Nigeria Climate Change and Health National Adaptation Plan, 2025-2030

HNAP master final draft 16 3 25 OFFICIAL OFFICIAL Nigeria Climate Change and Health National Adaptation Plan, 2025 - 2030 March 2025 With support from OFFICIAL OFFICIAL OFFICIAL OFFICIAL Foreword The health and well-being of Nigerians are at the core of Nigeria’s national development agenda. The increasing threats posed by climate change, including rising temperatures, extreme weather events, changing disease patterns and environmental degradation have profound implications for Nigeria’s health system as well as key health outcomes. In response to these critical challenges from climate change, the government of Nigeria, coordinated through the Federal Ministry of Health and Social Welfare (FMoH&SW), will lead the way for proactive evidence-based response to be delivered by government, civil society and Development partners. I am very pleased to present Nigeria’s first Health National Adaptation Plan (HNAP), which has been built on the foundation of evidence from the recently-completed Climate and Health Vulnerability and Adaptation (V&A) Assessment. The HNAP provides a roadmap for not only integrating climate adaptation into health systems planning but also building the resilience of Nigeria’s population’s health outcomes to the impacts of climate change. The HNAP underscores Nigeria’s commitment to safeguarding lives, strengthening its health systems, and adapting to climate change to reduce the impact from climate change on Nigeria’s health outcomes. The HNAP aligns with Nigeria’s broader climate policies, including the National Adaptation Plan (NAP) Framework, which is led by the Federal Ministry of Environment (FMoEnv), the revised Nigeria’s Nationally Determined Contribution (NDC), which is led by the National Council on Climate Change (NCCC), and international commitments under the Paris Agreement and the Sustainable Development Goals (SDGs). The HNAP results from extensive collaboration among multiple government agencies and sectors, development partners, civil society, the private sector, and health and environmental professionals. I would like to thank the national Climate and Health Technical Working Group (TWG) and appreciate the support from the UK government, via the Foreign, Commonwealth, and Development Office (FCDO), the World Health Organisation (WHO), the World Bank, the UK Lafiya programme, and the Nigeria Health Development partners Group, for their support, expertise, time and resources that enabled the HNAP to be developed. Implementing the HNAP will require significant investment, sustained commitment, and cross-sectoral partnerships. I call on all stakeholders across the public and private sectors, academia, development partners and communities to join hands with the government in implementing the HNAP. I urge the States and local governments to draw from this document and initiate the development of State and local governments’ health adaptation plans, sectoral frameworks, and other complementary activities and programmes for a holistic national response. Together we can build a resilient health system and health sector that protects our peoples’ health against the impacts of climate change and ensures a healthier and more prosperous Nigeria. Prof. Muhammad Ali Pate, CON Coordinating Minister of Health and Social Welfare Federal Republic of Nigeria Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Preface Climate change is already with us. It is an existential threat impacting Nigeria’s health system, and health outcomes. Rising temperatures, increased flooding, prolonged droughts, and evolving disease patterns are stressing our health system, and risk undermining decades of progress on improving Nigeria’s health outcomes and productivity. These changes exacerbate existing vulnerabilities and heighten the risk of new public health crises. In response to these challenges, Nigeria has formulated its first HNAP to guide a unified, evidence-based response aimed at bolstering the adaptation of our health system to increased risks and vulnerabilities to climate change and building the resilience of our population’s health outcomes to the impacts of climate change. The HNAP is a strategic call to action for embedding climate adaptation into health and health-determining policies, programmes, and infrastructure development across Nigeria. It contributes to a national approach to adaption planning and aligns with national and international commitments, such as the Paris Agreement, the SDGs, and Universal Health Coverage (UHC). It also supports the delivery of the commitments made at COP26 in Glasgow to build climate-resilient and sustainable low-carbon health systems. The HNAP will enhance our capacity to foresee, respond and adapt to climate-induced health hazards by prioritising climate-informed decision-making, developing and delivering strategies to strengthen our health system, health sector and health outcomes, including in our communities. We are pleased that in developing the HNAP, we drew the expertise of health sector stakeholders, including health professionals, climate scientists, policymakers, and development partners. This collaborative endeavour embodies our commitment to protecting public health in the face of climate change and ensuring that no one is left behind. As we move forward with delivering the HNAP, it is crucial to acknowledge that adaptation is an ongoing process that requires strong leadership, cross-sectoral partnerships and continuous investment. The HNAP is more than just a policy document; it is a call to action for all stakeholders, from Federal, State and local government bodies to local communities, to unite in building a climate-responsive and adaptive health system, and enhance the resilience of health outcomes to climate change. We eagerly anticipate the successful execution of the HNAP and reaffirm our unwavering dedication to safeguarding the health and well-being of all Nigerians. Daju, Kachollom S. Mni Permanent Secretary Federal Ministry of Health and Social Welfare Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Acknowledgements The development of Nigeria’s HNAP would not have been possible without the robust efforts of government agencies, development partners, health professionals, researchers, and civil society organisations. We are grateful for this partnership. We thank members of the Climate and Health TWG for their valuable insights, expertise, and participation in the stakeholders’ forums, which have enriched and validated this document. We are incredibly grateful to our development partners, especially FCDO, as well as others including the WHO, World Bank, the UK Lafiya programme, members of the Nigeria Health Development partners Group, and other international and local organisations, for their technical guidance, financial support, and steadfast commitment to climate adaptation. Special thanks go to the other critical stakeholders, including the academic institutions and research bodies, trade unions, and civil society organisations, who provided valuable insights and recommendations during stakeholder engagements and shaped the HNAP. We also acknowledge and appreciate the thorough and efficient work of the national and international consultants from Halcyon for their commitment, patience, and push, without which Nigeria would not have been able to develop this HNAP. Our special thanks go to Federal Ministry of Health & Social Welfare’s (FMoH&SW) management and the Department of Public Health’s Climate Change and Environmental Health (CC&EH) Division for their leadership and unwavering commitment to this initiative. We also thank other FMoH&SW, and State Ministry of Health (SMoH) technical units that have played a role, directly or indirectly, in developing the HNAP, along with the Federal Ministry of Environment (FMoEnv), and National Council on Climate Change (NCCC). Finally, the successful implementation of the HNAP will require continuous and robust collaboration across multiple sectors. We remain confident that together, we can build a healthier, more resilient, and adaptable health system across Nigeria that responds to climate change and protects our population’s health outcomes to the impacts of climate change. Dr Godwin Ntadom Director, Public Health Department Federal Ministry of Health and Social Welfare Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Contents FOREWORD 3 ACKNOWLEDGEMENTS 5 ABBREVIATIONS 7 HOW THE HNAP WAS DEVELOPED? 