The London Climate Week launch on 21 June 2026 of a new call from global partners turned three years of listening to community-based health workers into money on the table. What the room did not decide is whether the money will reach them the same way the listening did.
In Fada, Burkina Faso, what happens to women in labour when the rains close the roads?
When the rains close the roads around Fada, in eastern Burkina Faso, a woman in labour cannot reach a clinic, and the clinic cannot reach her.
So the community stopped waiting for the roads.
“Some roads are impassable during the winter months, making healthcare inaccessible,” the midwife Maiga Nana Jacqueline recounted.
“To remedy this, village midwives from these communities have been trained to assist in childbirth. Hygienic deliveries are taking place without complications.”
No ministry programme.
No donor grant.
A community deciding that childbirth would no longer depend on a passable road, and training its own midwives to make sure of it.
Maiga did not tell that story in London.
She told it, in her own words, somewhere else entirely, and where stories like hers get told turns out to decide whether it ever reaches a funder.
Learn more: How health workers are leading community responses to climate change impacts on health
That is worth keeping in mind, because about around 80 people had gathered on the summer solstice in London to reckon with stories exactly like hers, inside a members’ club called The Conduit, while the city sweltered through its second heat wave of the year.
The occasion was the launch of the first funding opportunity from Nexa, a global climate and health innovation initiative led by Grand Challenges Canada and the Science for Africa Foundation, together with a global consortium of partners.
Ambassadors, ministers, scientists, and funders filled the room.
Drinks waited on a rooftop five floors up.
They had come to shorten the distance between the trained midwives of Fada and funders gathered in a London club, before the next rainy season cut another community off.
The useful thing to know about that distance is that it has already been crossed once, by a network most of the room had never heard of.
The question the evening left open is whether Nexa’s global leaders will use that network, or build past it.
The network was the finding
The proof that the distance can be closed was already in the room, in the form of a survey.
When Grand Challenges Canada, the Science for Africa Foundation, and The Geneva Learning Foundation (TGLF) announced the Global Climate and Health Survey in The Lancet Global Health in January 2025, they made a specific promise: to reach the people closest to the crisis and to centre local voices, using participatory research rather than a questionnaire pushed out from headquarters.
The survey went on to become one of the largest of its kind, reaching over 6,400 respondents.
Its scale is not the interesting part.
Whether that promise held, and how, is.
TGLF built and piloted the survey, then spent three months in dialogue with its Teach to Reach community before collecting a single response, and kept that dialogue going for four months into 2025.
That patience was built on nearly a decade of prior work convening frontline health workers.
Learn more: A short history of the first five years of Teach to Reach
What happened next explains where the promise held.
The Foundation issued a call through Teach to Reach.
Alongside the 24,610 participants, 107 locally-led organizations across 28 countries committed to supporting the survey.
This diverse group spanned organizations from local government health clinics and community groups to faith-based clinics and a midwives’ union.
Together, they reach more than 15 million people.
Nearly half are government organizations, embedded in national health systems.
They ran the mobilization on the ground, from the provincial health division of Haut-Katanga in the DRC to the Oyo State Primary Health Care Board in Nigeria.
The bottom line?
More than 60% of every response collected came in through the Teach to Reach network, carried by those organizations and by the individual health workers the network had spent years connecting to one another.
The volume matters less than what it was made of.
Strip Teach to Reach out and the survey does not just shrink, it loses the very people it set out to reach.
- African representation would have fallen by roughly three quarters, gutting the sample from the region that carries the heaviest climate burden and the least responsibility for it.
- Responses from the DRC would have dropped by 95%.
- And the local actors closest to affected communities, the district health offices, the community groups, the faith-based clinics, the midwives, the ones who can say what a flood does to a maternity ward because they were standing in it, would have been the first to disappear.
What would have remained is the familiar pattern: a survey about vulnerable communities, answered mostly by people at a distance from them.
The network inverted that, so the people inside those communities ran the survey rather than being studied by it.
