign now requires under climate stress.
3. A reimbursement line in the Tanzania Ministry of Health budget for the motorbikes that the midwife in Tarime currently hires herself.
4. A grant from a global partner that arrives in time to finish the health centre that Jean-Richard Mutombo and his neighbours have started building in Tshibuba.
5. A WhatsApp antenatal protocol in Ghana that gives Kojo Pieterson the documentation framework, the airtime, and the legal cover to do what he has already shown can be done.
6. A district hospital in Uttarakhand that systematises Dr Mahesh Bhatt’s practice of relocating high-risk pregnancies before the monsoon road closes, with funding for the relocation costs.

These are not abstractions.

The people are named.

The places are real.

The actions are within reach.

The question is whether the systems that surround them will look.