15 MONITORING, EVALUATION AND LEARNING 19 HNAP TOC 19 FINANCING THE HNAP 23 1.1 INTRODUCTION TO THE HNAP 26 1.2 CLIMATE AND HEALTH IN NIGERIA 28 1.3 OVERVIEW OF THE HNAP DEVELOPMENT PROCESS 32 1.3.1 HNAP PRIORITY INTERVENTIONS 33 1. INTRODUCTION 36 2.2 HNAP INTERVENTIONS 37 3.1 INTRODUCTION 42 3.2 HNAP GOVERNANCE AND IMPLEMENTATION FRAMEWORK 42 3.2.1 NATIONAL-LEVEL GOVERNANCE AND IMPLEMENTATION FRAMEWORK 42 3.2.2 STATE-AND LGA-LEVEL GOVERNANCE AND IMPLEMENTATION FRAMEWORK 46 1. INTRODUCTION 50 1. INTRODUCTION 57 5.2 GUIDING PRINCIPLES FOR HNAP RESOURCE MOBILISATION 57 5.3 POTENTIAL FINANCING SOURCES FOR THE HNAP 59 6.1 INTRODUCTION 1 2. THEORY OF CHANGE 2 3. GUIDING PRINCIPLES 2 FIGURE 11. HNAP MEL GUIDING PRINCIPLES 2 FIGURE 11. HNAP TOC 1 4. MEL PLAN 1 6.5 IMPLEMENTATION OF THE MEL PLAN AND FRAMEWORK 2 6. TIMING AND MILESTONES 2 ANNEX 1. COMPREHENSIVE HNAP BUDGET 6 ANNEX 2. FULL IMPLEMENTATION PLAN 23 ANNEX 3. GUIDING PRINCIPLES FOR THE HNAP MEL PLAN AND FRAMEWORK 27 TABLE 21. GUIDING PRINCIPLES FOR THE HNAP MEL PLAN AND FRAMEWORK 27 ANNEXE 4. DETAILED MEL PLANS 29 TABLE 22. OUTPUT LEVEL INDICATORS AND TARGETS 30 TABLE 23. INTERVENTION LEVEL INDICATORS AND TARGETS 32 ANNEX 5. LIST OF CONTRIBUTORS 37 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Abbreviations Nigeria Climate Change and Health Health National Adaptation Plan March 2025 AF Adaptation Fund NASPA National Adaptation Strategy and Plan of Action BEmONCs Basic Emergency Obstetric and Newborn Care NASPA- CCN National Adaptation Strategy and Plan of Action on Climate Change for Nigeria BHCPF Basic Health Care Provision Fund NBS National Bureau of Statistics BMPHS Basic Minimum Package of Health Services NCCP National Climate Change Policy CCEH Climate Change and Health NCCC National Council on Climate Change CCKP Climate Change Knowledge Portal NCDC National Centre for Disease Control CDM Chronic Disease Management NDC Nationally Determined Contributions CEmONCs Comprehensive Emergency Obstetric and Newborn Care NEMA National Emergency Management Agency CHVA Climate Change and Health Vulnerability and Adaptation Assessment NGO Non-Governmental Organisation COPD Chronic Obstructive Pulmonary Disease NHA National Health Act CRF Consolidated Revenue Fund NHIA National Health Insurance Authority CSO Civil Society Organisation NHIS National Health Insurance Scheme DFI Development Finance Institutions NIHSA Nigeria Hydrological Services Agency DHIS2 District Health Information System v2 NIMET Nigeria Meteorological Agency DHS Demographic and Health Survey NMEP National Malaria Elimination Programme DLI Disbursement linked indicator NPHCDA National Primary Health Care Development Agency DPRS Department of planning, research and statistics NPI National Programme on Immunisation DRF Drug Revolving Fund NSC National Steering Committee DRR Disaster Risk Reduction NSHDP National Strategic Health Development Plan DTP Diphtheria Tetanus Pertussis NSRDA National Space Research and Development Agency ESRI Environmental Systems Research Institute NSITF National Social Insurance Trust Fund EWS Early Warning System NSPHP National Strategic Plan for Health Promotion FBO Faith Based Organisation NTLCP National Tuberculosis and Leprosy Control Programme FCDO UK Foreign, Commonwealth and Development Office NTD Neglected Tropical Disease FCT Federal Capital Territory OCHA United Nations Office for the Coordination of Humanitarian Affairs Nigeria Climate Change and Health Health National Adaptation Plan March 2025 FGoN Federal Government of Nigeria OOPE Out of Pocket Expenditure FMoEnv Federal Ministry of Environment PLWD People Living With Disability FMoH&SW Federal Ministry of Health and Social Welfare PLWHIV People Living with HIV/AIDS FMHDM Federal Ministry of Humanitarian and Disaster Management PNC Post-Natal Care FMoWR Federal Ministry of Water Resources PPP Public private partnership FSC FMoH Steering Committee PTSD Post-Traumatic Stress Disorder GAI Global Adaptation Index RMNCAH Reproductive, Maternal, Neonatal, Child and Adolescent Health GCF Green Climate Fund RUWASA Rural Water and Sanitation Agency GEF Global Environment Facility SDG Sustainable Development Goals GDP Gross Domestic Product SEMA State Emergency Management Agency GF Global Fund SMART Specific, Measurable, Attainable, Relevant and Time-bound GFF Global Financing Facility SORMAS Surveillance and outbreak response management and analysis system GHG Greenhouse Gas SPHCDA State Primary Health Care Development Agency GIS Geographical Information System SMoH State Ministry of Health GIZ Deutsche Gesellschaft fur Internationale Zusammenarbeit TA Technical assistance GNI Gross National Income THE Total Health Expenditure HCWs Health care workers ToC Theory of Change HeRAMS Health Resource Availability Monitoring Software ToR Terms of Reference HIV/AIDS Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome TWG Technical Working Group HMIS Health Management Information System UHC Universal Health Coverage HNAP Health National Adaptation Plan UNEP United Nations environment programme HRH Human Resources for Health UNFCC United Nations Framework Convention on Climate Change IDP Internally Displaced Person UNFPA United Nations Population Fund IPCC Intergovernmental Panel on Climate Change UNICEF United Nations Children’s Fund KPIs Key Performance Indicators USAID USA Agency for International Development L&D Loss and Damage V&A Vulnerability and Adaptation Nigeria Climate Change and Health Health National Adaptation Plan March 2025 LGA Local Government Area VBD Vector Borne Disease MEL Monitoring, Evaluation and Learning WB World Bank MDA Ministries, Departments and Agencies WHO World Health Organisation NAF National Adaptation Framework WMO World Meteorological Organisation NAFDAC National Agency for Food and Drugs Administration NAMA Nationally Appropriate Mitigation Actions NAP National Adaptation Plan NASCP National AIDs, Viral Hepatitis and STIs Control Programme Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Summary for policy makers Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 1. Summary for Policy Makers OFFICIAL OFFICIAL Introduction to the HNAP Nigeria’s Health National Adaptation Plan (HNAP, 2025 - 2030) represents a significant milestone in the country’s ongoing climate change and health programme, which has been evolving since Nigeria made ambitious commitments at COP26 in 2021. In recent years, Nigeria has made substantial progress in fulfilling these commitments. The HNAP will align with the country’s broader climate policies, including the National Adaptation Plan (NAP) – the strategic process established under the United