That is the finding underneath the finding, and the one Nexa should weigh most heavily.
The route from a flood to a funder already exists, and the network that carried the survey is what keeps it open.
What those who are there every day already know
The survey’s own results are still being analyzed.
But the same participatory method has already produced a published body of evidence, drawn not from the survey but from the accounts of over 1000 health workers across at least 60 countries gathered through the same Teach to Reach process, with eight take-aways and fourteen recommendations that follow from them.
It is worth reading closely by everyone who was in the London room, because it describes, in the workers’ own words, how a coalition like Nexa could find new, fruitful ways to connect with local actors.
Teach to Reach is where Maiga Nana Jacqueline from Fada District, Burkina Faso, told her story.
It is where these accounts are gathered, from health workers writing in from their own clinics and districts, and it is why the distinction matters.
A story told from a London stage reaches the people in the room.
A story told through Teach to Reach reaches a published report, a set of recommendations addressed to funders, and thousands of peers facing the same rains, and it does so without the worker ever having to leave her post.
That same process does something Nexa says it wants to do.
It carries the voices behind the data upward, from a clinic in Kinshasa to a report a funder can read, and back down again as something the community can use.
None of the contributors quoted here were in the London room, yet through Teach to Reach they were present in it.
- In Somalia, Lul Omar Ulusow, a maternal health manager, recognized her own life in the numbers: “I always face a flood, and sometimes I face the roadblocks.”
- In Kinshasa, the physician Noelly Zola Watusadisi described a city where clogged drains breed the mosquitoes that reach “the most vulnerable, pregnant women and children under five.”
- In Nairobi, the health-promotion lead Lillian Mutua counted the cost of one storm: “We lost more than 100 people. Health institutions were flooded. We lost a lot of hard copies of registers and cards.”
What ran through their accounts was initiative, not helplessness, and much of it was organized by women.
In Doba, in southern Chad, the public health technician Naingar Service described who was holding the line on children’s health: “It is above all the women who have adopted a responsible attitude to children’s health. They organise themselves into groups to contribute money for any health problems affecting their families.”
These are savings groups doing the work of health insurance, in a place where formal insurance does not reach.
“With no funding, no guidance, just an initiative to use local means, there is a will,” said Nathan Binene Kayeye of the DRC.
In Cameroon, the community facilitator Rameaux Nkollo described a method: “Once solutions come in and we work inclusively, all together, each with a small idea, we move forward better.”
A note on the evidence: where these findings come from
The stories, findings, and recommendations in this article do not come from the Global Climate and Health Survey. Those results, quantitative and qualitative, are still being analyzed and will appear in a forthcoming report.
They come from an earlier and separate body of work: 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, released in May 2026.
That report is itself the product of a participatory process, not a survey.
Frontline workers shared written accounts before, during, and after Teach to Reach 11, a global peer learning event held in December 2024, answering plain questions.
What happened?
What did you do?
How did you know it worked?
Did the community help?
From the 24,610 health workers registered across more than 70 countries, 100 detailed accounts spanning at least 19 countries were selected for publication.
The report was written first to give the findings back to the workers who produced them, and second so that national and global actors learn to see the value of what frontline workers know.
Two companion articles distil it: eight take-aways from the accounts, and fourteen recommendations drawn from them.
The trap in the good news
If the survey proved the route existed, the panel that followed named the way it could be lost.
Moderated by Doris Wangari, it seated Dr Devotha Nyambo of the Nelson Mandela African Institution of Science and Technology in Tanzania, Dr Claude Pirmez of Fiocruz in Brazil, and Reda Sadki of The Geneva Learning Foundation.
Reda Sadki set the promise and the trap side by side.
The survey had surfaced not dozens but hundreds of local solutions, most of them financed by communities themselves.
“What could be more sustainable than local actors not asking government for assistance, not asking international donors?” he asked, and then turned the question over.
Self-reliance that no one matches becomes a cost the poorest absorb alone.
