The Alliance for Transformative Action on Climate and Health is a voluntary coordination platform hosted by the World Health Organization, which provides its Secretariat. In early 2026, Cambridge Economic Policy Associates completed a formative evaluation of ATACH’s first year under its 2024 to 2028 strategy, assessing both what the alliance has achieved and where it needs to go. This article offers a close reading of that evaluation: not to diminish what ATACH has built, which is real and important, but to ask what it will take for the Alliance to move from its demonstrated strengths at the global governance layer to the transformative impact on health that its name promises and its mandate requires.
A critical friend’s assessment of a promising alliance at a crossroads
In October 2024, flooding cut off road access to health centers across Mali’s interior regions, including the capital Bamako.
Patients used makeshift boats to reach care.
That same year in Cameroon, a midwife named Geh Raphaela Agwa attended a woman in labor during a storm so severe that the water on the roads was deep enough to carry a car.
The woman had waited for hours, her waters already broken, before she could reach the clinic.
When she arrived, the baby had turned.
It was a cord presentation.
There was a twin.
The second twin was in bradycardia.
The team operated in time.
Both children lived.
After it was over, Agwa wrote down what had happened.
Not for a medical journal.
Not for a WHO technical report.
For a peer learning platform called Teach to Reach, run by The Geneva Learning Foundation, where health workers from low- and middle-income countries share the impacts of climate change on health and what they are doing about it.
She noted that the community had not waited for a policy response either.
Neighbors had begun digging gutters themselves so that cars could move through the water even when the storm was at its worst.
Agwa is one of more than 6,000 health and humanitarian workers who responded to a global survey on climate change and health, developed by The Geneva Learning Foundation with support from Grand Challenges Canada and disseminated through both the Teach to Reach network and that of global partners.
A quantitative analysis of the full dataset, together with a companion qualitative paper, is in the academic publication pipeline.
These remarkable stories of resilience will also be told in a series of new Teach to Reach eyewitness reports.
The survey is almost certainly the largest exercise of its kind ever undertaken to capture first-hand practitioner experience of climate health impacts in low- and middle-income countries.
It drew responses from clinical health workers, community health workers, public health professionals, and humanitarian staff, with just over half working at the local community or district level, where climate health consequences arrive first and are felt longest.
If only by virtue of scale, what these respondents shared cannot be dismissed as a collection of vivid, individual misfortunes.
The experiences they documented point toward a systematic pattern: the consequences of climate change that health workers on the ground are managing daily are often different in nature, and more severe in felt impact, than the primary indicators tracked by current global frameworks.
The secondary effects – malnutrition driven by agricultural disruption, vector-borne disease spreading into new territories, waterborne illness following floods, mental health deterioration from chronic loss and displacement – arrive faster and hit harder than the headline threats.
And the gap between what practitioners at the community level observe and what their counterparts at national and strategic levels report is consistent enough, across countries and contexts, to constitute a measurement problem rather than a difference of perspective.
What the people closest to the problem are observing is not yet fully visible to the systems designed to respond to it.
A physician in Kikwit, DRC, watched kwashiorkor and marasmus cases surge in his ward over three months in 2022 when the rains failed and crops were destroyed.
He is also an agropreneur.
He watched it happen in his fields and then in his hospital at the same time.
In Ahoada East, Rivers State, Nigeria, a public health worker documented over 500 patients arriving at a single health center in a single month following floods that destroyed farmland.
Most were children and elderly people.
The center faced simultaneous shortages of supplies and infrastructure damage from the same floods that had sent the patients.
In the Wa Municipal area of Ghana, a clinical health worker described farmers who borrowed money to plant in 2024, watched the rains stop entirely in June, lost their crops, and then began bringing their children to the health center with anaemia, kwashiorkor, and anxiety, without the income to pay for treatment.
And the practitioners are not only observing.
A community health worker in Tharaka Nithi, Kenya, began monitoring weather forecasts so she could advise tuberculosis patients to collect additional medication before flood season, avoiding treatment interruption when roads became impassable.
A midwife in Côte d’Ivoire organized mobile health teams to reach communities cut off by torrential rain, setting up temporary health points so that patients who could not reach the main facility could still receive care.
In the Ngandajika health zone in DRC, women organized a solidarity fund so that pregnant women from 32 weeks onward could take a roundabout route to the maternity ward and have their stays paid for collectively.
These are not improvised workarounds waiting to be replaced by proper systems.