Nations Framework Convention on Climate Change (UNFCCC) for identifying, assessing, and addressing short-, medium- and long-term adaptation needs to climate change, and Nigeria’s Nationally Determined Contributions (NDCs) – the national climate action plan submitted under the Paris Agreement and which outlines commitments to reducing greenhouse gas (GHG) emissions and adapting to climate change. Impacts of climate change on health in Nigeria Nigeria’s climate and health priorities build on its COP26 commitments in 2021. A crucial first step was the development of Nigeria’s first national Vulnerability and Adaptation (V&A) Assessment, which was launched in November 2024 from which the HNAP has been informed. The V&A highlights the multiple risks and impacts of climate change to health outcomes and the health system; these are projected to worsen in terms of severity, duration, and magnitude across all geographical areas of Nigeria, which will impact negatively on the populations’ health outcomes. Further evidence from the V&A can be found in Chapter 1.2 (climate and health in Nigeria) of the HNAP, and full analysis and recommendations can be found in the final V&A report. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 a. Based on analysis carried out under the V&A, Nigeria will experience an additional 21% burden of disease due to climate change b. Many waterborne diseases will increase due to climate change. Some Neglected Tropical Diseases are expected to increase e.g. Buruli ulcers, Guinea worm, Trypanosomiasis. Diarrhoea related deaths in children under 15,, resulting from climate change will account for 9.8% of the total diarrhoea related mortalities c. Non-communicable diseases will increase. Cardiovascular disease will increase by 10% to over 4.5m cases in 2030. Diabetes is predicted to increase to almost 450,000 in 2030 due to rising temperatures. High blood pressure is also expected to increase significantly from almost 900,000 cases in 2020 to over 1.6m in 2030 d. Mental health conditions will rise due to the stresses of climate change. Mental disorders will rise from 2.6m in 2020 to more than 3.1m by 2030. Interpersonal violece will increase from 900,000 in 2020 to 1.05m in 2030 and neurological disorders and self-harm will increase e. Respiratory disease, severe acute respiratory illness and asthma will see marginal increases. Tuberculosis (TB) is forecast to increase from over 41,000 cases in 2020 to more than 52,000 in 2030 f. Regarding vector-borne diseases, malaria is expected to increase significantly. There will be increases in yellow fever cases https://www.atachcommunity.com/fileadmin/uploads/atach/Documents/Country documents/Nigeria Climate and Health VA assessment report - FINAL.pdf https://www.atachcommunity.com/fileadmin/uploads/atach/Documents/Country documents/Nigeria Climate and Health VA assessment report - FINAL.pdf https://www.atachcommunity.com/fileadmin/uploads/atach/Documents/Country documents/Nigeria Climate and Health VA assessment report - FINAL.pdf https://www.atachcommunity.com/fileadmin/uploads/atach/Documents/Country documents/Nigeria Climate and Health VA assessment report - FINAL.pdf OFFICIAL OFFICIAL How the HNAP was developed? The HNAP was developed against international quality standards, including WHO’s Quality Criteria for HNAPs and Guidance to Protect Health from Climate Change through Health Adaptation Planning, as well as against other high- quality HNAPs from other countries. All methods and processes used to develop the HNAP were validated by the FMoH and the national Climate Change and Health Technical Working Group (TWG). The development of the HNAP followed a structured, pa r t i c i pa to r y and evidence-based approach that built on the V&A and incorporated extensive stakeholder consultations, including with the States. HNAP interventions were approved at the end of 2024 by the National Council of Health (NCH). Further details on how the HNAP was developed are provided in Chapter 1.3 (overview of the HNAP development process). HNAP summary framework The HNAP sets out an ambitious delivery framework that aims to transform the resilience of health outcomes in Nigeria to the impacts from climate change. HNAP vision: Build resilient health systems and health outcomes to the impacts of climate change HNAP mission: To build climate-resilient health systems and communities that mitigate the risks, enhance preparedness and equitably safe guards the well- being of Nigeria’s people from the impact of climate change Nigeria’s HNAP summary framework The HNAP v i s i on and mission are underpinned by a series of validated and approved in tervent ions which make up the core of the HNAP framework. Interventions are presented in the HNAP as two inter- connected and time-based categories which will build “ read iness” and fu ture “resil ience” of Nigeria’s climate change and health programme at the Federal, State and Local Government Authority (LGA) levels. While the interventions are p r e s e n t e d a s d i s t i n c t categories, it is important to note that readiness and r e s i l i e n c e - b u i l d i n g intervention categories are, to some degree, integrated and overlapping, meaning that some resilience interventions are already underway and others are expected to start within the first year of the delivery of the HNAP in order to ensure that as many people’s health outcomes Nigeria Climate Change and Health Health National Adaptation Plan March 2025 https://www.who.int/publications/i/item/9789240018983 https://www.who.int/publications/i/item/who-guidance-to-protect-health-from-climate-change-through-health-adaptation-planning https://www.who.int/publications/i/item/who-guidance-to-protect-health-from-climate-change-through-health-adaptation-planning OFFICIAL OFFICIAL are protected from climate change as quickly as possible. Summary details of the interventions are provided below and complete information is provided in section 2.2 (HNAP interventions). Summary of readiness and resilience interventions Nigeria’s short-term priority interventions, years 0 - 2 Components Priority interventions Multisectoral and multilevel health- c l i m a t e leadership and governance Support the National Council on Climate Change (NCCC), Federal Ministry of Health and Social Welfare (FMoH&SW), and the Federal Ministry of the Environment (FMoEnv) to integrate the HNAP into the National Adaptation Plan (NAP) and Nationally Determined Contributions (NDCs) processes to ensure health is included in the national climate change priorities Assess the technical and operational capacity of national and sub- national sectoral policymakers, leaders, managers and climate change and health units to plan for and improve resilience in the health sector and system Establish multi-sectoral coordination mechanisms with clear responsibilities between the FMoH&SW, State MoH and sector ministries and other relevant agencies (MDAs) Develop performance and accountability measures for health leaders’ commitments to climate and health Nigeria Climate Change and Health Health National Adaptation Plan March 2025 “Readiness” interventions These interventions will enhance the capacities and institutional frameworks in the health system and communities to build essential foundations and future resilience against climate change. Readiness interventions fall under the following key themes: Initiating multisectoral and multilevel health-climate leadership and governance - and delineate clear roles and responsibilities between institutions and stakeholders Identifying and