In Niger, the rains in 2024 were heavier than anyone alive could remember.

Elders told Sidikou Issaka Maiga that they had never seen rainfall destroy so much in such a short time.

The flooding washed away tracks, drowned crops, and cut whole villages off from the nearest health facility.

The seasonal malaria chemoprevention campaign was supposed to be running.

Children in flooded villages were unreachable by car or motorbike.

So the malaria control programme recruited local distributors and brought them in by pirogue (small river boats), with antimalarial drugs and campaign materials, and the campaign continued.

“We recruited local distributors and brought them in by pirogue to supply them with AQSP and campaign materials to carry out the activity. Supervision of the campaign was generally carried out by a small team, which took longer than usual, forcing us to make long detours by vehicle, sometimes three times the normal distance. This approach was also facilitated by the communities, who often came up with relevant suggestions for getting around the obstacles.”

Sidikou Issaka Maiga, National Malaria Control Programme (Research Unit), Ministry of Health, Niamey, Niger.

The Niger malaria campaign is one of 100 accounts published in Teach to Reach 11: Local action to mitigate the impact of the climate crisis on health, the twentieth Listening and Learning Report from The Geneva Learning Foundation (TGLF).

This article walks through eight things those workers taught us.

It is for the community health staff who are facing similar challenges, for the managers who make the plans, and for the global partners who fund and design the systems that surround them.

How to read what follows

Read it as the people who wrote it intended: as evidence of what works, told by the people doing the work.

The eight findings below are taken from the synthesis of contributor accounts in the report.

Each finding pairs a verbatim quote with what we can learn from it for three audiences: community health staff and volunteers, managers and planners, and global partners.

A separate companion article, What we should do with what health workers know, sets out recommendations that follow from these observations.

One contributor account does not prove what works everywhere.

It shows what is possible and what to test.

Where experience and routine data disagree, the question is not which to believe.

The question is why they differ.

What is in this evidence that is not in other evidence

Most climate-health evidence comes from formal research institutions in high-income countries.

The accounts in this report come from the people treating patients in the most climate-vulnerable countries in the world.

They tell the global research and policy conversation what is happening, who is doing it, and what it costs.

Finding #1: Track familiar diseases as they arrive earlier and reach further

“At the moment, the biggest problem in my community is management of plastic bottles. They are thrown everywhere in the city of Kinshasa, blocking all the sewage outlets, causing floods and loss of life. The piled-up bottles harbour mosquito larvae. Malaria has become very common in Kinshasa.”

Adhama Mirindi Tresor, Community health worker, Kinshasa, Democratic Republic of the Congo.

Across the contributions, the diseases that climate change is amplifying are familiar ones.

Malaria.

Cholera.

Diarrhoea.

Malnutrition.

Respiratory illness from harmattan dust.

Mental ill-health after a flood.

The pattern reported is that these conditions are arriving earlier in the season, lasting longer, and reaching places where they used to be rare.

Adhama Mirindi Tresor traces a chain that runs from urban waste to blocked drainage, to standing water, to mosquito breeding, to malaria in children.

The threat multiplier framing in the 2025 Lancet Countdown matches what workers in nineteen countries described from their clinics.

What can we take away from Finding #1?

• For community health staff and volunteers: The clinician who notices that a familiar disease has shifted its season or its geography is the first node in the climate signal. Documenting that shift, and sharing it with peers and supervisors, gives the system the evidence it needs.
• For managers and planners: The protocols health workers are following were written for a climate that no longer exists. Several contributors describe adapting in practice without waiting for formal revision. The question for a planner is whether the formal protocol has caught up with what clinicians are already doing.
• For global partners: Climate-health investment that searches for new diseases will miss the actual signal. The signal is in malaria caseloads in Kinshasa during a season when malaria used to subside, and in plastic waste that has become mosquito infrastructure.

Finding #2: Build the alternative route before the road closes

“In October 2024, Mali was hit by flooding throughout the interior regions, including the capital Bamako. As a result, the problem of access to basic social services arose. To get around this difficulty, the population was obliged use makeshift boats, pinasses and pirogues to reach the health centres.”

Dr Kassoum Barry, Medical doctor, Bamako, Mali.

In Mali, the population reached health centres in pirogues.

In Madagascar, some health districts used drones to supply health facilities during cyclones.

In Niger, the seasonal malaria chemoprevention campaign continued because local distributors were brought in by pirogue.

In Ghana, Ofosu-Kwabi Nasas reports that during the rains “people who can paddle canoes come in and help.”

The first response to access collapse is always local and improvised.

It is not a substitute for the formal system.

It is what the formal system depends on without naming.

What can we take away from Finding #2?

