Unless there is serious investment in climate-resilient health infrastructure and services, the road to achieving the 2030 Sustainable Development Goals (SDGs) will be paved with good intentions. Such investments will accelerate progress towards multiple SDGs in Africa. Fighting climate change. poverty reduction. Full and productive employment. and affordable, reliable and sustainable energy and other infrastructure.
Nursing care in sub-Saharan Africa is primarily carried out by women, but there are some characteristics. 1 First, African countries have large populations of young people, and some of them have some of the highest fertility rates in the world, with four children per woman. 2 Second, the aging population is increasing. In sub-Saharan Africa, the proportion of older people currently stands at a low 5% of the population, but the United Nations predicts that this proportion will increase to 12% of the continent’s population by 2050. 3 Importantly, adults are more likely to grow old at home or with children who provide for their needs. Third, women in many African countries, particularly in Southern Africa, continue to face a large unpaid care burden due to HIV/AIDS. 4 Fourth, most African countries have major infrastructure deficiencies (energy, water/sanitation, transportation) that make caregiving particularly burdensome. It also has one of the lowest rates of paid care employment on the continent. Other demographic patterns will also influence care needs, particularly migration and transitions from agriculture to urban employment (formal and informal).
Climate change is increasing the need for care and exacerbating already existing care challenges. 5 Extreme climate events are becoming more frequent and severe, disproportionately impacting Africa’s economies and societies. African countries warmed at a rate of +0.3°C per decade from 1991 to 2023. This is slightly faster than the global average6. Some parts of the African continent are experiencing severe and prolonged drought, crop failure, and famine. These challenges fall more heavily on women than men, given their disproportionate share in agriculture, care, and informal work, reducing labor productivity, straining care inputs, damaging care infrastructure, and threatening food security.7
We need to invest in climate-resilient health infrastructure. This includes investments in clean energy (and clean cooking), water/sanitation, and transportation, all of which are inputs into effective, quality care. In low- and middle-income countries, making assets more resilient in the power, water, sanitation, and transport sectors costs about 3% more on average. 8 However, its lifetime net income could reach an estimated $4.2 trillion, or $4 for every $1 invested. 9 Such investments have the potential to create jobs. 10 Importantly, low-carbon economies can be accelerated by workforce growth, if they are designed to reduce occupational gender discrimination and ensure women have access to new green jobs.11 Yet, women can only participate in the green transition if new care infrastructures are built.
Supporting the development of resilient health systems requires both domestic resources and international funding, but currently neither source provides sufficient funding in most countries. De Henau (2021) analyzed public spending on pre-primary education alone (without taking into account any climate adaptation measures) a small portion of the gross domestic product (GDP) of the six African countries. 12 Climate finance can play a complementary role to development finance. In sub-Saharan Africa, climate adaptation is estimated to cost between $30 billion and $50 billion per year over the next decade, representing 2% to 3% of regional GDP13. However, these estimates ignore the increasing costs of care services in response to climate change.
Like investments in green energy, public investments in resilient child and care infrastructure and services create direct jobs and generate multiplier effects, such as indirect jobs in industries that supply the care sector (food, energy, manufacturing), and increased tax revenues through increased employment, income, and consumption.14
Start-up costs should therefore be viewed as a transitional financing issue. Policy makers can explore synergies across investments that can support carers more effectively, including in the health, education and social protection sectors. The recently strengthened Climate Adaptation Fund window for local initiatives may include care services/infrastructure in its funding criteria. It is important to recognize that care is an essential public good for current and future generations. Prioritizing publicly funded climate-resilient care services and infrastructure will help accelerate progress towards multiple SDGs in Africa, while ensuring no one is left behind.
