Between July 2023 and June 2026, a nascent global community of health and humanitarian workers connected to learn from and support each other. Working with The Geneva Learning Foundation (TGLF), they built something that does not yet have a settled name in global health: a way to treat the observations of community-based health workers as evidence about climate change, gathered at a scale that no survey instrument had reached before, and returned to those workers as a basis for action.
This review reads the full body of that work, the reports and the three years of writing around them, and asks what it amounts to. Could this be an obviously-missing layer of the global response: the connective tissue between commitments made in conference halls and the communities where those commitments either reach people or come to nothing?
The Geneva Learning Foundation, or TGLF, is a non-profit research organization based in Geneva. TGLF researches, develops, and implements massive, open learning networks to support local leadership and action.
We write this review for partners, including planners, policymakers, funders, and researchers, who may know none of this.
For a reader who wants the conclusion first, here is what makes this work distinctive, argued in full in the closing section.
- It treats frontline experience as evidence and as early warning.
- It has a repeatable system that carries that evidence from a clinic in Cameroon to a peer-reviewed journal and back into local action.
- It occupies the layer between global commitments and the communities those commitments are meant to reach, a layer almost nobody else is working in.
- It costs a fraction of conventional approaches and works in fragile and conflict-affected settings where those approaches fail.
- And it treats health workers as producers of knowledge, not as recipients of training.
Everything between here and the end is the evidence for those five claims.
Here is the recurring question: why do we devalue the “self-reported anecdote” and simultaneously reify “lived experience”?
The accounts quoted throughout come from real health workers describing real experiences, collected with their consent through TGLF’s events and surveys.
They are self-reported and, in the words of the reports themselves, not independently verified.
Where a worker chose to remain anonymous, the experience is no less real, only the name is withheld.
This is a deliberate epistemic stance, examined directly in the section on anecdote and evidence, not a flaw to be hidden.
Where numbers vary across documents, this review states the variation rather than smoothing it.
A midwife saves twins during a flood, and writes it down
Start with one account, because the whole argument is contained in it.
In Bomaka, near Buea in Cameroon, a midwife named Geh Raphaela Agwa attended a woman who had been in labour for hours during a storm so heavy that the roads had flooded and a car could have been swept away.
The woman reached the clinic late, her waters already broken.
It was a cord presentation.
There was a twin.
The second twin was already in bradycardia.
The team operated in time, and both children lived.
After it was over, Agwa wrote it down.
Not for a medical journal, and not for a technical report.
She wrote it for Teach to Reach, a peer learning platform, community, and network run by TGLF, where health workers from low- and middle-income countries describe how climate change is reaching their communities and what they are doing about it.
In the same account, she noted that her neighbours had not waited for a policy response either.
The quarter heads had called on every household to dig the gutters so that vehicles could move through the water even at the height of the storm.
TGLF’s Reda Sadki quotes Agwa’s account twice: in his article announcing the May 2026 report about health workers leading community responses to climate change impacts on health, and again to close his March 2026 essay on the WHO climate-health alliance.
That single account holds the entire body of work.
There is a climate signal, a health consequence, a community response that preceded any official one, and a written record that exists only because a system was built to capture it.
A global instrument like the Belem Health Action Plan, if it is implemented well, will succeed precisely because it is rooted in knowledge like Agwa’s, with health workers recognized as trusted advisers to the communities the plan is meant to serve.
The work this review describes is the system that turns what she knows into evidence that such a plan can act on.
It began with vaccines: how an immunization network turned to climate
TGLF’s climate and health work did not begin with climate.
It began with vaccines.
By November 2022, TGLF was already running a large peer learning network of more than 47,000 health practitioners across 93 active country networks, with its largest single-country network reaching over 10,000 people.
The Foundation’s information brief for partners from that month describes the method that would later carry the climate work: intrinsic motivation, peer-to-peer learning across system levels and borders, and a pathway from learning through to implementation.
During the pandemic, more than 6,000 immunization staff from 86 countries had built recovery projects together through a COVID-19 peer hub, with more than a third reporting implementation within three months.