• For community health staff and volunteers: The alternative routes that worked were the ones mapped before the rains, not during them. Knowing which fisherman has a pirogue, which youth group can dig drainage, and which higher-ground building can become a temporary clinic is part of climate readiness.
• For managers and planners: District emergency plans rarely list canoe operators by name. The contributors’ accounts suggest they should. Authorisation to use local transport without case-by-case approval is the difference between a midwife arriving in time and a patient being lost.
• For global partners: The cost of a motorbike and the airtime to coordinate is paid out of pocket by health workers. Pre-positioned supply caches in climate-related disaster-prone districts and a reimbursement line for climate-related transport are small budgetary items that change what a worker can do on the day of the flood.

Finding #3: Recognise community financing as health financing

The Ngandajika women’s solidarity fund, featured in the launch communication for this report, is one example of a wider pattern in the contributions.

In Mali, Fousseyni Dembele describes a rapid multi-sector needs assessment after a flood that produced water, treatment for malnourished children, and vaccination through mobile clinics, financed through partner pooling.

In Ethiopia, community members made local materials available to construct temporary sheds for health workers during a rotavirus outbreak.

In Cameroon, community members in Kavumu bought a plot of land and built a health centre themselves.

Such initiatives already exist.

Health systems frequently do not see them.

What can we take away from Finding #3?

• For community health staff and volunteers: The women’s groups, savings groups, and traditional birth attendants in your catchment area are health system actors during a flood, whether the formal system labels them as such or not. Knowing them by name and knowing what they can do is part of preparedness.
• For managers and planners: The community financial structures in your district are infrastructure. Treating them as such, and including them in maternal health and emergency plans, costs little and changes who survives a flooded labour.
• For global partners: Cash transfer programmes designed in capital cities can compete with rather than reinforce existing solidarity funds. The contributors’ accounts suggest that financial protection mechanisms work better when they channel through what people have already built.

Finding #4: Treat communities as builders, not beneficiaries

“The community played a vital role. Local cyclists provided their bikes, and the Organization donated food and clothing for most affected families. Local volunteers were trained to identify and refer critical cases. They also helped in the distribution of emergency supplies to the elderly and orphans.”

Bridget Mark Udoaka, Public Health officer, NGO, Akwa-Ibom State, Nigeria.

Across the contributions, communities are not waiting for external help to arrive.

In Akwa-Ibom State, local cyclists provided their bikes, volunteers were trained to identify and refer critical cases, and high-ground community centres were converted into temporary shelters and healthcare hubs.

In Burkina Faso, village midwives were trained to assist in childbirth in communities cut off during the winter months.

In Cote d’Ivoire, Okou Gbouhouri Marius Romeo describes a community that, once aware of the danger, made available a team of volunteers to clean flooded areas and a team to learn how to disinfect wells.

What can we take away from Finding #4?

• For community health staff and volunteers: Community-built infrastructure and community-led volunteer teams can serve people in the gap between disaster and formal reconstruction. Documenting these structures and connecting them to district planning is how they become permanent.
• For managers and planners: A formal pathway that brings a community-built facility, a trained village midwife, or a volunteer well-disinfection team into the official health system is a quiet structural reform that the contributions show is overdue.
• For global partners: Reconstruction funding that arrives in months arrives after the community has already moved on. Rapid mechanisms that can reach community-led action in weeks match the timeline of an extreme weather event.

Finding #5: Run telemedicine on the tools workers already have

“We had to innovate. For the first time, we piloted telemedicine services using satellite phones to connect with doctors in urban areas for complex cases.”

Antony Okungu, multi-country

When access to a clinic collapses, contributors describe building remote-care arrangements out of whatever communication they have.

Antony Okungu piloted satellite-phone telemedicine for the first time during a flood.

Malick Ndome in Kolda, Senegal, distributed telephones to women in labour so midwives could give advice while they waited.

Mambo Zadiya Merveille in Lubumbashi describes remote consultations to reach otherwise unreachable facilities.

As far as we know, none of these were funded telemedicine programmes.

They were ordinary clinical work running on extraordinary improvisation.

What can we take away from Finding #5?

• For community health staff and volunteers: The WhatsApp group with pharmacies, volunteers, and high-risk patients is the telemedicine programme. Setting it up before the flood makes the difference between continuity and missed appointments.
• For managers and planners: Improvised telemedicine carries clinical risk that workers are absorbing alone. A documentation and liability framework that recognises these consultations protects both patients and the workers covering them.
• For global partners: Workers have already built the telemedicine system. The question is whether they have device access, airtime, and authorisation to keep running it.

Finding #6: Make community trust an explicit objective, not an assumption

“The community’s response was a mixture of cooperation and resistance. While many villagers welcomed our efforts and actively participated in creating temporary clinics, others were hesitant to engage due to fears of further flooding or distrust of external interventions. Educating them about the importance of seeking care and dispelling misconceptions required significant effort.”