Invest in better policy and better science without “a commensurate investment in communities and in local action,” he warned, and “5, 10, or 15 years down the line, communities are going to reject both.”
The warning read as a design brief.
Fund the science and skip the network that produced the evidence, and the coalition widens the very distance it came to close.
Learn more: Reda Sadki’s remarks at the Nexa funding announcement in support of local community responses
Dr Nyambo brought the same conviction from data, describing a community-rooted early-warning system for outbreaks in Tanzania.
Dr Pirmez brought three decades of research at Fiocruz.
Wangari closed by naming where the panel had arrived.
“Local knowledge is not simply complementary. It’s essential. We have to understand it and integrate it.”
“You call it a heat wave”
The politicians in the room argued for speed.
Mete Coban, Deputy Mayor of London for Environment and Energy, said he had come to the work not as an environmentalist but from “a very deprived community,” where “half a million people will never ever be able to breathe the full capacity of their lungs because of a crisis that they didn’t cause in the first place.”
He offered Nelson Mandela’s line, “it always seems impossible until it’s done,” with proof: experts once told London it would take 193 years to meet legal air-quality limits, a target the city hit in nine.
Proximity was his whole argument.
Cities are “cutting carbon emissions five times faster than the national average,” he said, “because we know our residents much closer in a way that governments don’t.”
Then the night’s most unscripted moment.
H.E. Shimane Lawrence Kelaotswe, High Commissioner of Botswana, rose to speak although “I was not supposed to say anything.”
Turning to the London heat wave everyone had spent the evening complaining about, he reset the scale.
“You call it a heat wave. In Botswana we’re talking about 45 or 49 degrees Celsius.”
Now sixty years old, he recalled seeing winter rain in his country for the first time only in 1990.
“We thought maybe we were coming to the end of the world.”
His warning doubled as the coalition’s mandate.
“Right now, if you don’t involve the communities, we’re going to get a shock of our life.”
Money on the table
Here the evening turned from diagnosis to commitment.
Dr Karlee Silver, CEO of Grand Challenges Canada, framed Nexa as an invitation that “gives action-oriented organizations a trusted, proven network of regional leaders to help direct their resources effectively,” which is, she said, “how we move the needle on the climate crisis, by connecting the global and the local, and meeting our most urgent needs.”
The commitment was funded, not hypothetical.
Five African governments, South Africa, Senegal, Malawi, Rwanda, and Botswana, had committed roughly \$2 million between them, with Grand Challenges Canada and partners pledging to match it.
They had joined, Dr Tom Kariuki of the Science for Africa Foundation stressed, “not in the middle when things have already rolled out, but at the very beginning.”
On the partner panel, Dr Daouda Diouf of the Sanofi Foundation and the High Commissioners of Malawi and Rwanda returned to one theme: trust built over years, not over grant cycles, is what decides whether resources ever reach a village.
A video message from Hillary Rodham Clinton (whose organization is amongst the funders) and closing remarks from Prof Shaukat Abdulrazak, Kenya’s Principal Secretary for Science, Research and Innovation, pressed the same point.
The science exists.
The task now is to act on what workers closes to the communities already know.
What should give that money its direction could be grounded in recommendations that frontline workers’ own accounts produced, addressed by name to global partners like the ones in the room.
They are specific. Three examples:
- Shift climate-health portfolios “from generating new knowledge to amplifying knowledge that already exists.”
- “Fund frontline workers directly through mechanisms that match the timeline of an extreme weather event,” because “reconstruction funding that arrives in months arrives after the community has already moved on.”
- “Treat community trust and community-built infrastructure as fundable outcomes,” since the grant cycle is “shorter than the time it takes to build trust in a community that has been let down before.”
These recommendations carry a weight that a strategy document cannot.
They are not the preferences of an intermediary.
They come from the communities Nexa’s partners say they intend to serve, which makes them less a critique than a set of instructions the coalition asked for.