The infrastructure existed.
So did the proof that it worked.
The conceptual leap to climate is made in a short essay by Reda Sadki, What does immunization have to do with climate change?, published on 21 July 2023.
Immunization staff, he argues, are already trusted observers embedded in their communities, and climate change is expanding the demand for exactly that role.
A companion call to action, Learning from frontline health workers in the climate change era, written by Sadki and Charlotte Mbuh with Julie Jacobson and Alan Brooks of Bridges to Development, states the principle that recurs through everything that follows: the hyperlocal impact of climate change on health cannot be addressed through global pronouncements alone, and frontline workers, most of them women, must be heard from a position of equity, not hierarchy.
The response was larger than expected.
Distributed through the Movement for Immunization Agenda 2030 and the Teach to Reach community, the call drew over 4,500 registrations before two parallel digital events, one in English and one in French, ran on 28 July 2023.
By the time the events closed, 4,700 health workers from 68 countries had taken part, and a follow-up citizen-science session ran on 2 August 2023 with the UCL Institute for Global Prosperity.
This was the founding moment, and it is worth being exact about what it was: not a campaign, but the first time a peer learning network built for immunization turned its method to climate and health.
The first report: 1,200 health workers as eyewitnesses at COP28
The two events produced the first major output, published at the twenty-eighth Conference of Parties known as “Cop28”, on 1 December 2023: On the frontline of climate change and health: a health worker eyewitness report, the seventh in TGLF’s Listening and Learning series.
It synthesizes structured survey responses from 1,260 registrants and written testimony from more than 1,200 practitioners, almost three-quarters of them working at the sub-national level.
It lists 1,028 named contributors in an honour roll.
The numbers establish a baseline.
Average concern about climate change was 4.47 on a Likert scale of 1 to 5.
93% of respondents believed climate change and health were linked.
The three most commonly reported health impacts were malnutrition at 59.3%, waterborne disease at 59.2%, and shifting vector-borne disease at 51.1%.
Women were more likely than men to report impacts across most categories, with the largest gap in mental health.
What gives the report its character is the testimony.
Samuel Chukwuemeka Obasi, of the Ministry of Health in Abuja, Nigeria, described returning to the community where he grew up to find rivers he once needed a boat to cross now shallow enough to walk through.
Coulibaly Seydou, in Boussé District, Burkina Faso, described farmers slipping into minor depression as they watched crops wither, “even just a couple of days without rainfall” enough to trigger sadness.
Dr Muhammad Taimoor, working with WHO in Somalia, described 4.2 million people in camps after prolonged drought, with malnutrition, cholera, and vaccine-preventable disease among the displaced.
The report is unusually careful about what this testimony is and is not.
It states plainly that the experiences “are not intended to prove that climate change is happening or that it is affecting human health,” because rigorous science has already done that.
Their value is to bring that science to life and to show how it lands locally.
It also states its limits: the contributions are self-reported, unverified, and drawn from a self-selecting group of committed experience-sharers.
The report was carried into the world through three channels in two weeks.
On 30 November, the Gavi VaccinesWork blog published Ian Jones’s collection of ten eyewitness reports from the frontline of climate change and health.
The launch announcement, Investing in the health workforce is vital to face climate change, framed the headline argument, that to maintain trust in climate science and policy, you have to invest in the workforce that communities rely on to make sense of change.
And on 11 December, Charlotte Mbuh delivered the argument in person at the COP28 Health Pavilion.
“What we know, we know because we are here every day”: the argument at COP28
The COP28 speech deserves its own section, because it states the intellectual core of the work more plainly than any later text.
TGLF’s Charlotte Mbuh, an immunization worker with more than fifteen years in Cameroon’s Ministry of Health, spoke at the COP28 Health Pavilion as one of more than 5,500 health workers then connected through TGLF.
The speech is reproduced in Climate change is a threat to the health of the communities we serve.
She read out testimony from colleagues, then confronted the skepticism directly, quoting hostile online comments that asked since when health workers were authorities on air pollution or water quality.
Her answer is the sentence the rest of the work turns on.
