Advancing Culture of Health & Health Systems Strengthening through Climate Adaptive Social Entrepreneurship: Social Impact Case Study for Climate Competent Care
Open AccessThe climate crisis poses an existential threat to humanity. Rapidly changing climate and an increase in extreme weather events such as heatwaves and flooding call for an urgent need to adapt our society to these climactic changes. Health systems are no exception, particularly in the Global South. Especially since climate change exacerbates preventable morbidity and mortality through a range of direct and indirect pathways, making it the paramount public health challenge of our times. This project focused on operationalizing the World Health Organization’s framework for climate-resilient health systems that identified a set of strategies for program development leading to health systems strengthening. Specifically, it focused on capacity building by operationalizing the WHO recommendations to develop “training courses on climate change and health topics targeting health personnel conducted” and “curricula on climate change and health developed and imparted at secondary and/or tertiary levels.” The geographic focus of the project was Pakistan. Pakistan, specifically, because it is one of the most climate-vulnerable nations with one of the least adaptive capacities and poor health systems infrastructure. Formative evaluation complemented by the social entrepreneurship tool of Impact Gaps Canvas was deployed to identify the needs and ensure better uptake, acceptability, and utility of the intervention for the end-users (physicians in Pakistan). Needs assessment results showed a gap in climate-health knowledge and physicians incorporating it to inform their clinical practice. Therefore, an intervention — Climate & Health Equity Practice Fellowship — was developed with a Climate Competent Care framework to fulfill this gap. Climate Competent Care framework focuses on training physicians on i. Climate-informed clinical practice; ii. Climate advocacy; and iii. Climate communications.The inaugural cohort for the fellowship was recruited from Pakistan, emphasizing diversity and inclusion principles, with fellows serving and representing historically marginalized, socially vulnerable communities. Seventeen fellows — majority self-identified women, younger than 40 years, early career, and first-generation — completed the six-week training that involved foundations of climate change and health with an emphasis on health equity, integrative approach to climate leadership development, and climate justice as it relates to clinical practice concerning pregnant people, children, older adults, people with disabilities, workers, and migrants. Climate communications and advocacy were also emphasized. Fellows were provided with an opportunity to write a blog. A team of fellows was also selected for the Climate Equity Practice Award to further disseminate the newly gained knowledge among their peers. Several fellows are already applying the knowledge into their clinical practice, including developing dissemination projects through virtual workshops, medical school curriculum modifications, and patient intake form changes to incorporate climate exposures. Program evaluation activities involved process evaluation using an exploratory sequential mixed-methods design with quantitative data informing the qualitative focus groups which were organized under the RE-AIM framework. Outcome evaluation using a Knowledge, Attitudes, and Practices (KAP) survey was also conducted. Several methodological limitations are noted. Results show that fellows had an overwhelmingly positive experience with the fellowship while identifying several opportunities for improvement. Detailed results of the evaluation are provided. KAP survey shows very modest changes in knowledge, attitudes, and practices among fellows. Recommendations, drawing from the lessons learned, for implementation, institutions, and policy changes are also provided. Public health practice contributions are also discussed.
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