Habila Christiana Habu, Community health worker, Ministry of Health, Taraba State, Nigeria.

Habila Christiana Habu names the constraint that supplies and logistics cannot fix.

In Taraba State, a portion of the community refused to engage with the flood response.

The reason was not absence of services, but distrust built up over years of external interventions that did not return.

Bridget Mark Udoaka in Akwa-Ibom State, Joseph Mbari Ngugi in Murang’a County, and Bernic Ameko in the Ashanti Region of Ghana describe variations of the same pattern.

In each account, sustained communication over time was what shifted it.

What can we take away from Finding #6?

• For community health staff and volunteers: The relationships that hold during a flood are the ones built years before. Showing up consistently in the dry season is part of the flood response.
• For managers and planners: Trust is a measurable outcome. It can have a budget line, a target, and a person responsible for it. None of the contributors described having one.
• For global partners: A grant cycle of twelve months is shorter than the time it takes to build trust in a community that has been let down before. Multi-year, presence-based funding is one of the implications of these accounts.

Finding #7: Stop letting health workers absorb the cost of climate adaptation alone

“I have to hire a motorbike and sometimes the road is so slippery and you fall down in the mud, and the next day you even get sick. I love my profession so much such that I am still working even in such a harsh conditions.”

Anonymous midwife, Ministry of Health, Tarime District Council, Tanzania.

The midwife in Tarime hires the motorbike out of her own pocket.

Keku Evans De-Clerk in Ho West District, Ghana, spends four days at a time travelling between hard-to-reach communities on roads that no car can cross.

In Sindh Province, Pakistan, Dr Khalid Hussain Memon describes finding the Medical Superintendent of a flooded rural health centre still on duty on the upper floors of houses, treating patients with whatever medicines were left.

Across the contributions, the personal cost of keeping services running during climate disruption is absorbed by individual workers, in money, time, and physical risk, with no reimbursement structure described.

What can we take away from Finding #7?

• For community health staff and volunteers: Recording out-of-pocket costs and the days lost to weather-related injury makes a structural pattern visible. It is also evidence that managers and global partners need.
• For managers and planners: The dedication of frontline staff is currently a hidden subsidy to the health system. The accounts in the report make it visible. The question is whether it stays a subsidy or becomes a budget line.
• For global partners: Health worker protection is climate-health investment. Reimbursement for transport, equipment, and weather-related sick days is a measurable line item that changes whether a worker can still reach a patient in five years.

Finding #8: Plan for floods, droughts, heatwaves, and cyclones together

“Extreme weather events in the Himalayan hills in Uttarakhand generally pose a challenging situation and increase people’s vulnerabilities because of its difficult geography. The biggest issue is the accessibility of people to healthcare facilities due to disruption in road connectivity. It was advised that pregnant women with an expected date of pregnancy within two weeks should shift nearer to the community health centre or district hospital so that they could reach the hospital in an emergency.”

Dr Mahesh Bhatt, Doctor, NGO, Garhwal Region, Uttarakhand Himalayas, India.

The same district often faces several climate hazards in succession.

Flooding in the rainy season, drought before it, harmattan dust in December and January, cyclones in Madagascar, snow that cuts mountain villages in Morocco, landslides on Himalayan roads in Uttarakhand.

Dr Djah Olivier Raphael in Cote d’Ivoire describes the harmattan dry season generating a high incidence of respiratory illness in children under five and pregnant women.

Dr Mahesh Bhatt’s response, relocating high-risk pregnancies to within reach of a hospital before the road becomes impassable, treats the hazards as a single integrated emergency rather than a sequence of separate ones.

What can we take away from Finding #8?

• For community health staff and volunteers: A single emergency plan that names the hazards your district actually faces, in the order they arrive, is more useful than separate plans for each one.
• For managers and planners: District microplans that adjust outreach calendars to the local climate calendar reach zero-dose children and high-risk pregnancies before access closes. Several contributors describe doing this informally. None describe it as a formal requirement.
• For global partners: Climate-health funding that arrives by hazard, with separate envelopes for floods, drought, and heat, mismatches the integrated emergencies workers are responding to. Funding mechanisms that match the local climate calendar work better.

Reference

The Geneva Learning Foundation. Teach to Reach 11: Local action to mitigate the impact of the climate crisis on health. Listening and Learning report 20. The Geneva Learning Foundation, 2026. https://doi.org/10.5281/zenodo.18246203

La Fondation Apprendre Genève. Teach to Reach 11: Actions locales face à l’impact du changement climatique sur la santé. Rapport « Écouter pour Apprendre » n° 20. La Fondation Apprendre Genève, 2026. https://doi.org/10.5281/zenodo.19069576