“Unlike scientists or global agencies, we cannot be dismissed as experts from on-high. What we know, we know because we are here every day. We are part of the community.”
The move here is subtle and important.
Mbuh does not claim that health workers are climate scientists.
Her claim is that their authority comes from being present every day in the community, which is exactly what an expert from on-high can never be.
She then connected this to trust, drawing on her immunization background: better science and policy, developed over years, will be rejected by communities that have no trusted local messenger.
Trust works as a determinant of whether health interventions succeed at all, well upstream of any communication strategy.
The immunization precedent is the proof of concept, since vaccine coverage fails for lack of trusted actors at least as often as for lack of science.
This is the founding articulation of what TGLF later calls the health worker as knowledge creator.
It is worth dwelling on because everything analytical that follows, the epistemic argument, the literature critiques, the decolonial turn, is an elaboration of the claim Mbuh made in one paragraph, speaking from Dubai.
Anecdote or evidence: why dismissing what health workers see is an injustice
Through 2024, the work moved from assertion to a developed theory of knowledge.
This is the most distinctive contribution of the entire body of work, and the one most likely to matter to researchers.
It begins with a critique of the literature on the literature’s own terms.
In a commentary by Reda Sadki and TGLF’s First Climate and Health Fellow Dr Luchuo E. Bain, What about the epistemic significance of health worker knowledge?, the two authors read the scoping review by Klepac and colleagues, which synthesized 511 papers on climate change, malaria, and twenty neglected tropical diseases published between 2010 and 2023.
Only 34% of those papers considered mitigation.
Only 5% considered adaptation.
The commentary draws the obvious inference: if the formal literature is this thin on what to actually do, the experiential knowledge of the people already doing it is not a luxury.
It introduces Miranda Fricker’s concept of epistemic injustice, the wronging of someone in their capacity as a knower, and connects it to the decolonization arguments of Seye Abimbola and Madhukhar Pai.
The argument deepens in Reda Sadki’s essay, Anecdote or lived experience: reimagining knowledge for climate-resilient health systems.
The phrase “it is just anecdotal,” he argues, is a way of delegitimizing knowledge that does not fit established methods.
Against it, the work reaches for Donald Schön’s knowing-in-action and James Scott’s metis, the practical knowledge that comes from sustained, intimate engagement with a place.
A health worker who notices malaria arriving earlier in the season is detecting a signal that formal surveillance might take years to confirm.
Calling that signal an anecdote does not make it less real.
The question the work poses is sharp and fair: is the risk of acting on that signal greater than the risk of waiting?
The critique then turns on the field’s flagship document.
In a second essay, Critical evidence gaps in the Lancet Countdown on health and climate change, Sadki identifies a paradox in the 2024 report.
The Countdown acknowledges that health workers are “already intimate witnesses to the impacts of climate change,” yet its methodology privileges internationally standardized data and does not integrate that witness. Its data are rarely disaggregated by indigeneity, gender, age, or ethnicity.
A third essay, Strengthening primary health care in a changing climate, makes the same move against a Lancet article by Andy Haines and colleagues, arguing that it treats health workers as passive recipients of training rather than as creators of knowledge, sidelining what Aristotle called phronesis.
The argument is disciplined throughout.
It does not ask to replace scientific method.
It asks to widen what counts as evidence and to build the methods that would let different ways of knowing inform each other.
That restraint is what makes it credible rather than merely provocative.
From Algiers to Acre: when a silent frog is data
In September 2025, the argument found its deepest root.
Reda Sadki’s essay, Colonization, climate change, and indigenous health: from Algiers to Acre, opens with a personal account: a mother sent to a tuberculosis sanatorium in colonized Algiers, told the disease marked her people as inferior, and an independent Algeria that eliminated that scourge within years of freedom.
The essay then sits in a conference hall in Rio Branco, Acre, at Brazil’s First National Seminar on Indigenous Health and Climate Change, and hears the same colonial lie being dismantled.
The testimony of the indigenous leaders carries the section.