securing financing for H N A P i m p l e m e n t a t i o n t o s u p p o r t programmes at the Federal, State and LGA levels Building the capacity of national and sub- nat ional sectora l inst i tut ions and stakeholders to plan for and improve climate resi l ience in the heal th system and communities Further assess key climate and health priorities at the Federal, State and LGA levels and develop plans that can be delivered to strengthen future climate resilience “Resilience” interventions These interventions will build from the foundational “readiness” interventions by responding to and addressing climate threats to Nigeria’s health system over the longer- term. Resilience interventions fall under the following key themes: Improving the provision of climate- responsive and disaster-resilient health care at the Federal, State and LGA levels Strengthen ongoing evidence-gathering and knowledge-management for identifying, understanding and addressing climate-induced health risks and climate-sensitive diseases and health programmes Reinforcing the resilience of public health and environmental infrastructure and addressing vulnerabilities in the health supply chain, including retrofitting the basic- and comprehensive emergency obstetric facilities to improve their climate resilience. Maintaining and improving community-level health outcomes through climate-informed health programming and capacity-building OFFICIAL OFFICIAL Nigeria’s medium-long term priority interventions, years 3 - 5 Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery roles and responsibilities B u i l d t h e capacity of key institutions and stakeholders Develop an education and capacity building campaign for the national and sub-national health workforce on the impact of climate change, including on managing climate change events and public health emergencies Develop a national capacity building programme that will equip communities to respond to adverse weather events I d e n t i f y a n d secure financing Develop a domestic resource mobilization strategy that includes pooled funding, climate insurance, strategic purchasing and other financing options Work with international development partners to secure catalytic financing aligned to and directly supporting the implementation of the HNAP Further assess key climate and health priorities a n d d e v e l o p p l a n s t o s t r e n g t h e n future cl imate resilience Assess climate impacts on key health programmes (e.g. malaria/vector borne diseases, maternal and child health, tuberculosis, HIV, zoonoses, malnutrition and mental health) Develop climate informed intervention plans for key health programmes Assess the climate resilience of the procurement and supply chain to identify key vulnerabilities and adaptations, including exploring low carbon supply chain alternatives Assess the role and potential vulnerabilities of laboratory services in addressing the current and future impacts of climate change on health Develop health service delivery contingency plans for extreme weather events Develop climate-resilient health infrastructure models and blueprints by type/level of health infrastructure (*please note: at the time the HNAP was finalised this intervention for primary health care centres has largely been completed) Develop climate-informed health indicators for inclusion in DHIS2 Develop one integrated climate change, health and environmental early warning system that is linked to other sectors and government departments Components Priority interventions Multisectoral and multilevel health- c l i m a t e leadership and governance Support the National Council on Climate Change (NCCC), Federal Ministry of Health and Social Welfare (FMoH&SW), and the Federal Ministry of the Environment (FMoEnv) to integrate the HNAP into the National Adaptation Plan (NAP) and Nationally Determined Contributions (NDCs) processes to ensure health is included in the national climate change priorities Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Components Priority interventions I m p r o v e t h e p r o v i s i o n o f c l i m a t e - responsive and disaster-resilient health care at the Federal , State and LGA levels Operationalise and provide ongoing support to the established Federal and State multi-sectoral coordination mechanisms that will strengthen multi-sectoral responses to climate change adaptations Roll out the education and capacity building campaign for the health workforce to enable them to understand and respond to the impacts of climate change Maintain and update integrated climate change, health and environmental early warning system Support and monitor service delivery contingency plans in response to extreme weather Train health workers and health information teams on how to collect, analyse, interpret and respond to new climate informed indicators Operationalise and provide ongoing support to track and monitor the defined performance and accountability measures and hold leaders to account Support States with technical capacity to deliver their adaptations plans for climate and health Build the technical and operational capacity of national and sub-national sectoral policymakers, leaders, managers and climate change and health units Support the delivery of the climate informed health programme intervention plans (e.g., malaria/vector borne diseases, zoonoses, mental health etc) S t r e n g t h e n e v i d e n c e - gather ing and k n o w l e d g e - management Build a cadre of climate change health researchers (e.g. on climate and health into master’s degree programmes; training and mentorship for early and established researchers and research teams; including climate and health as a priority research theme in national priorities; partnerships with research institutes specialising in climate and health in other countries) Rein force the r e s i l i e n c e o f p u b l i c h e a l t h in f ras t ruc tu re supply chain Support the modification of infrastructure in the highest-risk and highest priority facilities to ensure they are climate resilient (*please note: at the time the HNAP was finalised, this intervention was already underway) Support the upgrading of laboratories and staff capabilities, as directed by the assessment of laboratory systems climate vulnerability assessment Support the upgrading of the procurement and supply chain to be more resilient to climate change and introduce low carbon alternatives I m p r o v e community-level health outcomes Support the delivery of the community capacity building programme, building from the national community capacity assessment Nigeria Climate Change and Health Health National Adaptation Plan March 2025 HNAP ToC narrative IF policies, plans, frameworks, mechanisms and technical capacity are in place AND climate threats to Nigeria’s health sector, health system and health outcomes are identified and addressed THEN the capacity and institutional frameworks for building resilience will be enhanced AND the vulnerability of Nigeria's health sector, health system and health outcomes (adaptive capacity, sensitivity, resilience) will be reduced IN ORDER TO reduce climate change-related morbidity and mortality in Nigeria. OFFICIAL OFFICIAL Monitoring, evaluation and learning The delivery of the HNAP will be supported through a robust monitoring, evaluation and learning (MEL) framework and plan which covers all the HNAP interventions and is informed by, and aligned to, a theory of change (ToC) for the HNAP. The ToC describes the internal logic of the HNAP, demonstrating how the activities, outputs and