They are more accurately understood as climate-health adaptation protocols, invented by practitioners with direct knowledge of the terrain, the disease burden, and the community they serve.
The survey surfaced thousands of experiences of this kind.
Its reach depended critically on the network that disseminated it: without the frontline practitioner connections that The Geneva Learning Foundation brought through Teach to Reach, the geographic representation from the African countries bearing the heaviest climate health burden would have been a fraction of what it became, and the community-level perspectives that give the dataset its distinctive character would have been largely absent.
The frontline network did not simply add volume to the survey.
It changed what the survey could see.
It is against this backdrop that a recent evaluation of ATACH, the Alliance for Transformative Action on Climate and Health, deserves a careful reading.
Not as a critique of what ATACH has attempted, but as a map of where the work of building genuinely transformative climate health action still remains to be done, and where the evidence for how to do it already exists.
What the global governance layer has built toward transformative action on climate and health
Consider what ATACH has been doing at the same time.
The Alliance for Transformative Action on Climate and Health was launched at the Glasgow climate summit in 2021, with a mandate to build climate-resilient and low-carbon health systems globally, using WHO as its Secretariat.
(Teach to Reach was also launched in 2021.)
A recent formative evaluation, conducted by Cambridge Economic Policy Associates and finalized in February 2026, documents a genuine record of achievement at the level where ATACH is designed to operate.
ATACH contributed meaningfully to the Belém Health Action Plan at COP30, the most significant global commitment on climate and health in years.
- It advanced health indicators for the UNFCCC Global Goal on Adaptation, including on mental health.
- It produced WHO guidance on measuring greenhouse gas emissions from national health systems and collaborated with the World Bank on a Smart Buys report identifying high-value climate-health interventions.
- Membership grew from 50 founding members at COP26 in 2021 to over 200 by January 2026, including 103 country and area members.
- Over 80% of country member survey respondents agreed that ATACH had made a significant contribution to its mandate.
These achievements are real and they reflect something that cannot be easily substituted.
An intergovernmental platform hosted by WHO, with the political relationships and technical credibility to influence COP declarations and World Health Assembly decisions, operates at a layer of global governance that peer learning networks and community organizations cannot reach.
The Belém Health Action Plan’s language on health adaptation did not appear by accident.
ATACH’s Secretariat was in those rooms over years of relationship-building.
That matters.
The evaluation is also honest about where the alliance has struggled.
Country-level implementation and financing facilitation are the weakest areas by every measure in the report.
Members consistently describe knowledge products as valuable and consistently call for more support in actually applying them.
The evaluation notes, with commendable candor, that “a library alone is often not enough to trigger action.”
Of fourteen country members interviewed in depth, two attributed a national policy change directly to ATACH’s advocacy across three and a half years of operation.
The evaluation presents these as evidence of a meaningful shift toward policy influence.
They may be exactly that.
They are also, against a membership of 103 countries and a cumulative investment of approximately seven million US dollars, a thin thread of documented country-level effect.
Most significantly: the evaluation contains no health outcome data of any kind.
This is by no means a methodological failure.
Rather, it is an honest account of where the evidence currently stops.
ATACH has built credible political and technical infrastructure at the global level.
Whether that infrastructure has yet produced a change in what happens in a district health center during a flood, a drought, or a heatwave is a question the evaluation cannot answer, because the evidence to answer it does not exist.
The missing connection for transformative action on climate and health
Here is what is striking when these two bodies of work are placed beside each other.
The global climate change and health survey documented, from 6,418 practitioners across 128 countries, exactly the health system conditions that ATACH’s policy chain is designed to eventually reach.
- It documented them in specific, named places, with specific disease burdens, specific resource constraints, and specific adaptations already underway.
- It documented a 30% stunting rate among children under five in Rukwa Region, Tanzania, following a prolonged drought.
- It documented a midwife in Cameroon navigating a twin bradycardia during a flood while her community dug gutters outside.
- It documented a physician in Lubumbashi watching a three-month surge in child malnutrition coincide precisely with the failure of the rains.
ATACH has produced guidance on measuring greenhouse gas emissions from health systems, indicators for tracking health adaptation in UNFCCC frameworks, and a report on high-value climate-health interventions.
- These are tools designed to help governments build climate-resilient health systems.
- The practitioners in the survey are the people who work in those systems.
- They are already building resilience, without waiting for the tools, because they have no choice.
The connection between these two levels does not currently exist.
This is not a criticism of ATACH.