Ceiça Pitaguary describes the crisis as “real losses experienced in the body and on the territory” and declares that the fight against the climate crisis “will not be won without Indigenous peoples.”
Elisa Pankararu names a “collective sadness.”
Weibe Tapeba, Brazil’s Secretary of Indigenous Health, diagnoses the structural trap: indigenous territories cannot issue their own decrees, and so cannot formally prepare for or respond to disaster.
The sharpest moment is Putira Sacuena’s account of a small frog in the Xingu territory whose silence, across generations, preceded outbreaks of respiratory illness and diarrhoea.
“We stopped hearing its sound in the territory,” she says. “This is ancestral science.”
The essay’s section title makes the claim explicit: what you call anecdote, we call ancestral science.
This is where the epistemic argument and the structural one fuse.
The same colonial logic that once dismissed indigenous health knowledge, the essay argues, dismisses the frontline health worker today.
The fight for health becomes, in the author’s own words at the seminar, “a fight for cognitive justice, a demand that such knowledge be seen not as a cultural artifact, but as essential data.”
For a funder or researcher, this section reframes the entire enterprise.
What might look like a programme that collects stories is, at root, a position on whose knowledge the apparatus of science is built to see.
The numbers behind the case: five billion disease cases and a workforce short by millions
The work does not rest its case on testimony alone.
It reads the quantitative literature closely and sets the workforce question against it.
Reda Sadki’s reading of the World Bank, The cost of inaction: quantifying the impact of climate change on health, reviews the largest figures.
By 2050, in low- and middle-income countries alone, climate change is projected to drive 4.1 to 5.2 billion additional disease cases, 14.5 to 15.6 million deaths, and 8.6 to 20.8 trillion dollars in costs, with sub-Saharan Africa bearing roughly 71% of cases.
His commentary written around the COP29 climate summit, Health at COP29: workforce crisis meets climate crisis, places this against the WHO projection of a shortage of 10 million health workers by 2030, six million of them in climate-vulnerable sub-Saharan Africa.
His report on the WHO Global Conference on Climate and Health, held in Brasilia in 2025, WHO Global Conference on Climate and Health: new pathways to overcome structural barriers, adds the shock that reframes everything: roughly 70% of global health funding contracted almost overnight.
The 2025 Lancet Countdown, read in Reda Sadki’s analysis How the Lancet Countdown illuminates a new path to climate-resilient health systems, supplies the current state of harm: 13 of 20 indicators at record highs, heat-related mortality at 546,000 deaths a year, a 63% rise since the 1990s.
The work’s consistent argument is that these numbers describe a demand curve that conventional supply cannot meet.
Flying experts in to run workshops and cascading training down hierarchies is slower and more expensive at exactly the moment when funding has collapsed and the workforce is short by millions.
The critique of the World Bank report is precise and not dismissive: the report quantifies the crisis well but undervalues the workforce as a determinant of adaptive capacity.
The point for funders is direct.
If the problem is this large and resources are contracting, the question is which approaches scale when money is tight, and that is an empirical question the next section addresses.
How listening becomes action: Teach to Reach and the Accelerator
The critique comes with a mechanism, and the mechanism is what separates this work from advocacy.
It is repeatable, and it has been run many times.
Teach to Reach is an ongoing peer learning programme that culminates in an online experience-sharing and networking event.
Learning starts before the event, when participants reflect on local challenges and share formative experiences, and continues after, when they consider how to adapt what they heard.
The network grew from 2,604 participants at its launch in March 2021 to 24,610 registered for Teach to Reach 11 on 5 and 6 December 2024.
The participant profile is the part that matters most.
At that edition, 62% worked in remote rural areas, 47% with the urban poor, 25% with refugees or displaced people, and one in five in areas of active armed conflict.
These are precisely the settings where expert-led capacity building is hardest and most expensive.
The conceptual frame for what the formal system misses comes from a talk Reda Sadki gave at the London School of Hygiene and Tropical Medicine in December 2025, written up as Planetary health: from ground truth to local action at global scale.