outcomes combine to achieve the HNAP’s ultimate goal and impact. Acknowledging the evolving circumstances of funding and implementing the HNAP, a set of core priority indicators has been selected by the Climate Change and Health TWG to inform the initial 2 years of the MEL plan, to be reviewed and expanded during implementation. These indicators will track the initial progress and development of the HNAP, as well as ensure alignment with ongoing projects and processes. Targets and ambition are to be confirmed with donors on the basis of funding. These indicators map onto some of the outputs of the ToC, although not comprehensively, as certain outputs refer to interventions only taking place in the later years of implementation. As implementation progresses, the indicators, and targets may be used to shape and direct the evolving HNAP, including modifying the set of indicators based upon the priority interventions that are being supported at certain stages of the HNAP delivery. Full details on the MEL plans are provided in section 6 of the HNAP. HNAP ToC HNAP core indicators, year 1 -2 Priority Interventions Core indicator (target) Means of verificatio n Frequency of reporting Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Support NCCC, FMoEnv and the FMoH&SW to integrate the HNAP into the NAP and NDCs processes to ensure health is included in the national climate change priorities a. HNAP priority interventions and data included in NAP and NDCs updates (target: x% of interventions included) b. Health mainstreamed in NAP and NDC updates (target: health priorities reflected/ discussed in NAP and NDC updates) NAP; NDC Alongside NDCs, NAP update timeline Establish multi-sectoral coordination mechanisms with clear responsibilities between the FMoH&SW, State MoH and sector ministries and other agencies a. Multi-sectoral climate-health coordination mechanism (TWG and HNAP National Steering Committee) established with respective TOR (target: in place by X date) b. Functional chair/deputies in place and regular meetings taking place (target: in place by X date) TOR, meeting minutes One off, ongoing operation reviewed annually Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery roles and responsibilities a. State Change and Health Adaptation Plans on climate change and health (target: developed, costed, and validated for 36+1 States by X date) Note: Aligns with HOPE-PHC DLR 10.1-10.4: Climate and health adaptation plan developed, costed, and validated (number) State Climate Change and Health Adaptation Plans One off, and as plans are revised/ updated Develop climate-informed intervention plans for key health programmes a. Climate-informed intervention plans for key health programmes developed, costed, and validated (target: completed for X key health programmes by X date) Note: Aligns with HOPE-PHC DLR 10.1-10.4: Climate and health adaptation plan developed, costed, and validated (number) Climate- informed intervention plans Reviewed as needed Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Develop climate-resilient health infrastructure models and blueprints by type/level of health infrastructure a. Climate-resilient health infrastructure models and blueprints (target: completed for TYPE by X date) b. Guidelines for facilities developed from the Smart Hospitals Toolkit (target: xx by X date) c. CRIBS Framework, guidance and tools published and accessible (target: completed by X date) Note: Aligns with HOPE-PHC PDO Indicator: PHC facilities achieving service readiness assessment criteria (%) Note: Aligns with HOPE-PHC DLR 1.1: Improved primary healthcare facility readiness, quality, and climate resilience in participating states (%) Note: Aligns with HOPE-PHC DLR 1.2: Increased empanelment and refurbishment of CEmONC facilities that demonstrate service readiness and climate resilience and energy efficiency (number) Final models and blueprints One off Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Governance and implementation framework The HNAP governance and implementation framework aligns with other similar coordination and management frameworks in the health sector, especially the Sector Wide Approach (SWAp), as well as with other key sectors that are impacted by climate change and which the health sector will partner with through an integrated “one-government” approach to effectively address climate change. The framework aligns with Nigeria's NAP and NDCs to ensure synergy across sectors. Full details of the governance and implementation arrangements are provided in section 3 of the HNAP. Objectives of Nigeria’s HNAP governance 1. Provide oversight and set direction with regards to policy, strategy and implementation 2. Ensure alignment of the HNAP with national health, environmental, and climate change ambitions, including the NAP and NDC 3. Ensure accountability for the effective delivery of the HNAP 4. Define, coordinate and align roles, responsibilities, and decision-making authorities across the FMoH&SW through the Public Health Department, Federal MDAs, State governments and MoHs, as well as the LGAs, and community levels 5. Support the coordination of key partners and stakeholders across multiple sectors (beyond the health sector) and MDAs to deliver the HNAP 6. Establish effective financial controls by overseeing the establishment of a dedicated Financial Management Unit within the HNAP governance structure The HNAP governance and implementation framework is fully aligned with and supports Nigeria’s health SWAp governance and delivery arrangements – at both the Federal and State levels. This places a focus on coordination across multiple partners with an aligned focus on one plan, one budget and one MEL framework. HNAP governance and implementation framework The HNAP will be governed at the highest level by the HNAP National Steering Committee (NSC) which will be supported at the Federal level through a results-oriented HNAP TWG, under which thematic working groups will operate. At the State level, it is suggested that State Climate and Health Adaptation Plan Implementation Committees – or similar will be established, and also at LGA, Climate and Health Adaptation Plan Implementation Committees, although it is recognised that the governance and implementation frameworks may differ between the States. Each State in Nigeria will develop their own State Climate and Health Adaptation Plans - and supporting governance and implementation frameworks – in the manner that they deem to be most effective given their local context. The HNAP makes suggestions for State governance and implementation frameworks. These suggestions should be considered as minimum standards rather than prescriptive directives. It is suggested that the governance and implementation of the State Climate and Health Adaptation Plans should also mirror the SWAp arrangements and be coordinated through a State Climate and Health Adaptation Plan Implementation Committee or similar, which will be supported through LGA Implementation Committees. In all cases, guidance on developing State Climate and Health Adaptation Plans and governance and implementation frameworks will be provided by the Federal levels to the States for consideration. HNAP governance arrangements Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Financing the HNAP It is estimated that up to $355 million is required to fully implement the agreed HNAP interventions, i.e., to implement all proposed activities and interventions. Full details on the financing and costs are provided in section 4 of the HNAP. The HNAP's financing