Building that connection was not part of the alliance’s founding mandate, and the evaluation does not identify it as a gap, because the evaluation was designed to assess what ATACH set out to do, not what it has not yet attempted.
But the evaluation does identify something adjacent to it.
ATACH’s members want the alliance to move from knowledge production to implementation support.
The evaluation names this as the central challenge of the next phase.
And the question of how a global alliance demonstrates that its knowledge products actually reach communities and improve health outcomes, the attribution problem that the evaluation sidesteps entirely, is precisely the question that a peer-supported implementation methodology is designed to answer.
The Impact Accelerator, developed by The Geneva Learning Foundation, brings practitioners facing the same type of challenge together in a structured cycle that links learning to action.
The peer validation step is what makes this evidence rather than self-report.
Colleagues who work in the same conditions, face the same barriers, and understand what is realistic cannot be easily deceived by overclaiming.
After the first cohort in 2019, implementation progress among participants was seven times higher than among a control group that had developed action plans but not joined the process. This has been replicated and validated in every Accelerator, which has spread as a key component of TGLF’s learning-to-action model. What about sustainability? 82% of its users then use it for their own needs, and 78% do it without needing any further support from TGLF.
This methodology addresses exactly what ATACH cannot currently demonstrate: not that it has produced knowledge, but that knowledge has produced change.
Connecting the dots for transformative action on climate and health
The Teach to Reach network launched in January 2021, the same year as ATACH, and has grown to over 80,000 health professionals from more than 70 countries.
Eighty percent work at district and facility levels.
Half are government employees.
The Teach to Reach network has documented over 10,000 local solutions.
Leaders from more than 4,000 locally led organizations participate, and take back what they learn to their organizations.
The Teach to Reach partner network that supported the climate and health survey included 107 organizations spanning 28 countries, collectively reaching over 15 million people.
ATACH has 200 organizational members and the ear of health ministers, UNFCCC negotiators, and WHO leadership.
Teach to Reach connects 80,000 health and humanitarian workers, more than 4,000 organizations. They come from communities those ministers are supposed to serve.
These are not rival models.
They are the top and the bottom of the same causal chain.
One operates where commitments are made.
The other operates where commitments either reach communities or quietly dissolve.
What neither currently provides is the connection between them.
Geh Raphaela Agwa is still working in Cameroon.
The community around her clinic is still digging gutters.
The woman whose twin pregnancy she saved during a flood is presumably raising two children in a region where the storms are getting worse.
None of this appears in the Belém Health Action Plan.
All of it is what the Belém Health Action Plan is ultimately for.
The distance between those two sentences is the work that remains.
References
- Gasparri G. Evaluation of the implementation and achievements of the ATACH 2024-2028 strategy and 2.0 structure. 2026 Mar 31. Retrieved from https://www.atachcommunity.com/fileadmin/user_upload/ATACH_Evaluation_Final_Report_11.02__1_.pdf
- Romanello M, Walawender M, Hsu SC, Moskeland A, Palmeiro-Silva Y, Scamman D, et al. The 2025 report of the Lancet Countdown on health and climate change. The Lancet. 2025 Oct;S0140673625019191. doi:10.1016/S0140-6736(25)01919-1
- Sadki R. Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline. Reda Sadki [Internet]. 2023 Dec 1 [cited 2025 Oct 26]. Available from: https://redasadki.me/2023/12/01/investing-in-the-health-workforce-is-vital-to-face-climate-change-a-new-report-shares-insights-from-over-1200-on-the-frontline doi:10.59350/3kkfc-9rb27
- Sadki R. Klepac and colleagues‘ scoping review of climate change, malaria and neglected tropical diseases: what about the epistemic significance of health worker knowledge? Reda Sadki [Internet]. 2024 Jun 3 [cited 2025 Oct 26]. Available from: https://redasadki.me/2024/06/03/klepacs-scoping-review-of-climate-change-malaria-and-neglected-tropical-diseases-what-about-the-epistemic-significance-of-health-worker-knowledge doi:10.59350/n8r6f-46t95
- Sadki R. The cost of inaction: Quantifying the impact of climate change on health [Internet]. 2024 Dec. doi:10.59350/gn95w-jpt34
- Sadki R. Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries [Internet]. 2025 Jul. doi:10.59350/redasadki.21339
- Sadki R. Critical evidence gaps in the Lancet Countdown on health and climate change [Internet]. 2024 Nov. doi:10.59350/nv6f2-svp12