The talk names a “dark matter” of implementation: the hyperlocal adaptation, the hidden mental health burdens, the community coping mechanisms, and the subtle shifts in vector behaviour that formal research rarely captures.
The hypothesis, stated as a falsifiable claim, is direct.
You can build a system in which an anecdote becomes an eyewitness report, and an eyewitness report becomes local action.
That last step is the work of the Impact Accelerator.
Running since August 2019, it follows a simple weekly and monthly rhythm.
On Monday, a participant commits to one concrete action they can complete by Friday.
Midweek, they compare notes with peers facing the same kind of challenge.
On Friday, they report what happened, including what failed, and the next Monday they set the next goal with that experience behind them.
Expert guides sit beside the process rather than running it.
The Accelerator answers the obvious objection, that prioritizing context over content might let workers act on unproven strategies.
The commitment each participant makes is to secure their supervisor’s approval, to act in line with national strategies and plans, and to use the best available global knowledge as they go.
So the method raises adherence to proven protocols, such as WHO heat-stress and malaria guidance, while leaving the analysis of the local situation to the person who lives in it.
The performance figures are specific, and they should be cited with their basis stated.
Measured against conventional technical assistance and cascade training, the work reports implementation roughly seven times faster and cost roughly 90% lower.
In a Ministry of Health initiative in Cote d’Ivoire, 82% of participants continued using the method without further support, and 78% said they needed no further external assistance.
These results derive substantially from a July 2019 immunization cohort and from measurement by independent researchers against a comparison group.
Not a course, a support system for local action
The most recent phase puts the whole argument to work.
It turns the evidence into something a health worker does, not something a health worker is taught.
This is the distinction that matters, and it is easy to miss because the word used is “course.” These are not courses in the ordinary sense of knowledge passed from an expert to a student.
They are stages in a single support system, grounded in the learning theory developed by Reda Sadki over 15 years of practice, where the learner is treated as a knowledgeable practitioner whose own experience is the primary text.
The aim throughout is for each local leader to analyze their own situation, find the root causes of the challenges they face, and map and carry out the actions that address those causes.
The system has a shape.
- A Primer mobilizes a large network around a shared problem in short, text-only readings that respect a working professional’s time.
- A peer learning course, built from an insights or listening report, lets a practitioner learn from hundreds of documented peer experiences and write their own plan.
- A sixteen-day peer learning exercise takes a single challenge through development, peer review, and revision.
- The Impact Accelerator then stays alongside the participant as they implement, week by week.
At each stage the learner produces something usable in their own context, and the certificate that follows documents what they did, not how long they sat through a screen.
The climate and health curriculum was born from the reports themselves.
As Reda Sadki recounts in a short history of the first five years of Teach to Reach, there was so much in the first eyewitness report that TGLF built an entire Certificate peer learning programme for leadership in climate change and health to help workers make sense of it and put it to use.
The inaugural course, Learning together to lead change on the frontline of climate change and health, launched in August 2025 and is built directly on that first report, the testimony of more than 1,200 workers from 68 countries.
Leading change on the climate and health frontline: learn, take action, and get certified
Share your experience and learn from colleagues about leadership in climate change and health. Learn more and enrol in this certification from The Geneva Learning Foundation: CLIMATE-EN-02 Learning together to lead change on the frontline of climate change and health
It announced the programme in a new peer learning programme by and for health workers from the most climate-vulnerable countries.
The curriculum has grown as the evidence has grown.
- A One Health primer treats malaria, zoonotic disease, antimicrobial resistance, and climate-driven outbreaks as one problem seen through different windows, and helps a worker map the connections in their own district and plan one cross-sector action using resources they already have.
- A course built with Save the Children, Our common ambition: prioritising children’s health amidst the climate crisis, turns the organization’s policy guidance into a peer learning experience for workers in more than 80 countries, anchored on the finding that children born today will face six times more heatwaves than children born sixty years ago.
- The newest course is the one to watch, because it closes the loop the review has been tracing. Climate change is harming your community’s health: what you can do now is built directly on the May 2026 insights report.
The evidence that health workers generated in Teach to Reach 11 becomes, within months, the material that other health workers use to plan their own response.