component, while outlining an ideal scenario, is dependent on the fluctuating landscape of government and development partner funding, both within Nigeria and globally. Therefore, the financing details presented in the HNAP should be understood as a flexible framework requiring potential adjustments based on evolving financial and delivery contexts. Most of the funding to support HNAP implementation is required between year 2 and year 4, peaking in year 3. Nigeria's required investment for climate and health, 2025/6-2030 Nigeria's required investment for climate and health, 2025/6-2030 US$ millions Nigeria Climate Change and Health Health National Adaptation Plan March 2025 U SD m ill io ns 0 30 60 90 120 Year 1 Year 2 Year 3 Year 4 Year 5 HNAP technical and thematic working groups (e.g., finance/resource mobilisation, MEL, state liaison etc.) State Climate Health Governance / Implementation Committee Overall lead for the State Climate and Health Adaptation Plans FMoH&SW Health SWAp Steering Committee Public Health State Ministry of Health CC&EH Division HNAP National Steering Committee Overall lead for the HNAP governance and accountability Chaired by the Coordinating Minister, FMoH&SW (Alternate Chair: Minister of State, FMoH&SW) HNAP TWG LGA Implementation Committees Drives operational activity and delivery of the LGA Climate and Health Adaptation Plans State Public Health Dept. Implementing and development partners MDAs OFFICIAL OFFICIAL It is anticipated that the vast majority of the required funds (approximately $311 million or 88% of the total budget) is required for interventions under the climate-informed health programmes ($241 million, 68%) and technology and infrastructure ($70 million, 20%) building blocks/themes. Significant financial resources will need to be mobilised to support the delivery of the HNAP, including domestic and donor sources, which will serve as catalytic investments. Recognising this need, a dedicated HNAP intervention in year one will develop a detailed resource mobilisation strategy. This should include a thorough assessment of funding needs, a comprehensive gap analysis, and a targeted strategy for engaging with potential funding sources. It should outline clear mechanisms for financial management, monitoring, and evaluation to ensure transparency and accountability in the use of resources. It is also important to recognise that resource mobilisation is an ongoing process that requires new challenges and opportunities to emerge; the HNAP resource mobilisation framework and plan should be regularly reviewed and updated to ensure its continued effectiveness and relevance. Cost breakdown by health building block/programme theme Financiers of the HNAP should consider pursuing a ‘fund agnostic’ or diversified funding strategies, carefully matching interventions to the most appropriate financing sources based on their specific needs, circumstances, and long-term development goals. Further details on resource mobilisation are provided in section 5 of the HNAP. Year 1 Year 2 Year 3 Year 4 Year 5 Total 7,057,382 93,132,459 115,764,000 83,435,000 56,009,000 355,397,841 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 T h e m e Climate-informed health programmes Technology & infrastructure Leadership & governance Emergency preparedness & management Health workforce Implementation/secretariat Health & climate research Integrated risk monitoring & early warning Climate & health financing US$ million 1 10 100 1,000 1.8 2.2 2.5 2.8 5.0 9.3 20.6 70.2 240.8 OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 1. Introduction OFFICIAL OFFICIAL 1.1 Introduction to the HNAP Nigeria’s Health National Adaptation Plan (HNAP, 2025 - 2030) represents a significant milestone in the ongoing climate change and health programme, which has been evolving since Nigeria made ambitious commitments at COP26 in 2021. In recent years, the country has made substantial progress in fulfilling these commitments, as illustrated in Figure 1 below. Under the leadership of the Coordinating Minister for Health and Social Welfare, Professor Muhammad Ali Pate, along with the Permanent Secretary of Health, development partners, and key stakeholders within Nigeria’s Climate Change and Health Technical Working Group (TWG), there has been a renewed commitment to advancing these goals. This collective effort has strengthened the momentum behind Nigeria’s climate and health agenda. Figure 1. Timeline of Nigerian climate change and health program since COP26 Nigeria’s climate and health priorities build on its COP26 commitments. A crucial first step was the development of Nigeria’s first Vulnerability and Adaptation (V&A) assessment, which was launched in November 2024, and on which the HNAP builds from. As presented in section 2.2 below, the V&A highlights that the risks and impacts from climate change to the health system are projected to worsen in terms of severity, duration, and magnitude across all geographical areas of Nigeria and across all 10 climate resilient building blocks, which are presented in Box 1 and used throughout the HNAP. The HNAP aligns with the country’s broader climate policies, including the National Adaptation Plan (NAP) - strategic process established under the United Nations Framework Convention on Climate Change (UNFCCC) for identifying, assessing, and addressing short-, medium- and long-term adaptation needs to climate change and Nigeria’s Nationally Determined Contributions (NDCs) – the national climate action plan submitted under the Paris Agreement and which outlines commitments to reducing greenhouse gas (GHG) emissions and adapting to climate change. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 https://www.atachcommunity.com/fileadmin/uploads/atach/Documents/Country documents/Nigeria Climate and Health VA assessment report - FINAL.pdf OFFICIAL OFFICIAL The HNAP recognises the interconnection between climate change and public health and is framed such that health-determining activities are integrated into the broader NAP through sectoral integration, policies coherence, public health systems and infrastructure resilience building, and tracking and evaluation of climate change adaptation across the country. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Box 1. The 10 building blocks of climate resilient health systems 1. Leadership and governance that ensures political commitment and effective leadership to build climate resilience through policy prioritisation and planning to address climate risks, including through partnerships and accountability 2. Climate and health financing which supports countries in identifying and accessing sustainable financing to support climate change and health interventions, including climate change funding streams. and funding allocated for health-determining sectors 3. Health workforce that ensures sufficient recruitment and training of staff to ensure health resilience planning. Using climate information for health decision making. 