With its call for proposals only now launching, Nexa can still decide to follow them.
Anyone who wants to test them against the source can now put questions directly to the underlying evidence, through a chat interface built on three years of frontline accounts.
Learn more: Climate change and health: 14 recommendations for health workers, national planners, and global partners
Fund the network, not only the findings
The survey settled one question.
A participatory approach reaches the most vulnerable communities as leaders rather than subjects, and it does so because the design and the mobilization were built with the Teach to Reach network over years, not weeks.
That network is the asset Nexa inherits, whether or not it decides to use it.
The open question is whether the next step will be built the same way, and the workers have already described what that would take.
Funding that reaches community-led action “in weeks.”
Worker protection written into “every emergency response grant.”
Community financial mechanisms, the women’s solidarity funds, the savings groups, recognized “as health system infrastructure” instead of being bypassed by cash programmes designed in capital cities.
A call for proposals can be run at arm’s length, judged by reviewers who have never met the people they are funding.
Or it can carry the same logic that made the survey reach so deep.
The individual leaders and organizations that carried the survey already know which local solutions work in their own districts, and which recommendations match conditions on the ground.
Kept in place and resourced as a standing backbone, rather than disbanded once the data was in, they could do for the money what they did for the survey.
They can find the frontline, vouch for what actually works, and carry a proposal written in a village to a decision made in a capital.
As the Kenyan health worker Joseph Njoroge put it, “community ownership and involvement in the whole process is quite important for the success of climate change interventions.”
The Guinean physician Issa Barry named the gap that a backbone closes. “Communities are always ready. Often it is language that creates the gap. We speak in technical terms.”
Somewhere in the Teach to Reach network are the village midwives of Fada, still delivering babies safely on the days the roads are gone.
Between July 2023 and June 2026, The Geneva Learning Foundation’s climate and health programme listened to health workers like them, and it did so by working with them rather than around them.
That programme is a working prototype of the layer the global response has been missing, the connective tissue between commitments made in conference halls and the communities where those commitments either reach people or come to nothing.
Whether it becomes a permanent part of how the world responds depends on what a coalition like Nexa decides to fund.
On the longest day of the year, in a London club, the money arrived.
The remaining task is to spend it the way the listening was built.
References
Sanchez JJ, Gitau E, Sadki R, Mbuh C, Silver K, and the Climate and Health Expert Panel. The climate crisis and human health: identifying grand challenges through participatory research. Lancet Glob Health 2025;13(2):e199-e200. https://doi.org/10.1016/S2214-109X(25)00003-8
Sadki R. Climate change and health: 14 recommendations for health workers, national planners, and global partners. The Geneva Learning Foundation; 2026. https://doi.org/10.59350/hs8am-cn216
Sadki R. Climate change and health: 8 take-aways from community-based responses. The Geneva Learning Foundation; 2026. https://doi.org/10.59350/fxxec-dxj41
The Geneva Learning Foundation. Lessons in resilience: what health workers in Africa, Asia, and Latin America know and do in response to worsening climate change impacts on their communities. 2026. https://doi.org/10.59350/bc869-5z763
The Geneva Learning Foundation. New insights report: health workers are leading community responses to climate change impacts on health. The Geneva Learning Foundation; 2026. https://doi.org/10.59350/v01fe-myj60
The Geneva Learning Foundation. Talk to the evidence: a chat interface to explore what health workers know and do about climate change and health. 2026. https://doi.org/10.59350/7gdaj-f8588
Jones I, Njua Mbuh C, Steed I, Sadki R. Teach to Reach 11: Local action to mitigate the impact of the climate crisis on health. Listening and Learning report 20. Geneva: The Geneva Learning Foundation; 2026. https://doi.org/10.5281/zenodo.18246203
The Geneva Learning Foundation. What you can do if climate change is harming your community’s health: a practical guide to the Certificate peer learning programme for leadership in climate change and health. 2026. https://doi.org/10.59350/c05zy-caf92