Children’s health and climate change: learn, take action, and get certified
Share your experience and learn from colleagues about children’s health amidst the climate crisis. Learn more and enrol in this certification from The Geneva Learning Foundation: CLIMATE-EN-01 Our common ambition: prioritising children’s health amidst the climate crisis
Listening generates insights, insights become a course, and the course becomes action, supporting the emergence of new leadership for change.
Climate change and health: learn, take action, and get certified
Share your experience and learn from colleagues about local action on climate change and health. Learn more and enrol in this certification from The Geneva Learning Foundation: CLIMATE-EN-004 Climate change is harming your community’s health: what you can do now
Completion routes a participant onward into the REACH network of more than 4,000 locally led organizations and into the Accelerator.
The partnership with the Global Consortium on Climate and Health Education, the largest academic network for climate and health education, based at Columbia University, gives the system its missing complement.
Expert-led scientific education and frontline peer learning have tended to talk past each other.
The three-year agreement builds pathways between them, so a practitioner can move from a Consortium course into TGLF’s network for support to apply it, the experience practitioners share informs what the Consortium teaches, and the partners run the Accelerator for selected cohorts.
Knowledge moves in both directions, which is the condition the whole body of work has argued for.
6,436 voices: the largest survey of its kind, now entering peer review
In 2025, the listening reached a new scale.
The Global Climate Change and Health Survey, developed with support from Grand Challenges Canada and disseminated through Teach to Reach and partner networks, gathered responses from 6,436 health and humanitarian workers, of which the TGLF network contributed about 3,900, or 61%.
Reda Sadki describes the survey and its reach in his March 2026 essay The road to transformative action on climate and health: what we can learn from the ATACH evaluation.
The partner network behind it spanned 107 organizations across 28 countries, collectively reaching more than 15 million people.
The work describes it as almost certainly the largest exercise of its kind to capture first-hand practitioner experience of climate health impacts in low- and middle-income countries, and that claim is plausible given the numbers.
The survey is the bridge from a peer learning network into the formal evidence base, and it is the strongest single signal that health worker experiences are critical to making sense of the impacts of climate change on health.
The first formal evidence base for local action on climate and health
Every section before this one has argued that frontline experience deserves to count as evidence.
In May 2026, that argument acquired a new proof of concept: a comprehensive insights report, built from a large and structured collection of experiences, that documents what local action on climate and health actually looks like.
The report is Local action to mitigate the impact of the climate crisis on health, the twentieth in TGLF’s Listening and Learning series.
Reda Sadki and Charlotte Mbuh it in his article announcing that health workers are leading community responses to climate change, draws out its findings in eight things health workers taught us about climate change and health, and converts those findings into 14 recommendations for health workers, national planners, and global partners.
What deserves attention here is the existence of the report itself, more than any single finding inside it.
For the first time, the local response to the climate crisis in health has a formal evidence base.
Frontline workers were asked four plain questions about their own practice.
What exactly happened.
What did you do.
How did you know it worked.
Did the community help, or make things harder.
The answers came in writing, in English and French, from contributors among the 24,610 health workers registered for Teach to Reach 11 from more than 70 countries.
One hundred detailed accounts were selected for full publication, drawn from at least 19 countries, with the largest groups in the Democratic Republic of the Congo, Niger, Nigeria, Cameroon, Kenya, Ghana, and Cote d’Ivoire.
The scale and the structure behind that collection are what give it standing.
A single vivid story would not.
What is in this evidence that is not in other evidence
The report names the gap it fills, in a sentence that should be read by anyone deciding where climate-health money goes.
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.
That knowledge answers a question the existing literature cannot.
The Lancet Countdown can establish that heat-related mortality is rising.
It cannot tell a district health officer which building becomes the temporary clinic when the road floods, or which fisherman owns the pirogue that carries the seasonal malaria drugs to a cut-off village.
The report supplies that second layer at a scale and geographic breadth that has not been available before.
It also changes what local action is understood to be.
Communities here are building, financing, and improvising health care faster than any external system could arrive.