4. Vulnerability, capacity and adaptation assessment that establishes a baseline of the health systems’ vulnerability and capacity together with future risk and adaptation assessments in a form to enable their regular update 5. Integrated risk monitoring and early warning to strengthen climate change and health integrated disease surveillance and climate-informed early warning systems 6. Health and climate research to develop an evidence base for policy, and innovative solutions for climate change and health 7. Climate resilient and sustainable technology and infrastructure adaptation across infrastructure, technologies and supply chains 8. Management of environmental determinants of health to step up efforts to respond to environmental risks to health by strengthening monitoring and management of environmental determinants of health; developing and implementing regulatory instruments and mechanisms; and promoting coordinated intersectoral management including air, water, soil, food, housing, waste 9. Climate informed health programmes using the information gathered from health information systems from assessments, research and monitoring, to inform the way specific climate sensitive health programmes are delivered 10. Emergency preparedness and management to build preparedness, response capacity and health security in health systems and communities by implementing climate related risk management for emergencies and disasters, through climate-smart policies and protocols and establishing climate-informed health emergency and disaster risk management and supporting community empowerment Baraka Muazu Baraka Muazu OFFICIAL OFFICIAL 1.2 Climate and health in Nigeria The priority interventions outlined in chapter 2 of the HNAP have been developed in direct response to the main findings from the Climate and Health V&A assessment, including the key risks and vulnerabilities to health outcomes and the health system to climate change. The overarching headline findings from the V&A assessment are outlined below. a. The overall trend – across all scenarios - is that the risks and impacts from climate change to the health sector are projected to worsen in terms of severity, duration and magnitude across all geographic areas of Nigeria b. Under all scenarios and despite any efforts on behalf of Nigeria, the country’s risk to climate change is increasing and will continue to increase. These increased risks will create a situation that will impact health care capacity, increase the vulnerability of communities and create conditions more conducive to increased disease incidence and prevalence, with some geopolitical zones and States being more at risk that others c. Based on analysis, Nigeria will experience an additional 21% burden of disease due to climate change d. Many waterborne diseases will increase due to climate change. Some Neglected Tropical Diseases are expected to increase e.g. Buruli ulcers, Guinea worm, Trypanosomiasis. Diarrhoea related deaths in children under 15 resulting from climate change will account for 9.8% of the total diarrhoea related mortalities e. Non-communicable diseases will increase. Cardiovascular disease will increase by 10% to over 4.5m cases in 2030. Diabetes is predicted to increase to almost 450,000 in 2030 due to rising temperatures. High blood pressure is also expected to increase significantly from almost 900,000 cases in 2020 to over 1.6m in 2030 f. Mental health conditions will rise due to the stresses of climate change. Mental disorders will rise from 2.6m in 2020 to more than 3.1m by 2030. Interpersonal violence will increase from 900,000 in 2020 to 1.05m in 2030 and neurological disorders and self- harm will increase g. Respiratory disease, severe acute respiratory illness and asthma will see marginal increases. Tuberculosis (TB) is forecast to increase from over 41,000 cases in 2020 to more than 52,000 in 2030 h. Regarding vector-borne diseases, malaria is expected to increase significantly. There will be increases in yellow fever cases Nigeria’s entire health sector, health system and citizens’ health outcomes are affected by the impacts from climate change, which will increase in intensity creating poorer health outcomes and widening health inequalities. Nigeria faces significant health vulnerabilities associated with anticipated future climatic conditions, as shown in Table 2. These conditions include rising temperatures, increased frequency and intensity of extreme weather phenomena such as heavy rainfall along with prolonged and more severe periods of heat, drought and aridity. Climate change in Nigeria affects different population groups disproportionately, causing and exacerbating socioeconomic and health inequalities. Health sector stakeholder perceptions are that women, especially pregnant mothers and those in their Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Baraka Muazu Baraka Muazu Baraka Muazu Baraka Muazu Baraka Muazu Baraka Muazu OFFICIAL OFFICIAL reproductive age group; children; the elderly; persons with disabilities; people with psychosocial disorders; and individuals with pre-existing and chronic health conditions are the most vulnerable to climate change impacts. Poor women who bear the unpaid burden of childcare, family health and children’s schooling, for example, are more likely to be vulnerable to these impacts. People residing in poor living conditions, north-east and north- west Nigeria, indigent communities' urban slums, unsecured settlements, overcrowded communities, and places prone to the impacts of extreme weather such as coastal parts of southern Nigeria are also disproportionately vulnerable to climate change. Table 1. How Nigeria’s weather will be affected by climate change 1 Nigeria’s risk to climate change is increasing and will continue to increase. These increased risks will create a situation that will impact healthcare capacity, increase the vulnerability of communities and create conditions more susceptible to the spread and increase in disease incidence and prevalence. Risks and impacts from climate change to health outcomes are projected to worsen in terms of severity, duration and magnitude across all geographic areas of Nigeria, as shown in Table 2 and Figure 2. Table 2. Nigeria’s cumulative health system vulnerability to climate change Temperature Extreme heat Rainfall Sea levels Will continue to rise ac ross N ige r ia by approximately 1.0 - 1.1 °C between 2020 and 2 0 5 0 u n d e r m i l d c l imat ic scenar ios. Under more extreme scenarios it is expected to rise by at least +3.0 °C Nigerians exposed to heat waves each year will quadruple from 6% in 2000 to 19 - 22% by 2080. Deaths from heat are expected to double, increasing from 2.5 to 5 per 100,000 people per year by 2080 800,000 individuals are at risk from riverine flooding by 2030 and approximately 550,000 people each year could be affected annually by flooding from rising sea levels by 2070 P r e d i c t e d t o r i s e between 0.5 and 1.0 meters by the end of the century which will have a s ign i f i can t impact, increasing the risk of flooding for coastal towns, and which will alter patterns o f i n f e c t i o u s a n d vector-borne disease transmission Most States in the North-West and North- East zones – Kebbi, Zamfara, Katsina, Kaduna, Jigawa Taraba, Bauchi and Yobe Eastern parts of Niger and Kwara State in North Central zone, south parts of Cross Rivers State in South zone and Imo and Abia States in South- East zone States in North- East and North Central zones States in the South-West and South zones Nigeria’s Vulnerability and Adaptation Assessment, 20241 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Highest vulnerabilities High vulnerabilities Medium vulnerabilities Lower vulnerabilities OFFICIAL OFFICIAL Figure 2. Nigeria’s cumulative health system vulnerability to climate change Nigeria’s health system is very vulnerable to the impacts of climate change and is often overburdened by changing climate conditions. Nigeria’s recent climate and health V&A assessment indicates several concerns regarding the effects of climate change impacts on an already underperforming health system, as summarised