The report sorts that activity into a usable taxonomy: two families of response, emergency action and the building of resilience, with 17 distinct kinds of action named across them.
A taxonomy is what turns a pile of stories into something a planner can plan against.
The discipline that makes it credible
The report is careful about what it is, and that care is part of why it can be trusted.
One contributor’s account is treated as a demonstration of what is possible and what to test, never as proof of what works everywhere.
Where a worker’s experience and the routine data disagree, the report holds both and asks why they differ.
That posture earns a hearing from researchers who would otherwise reach for the word anecdotal.
The honesty extends to the report’s own purpose.
Its first purpose, stated plainly, is to give back to the health workers who shared what they know, because they shared it to learn from each other and the synthesis belongs to them first.
Serving the policy audience comes second.
A report that orders its purposes this way is making a claim about whose knowledge counts, and it is living that claim on the page.
Why it lands now, and what it asks of each reader
The timing carries weight.
The 2025 Lancet Countdown opened a path to climate-resilient health systems that explicitly recognizes the value and significance of local knowledge.
The Belem Health Action Plan adopted after COP30 placed adaptation and community resilience at the centre of the global response.
Both depend on knowing what is happening at community level, what is blocking action, and what local solutions already work.
This is the report that supplies that knowing, at the moment the global frameworks need it and cannot generate it themselves.
The eight findings and the fourteen recommendations are best read in full, in the workers’ own words, through the companion articles linked above.
What the review carries forward is the shape of the argument they make together, addressed deliberately to three audiences at once.
- To the practitioner, the report says that the protocol you quietly rewrote during the last flood is evidence, and that writing it down and sharing it is how the system learns.
- To the national planner, it says that the women’s solidarity fund, the canoe operator, and the village-built health post are already part of the health system, and that a plan which fails to name them is planning against a system that does not exist.
- To the global partner, it says the sharpest thing of all. The cost of climate adaptation is already being paid, in money and in injuries, by frontline health workers and the communities they serve.
The midwife in Tarime hires her own motorbike.
What the report asks for is recognition, protection, and reimbursement of what already works, delivered on the timeline a flood actually runs on, which is weeks, against the timeline of a grant cycle, which is years.
The report’s own closing test is the right one to end on.
The people are named.
The places are real.
The actions are within reach.
The question is whether the systems that surround them will listen and learn.
What does ‘local-to-global’ mean for climate change and health?
The most useful single framing for partners and funders comes from Reda Sadki’s March 2026 article, The road to transformative action on climate and health: what we can learn from the ATACH evaluation.
The Alliance for Transformative Action on Climate and Health, or ATACH, hosted by WHO, launched at COP26 in the same year as Teach to Reach.
By early 2026 it had grown from 50 founding members to more than 200, including 103 country members, and had contributed to the Belem Health Action Plan and to health indicators for the UNFCCC Global Goal on Adaptation.
The self-evaluation, led by Cambridge Economic Policy Associates, found that over 80% of country members agreed it had made a significant contribution to its mandate.
It also found, after about 7 million dollars and three and a half years, that 2 of 14 country members interviewed in depth could attribute a national policy change to it.
And that no health outcome data of any kind could be discerned.
ATACH operates where commitments are made, with the ear of ministers, UNFCCC negotiators, and WHO leadership.
Teach to Reach operates where commitments either reach communities or fail there unseen, with more than 80,000 health workers and over 4,000 locally led organizations.
The two are the top and the bottom of the same causal chain, and what neither currently provides is the connection between them.
For a funder deciding where a marginal dollar does the most good, that gap is the investable proposition, and it is stated more clearly here than anywhere else in the corpus.
This is why the ATACH reading ends with Geh Raphaela Agwa, the midwife from the opening of this review.
She also answered the global survey.
A plan agreed in Belem and the gutters her neighbours dug in Bomaka belong to one system, and that system works best when each layer can reach the other.
Build the rungs between them, and what Agwa knows informs the plan while the plan finally reaches Agwa.
The work argues that those rungs are the part still missing, and that peer learning is how they get built.
This is also where the network figures should be kept precise, because the work itself is careful about them.
The overall TGLF network is more than 80,000 health workers across 137 countries.
Teach to Reach and the REACH network of locally-led organizations span 70-plus countries.
Teach to Reach 11 had exactly 24,610 registered participants.
These are distinct measures of distinct things, and conflating them weakens the case rather than strengthening it.
The field catches up: the Lancet Countdown and Bill Gates move closer
Two developments in late 2025 suggest the field is converging on positions TGLF’s work had held for years.
The first is Reda Sadki’s essay on Bill Gates’s pivot to “development is adaptation,” Development is adaptation: Bill Gates’s shift is actually about linking climate change and health.
Gates argued, just before COP30, that the metric for climate action should be measurable improvement in the lives of the most vulnerable, not temperature or emissions alone.
For nearly a decade, Sadki explains, TGLF had been arguing that meeting these challenges requires strengthening the connective tissue of the health system, its workforce.
The second is the 2025 Lancet Countdown itself, read in Reda Sadki’s companion article What the Lancet Countdown says about the value and significance of local knowledge and action.
For the first time, the Countdown’s country profiles integrate direct testimonials from frontline health workers and explicitly name their lived experiences as valuable evidence.
It now states that community-led actions are “more likely than top-down interventions to maximise health benefits.”
Sadki welcomes this while marking its limit: the same report still frames health workers as people to be educated and trained because they are unprepared, rather than as creators of knowledge.
The shift is real but incomplete, and naming both halves is what keeps the analysis honest.
For a researcher or funder, the significance is that the work is not arguing against the mainstream from outside it.
The mainstream is moving toward the work.
That changes the question from whether the argument is right to whether the field will build the mechanism the argument requires.
What is unique, and why it matters now: the five dimensions, with the evidence behind them
The orientation at the top of this review made five claims about what is distinctive here.
Having walked through the evidence, we can now state each one with the proof attached.
1. The epistemic claim
The work treats frontline experience as evidence and as early warning, and it engages the Lancet Countdown, the Klepac review, and the World Bank on their own terms.
The proof is the eyewitness report, the Anecdote or lived experience argument, and the 2025 Countdown moving toward the same position.
2. The methodological claim
The work runs a repeatable system, Teach to Reach and the Accelerator, that carries evidence from listening to documented local action.
The proof is the growth from 2,604 to 24,610 participants and the measured comparison against conventional training.
3. The structural claim
The work occupies the layer between global commitments and local implementation.
The proof is the ATACH evaluation, which found strength at the top of the chain and silence at the bottom.
4. The economic claim
The work is low-cost, fast, and sustainable where conventional approaches fail.
The proof is the Cote d’Ivoire continuation figures set against a 70% funding contraction.
5. The ethical claim
The work returns knowledge to the community and treats health workers as authors.
The proof is the certificate programme built by and for workers in the most climate-vulnerable countries, and the recommendations written for them rather than about them.
What matters now, more than ever?
The reason this matters now is a convergence.
Global health funding has contracted sharply.
The World Health Assembly has an approved climate and health action plan but no proven mechanism for community-led implementation.
The workforce is projected to fall short by 10 million.
And the most influential voices in the field, from the Lancet Countdown to Bill Gates, are moving toward the position that adaptation means improving the lives of the most vulnerable.
In that environment, the layer this work has built between global plans and local action is no longer optional.
It is the part of the system that decides whether better science and policy reach anyone at all.
Three years of this work can be read as one long argument for taking Geh Raphaela Agwa seriously.
Not as a beneficiary to be reached, but as a colleague who already knew what to do during the flood and wrote it down so that a midwife in another country might learn from it.
The contribution of The Geneva Learning Foundation is to have built the system that can hear her, at the scale of tens of thousands, and turn what she knows into action others can use.
The harder question belongs to the people reading this review.
The mechanism exists, it is cheap, and it works where almost nothing else does.
Whether it connects to the conference halls above it is now a decision for partners, funders, and researchers, not a problem for Agwa to solve alone in the rain.
References
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