in Table 2. Table 3. Summary of climate change implications on Nigeria’s health system Climate resilient building block Climate change impacts • Difficulties in planning, disruptions to operations and increased costs, due to unpredictability of weather patterns • Multi-sectoral coordination efforts are required to mitigate the impacts of climate change • Climate change undercuts financial resources budgeted for health service provision – needing re-allocation of funds to treat new disease burden or re-design of healthcare programmes and services • Safety of health workers compromised when carrying out duties under extreme weather conditions • Increased workload - overstretched health workers who have to cope with increased demand from climate health risks • Increased occurrence of errors, due to the unsuitable working environment (e.g. very high temperatures) and excessive workload • Increased prevalence and incidence of climate health risks places new demand on the already week HMIS to analyse disease impacts • Increased amounts of health information that needs to be gathered and reported overwhelms the HMIS and data availability for decision making • Greater need for more climate and health research to inform Nigeria’s adaptation to climate change and build resilience • Increased need for an integrated and cross sectoral EWS that addresses health impacts of climate change Climate and health financing Leadership and governance Vulnerability, capacity and adaptation assessment Health workforce Health and climate research Integrated risk monitoring and early warning Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL • Disruption to transport facilities/services from extreme weather events leading to shortages of essential medicines and supplies • Changes in temperature affecting storage conditions for vaccines and drugs which causes many problems with the safety of drug use • Flood water destroy medical equipment, drugs, and supplies Climate resilient building block Climate change impacts Climate resilient and sustainable technologies infrastructure Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 1.3 Overview of the HNAP development process Nigeria’s HNAP was developed against international quality standards, including WHO’s Quality Criteria for HNAPs and Guidance to Protect Health from Climate Change through Health Adaptation Planning, amongst others, as well as against other high-quality HNAPs from other country contexts. All methods and processes used to develop the HNAP were validated by the Federal Ministry of Health and Social Welfare (FMoH&SW) and the national Climate Change and Health TWG. The development of the HNAP followed a structured, participatory and evidence-based approach that built on Nigeria’s Climate and Health V&A. The HNAP was developed through extensive stakeholder consultations, including with the States, and supporting government leadership and enhancing capacity throughout. Summary details of the processes used to develop the HNAP are provided in Table 3. below Table 4. Summary of the iterative process used to develop the HNAP • Damage to health care facilities due to extreme weather and decreasing access to water during droughts • Reduced access to water during floods and extreme weather events as water sources compromised and no longer 'safe' • Disruption to power and energy sources impacts the operation of primary health care and key services • Health facilities must meet increased demand for services due to climate change resulting from climate-sensitive health risks Climate resilient building block Climate change impacts Emergency preparedness and management Environmental determinants of health Climate-informed health programmes Phases Key components Inception phase – August and September 2024 a. Consultation meetings with the FMoH&SW, Climate and Health TWG and development partners – established modalities of working, scope and expectations; and capacities to be developed to support government ownership and leadership of the HNAP. b. Initial TWG meeting – established the HNAP aim and objectives; ways of working; capacities of the TWG members to develop; scope and expectations; and the approaches to develop the HNAP by building on good practices and WHO quality criteria. c. Rapid background review – together with the FMoH and the TWG, information to inform the HNAP was identified - primarily the V&A assessment report as well as relevant assessments and HNAPs from other countries. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 https://www.who.int/publications/i/item/9789240018983 https://www.who.int/publications/i/item/who-guidance-to-protect-health-from-climate-change-through-health-adaptation-planning https://www.who.int/publications/i/item/who-guidance-to-protect-health-from-climate-change-through-health-adaptation-planning OFFICIAL OFFICIAL 1.3.1 HNAP priority interventions The core of the HNAP framework are the priority interventions that will be resourced, delivered, effectively governed and supported by robust monitoring, evaluation and learning (MEL). The HNAP interventions were prioritized through extensive consultations with the Federal and State MoHs; the national Climate and Health TWG, which includes key stakeholders from within the health sector as well as other allied ministries, departments and agencies (MDAs); donor agencies, development partners, and academia. In extensive consultations with stakeholders, more than 120 identified interventions from the V&A assessment were developed, ranked and prioritised by stakeholders against a set of weighted criteria as seen in Table 5. The priority HNAP interventions were reviewed by key stakeholders from the national Climate and Health TWG in early November 2024, presented at CP29, and subsequently presented in a memo to the National Council of Health, and were approved later in the same month. The HNAP interventions are presented in the HNAP framework section in chapter 3. Draft HNAP document – September to November 2024 a. Key HNAP actions and implementation strategies – detailed the actions and implementation strategies necessary to reduce the potential health risks from climate change as identified in the V&A. b. HNAP actions and implementation strategies presented to FMoH, TWG and development partners for inputs and validation. The TWG and other stakeholders – including stakeholders from other sectors – were widely consulted. A prioritisation matrix was developed to categorise the implementation activities and strategies as agreed with the FMoH and TWG. c. Costed HNAP interventions – detailed cost estimates of the agreed HNAP implementation activities were conducted with the FMoH&SW and stakeholders. d. HNAP costings agreed in-person with FMoH, TWG and development partners - for inputs and validation. e. Agree the priority interventions for the HNAP which were presented to development partners at COP26 and in a memo for approval by the National Council on Health (the highest policy making body for health in Nigeria). Finalise HNAP report – December 2024 to February 2025 a. Incorporated feedback into final and costed HNAP document. b. Developed final HNAP document. c. Presented draft HNAP report to FMoH, TWG and development partners for final review, validation and approval. d. Review and approval of the HNAP for publication by the Coordinating Minister for Health and Social Welfare and the Permanent Secretary. Phases Key components Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Table 5. Weighted criteria that interventions were ranked and prioritised. Together with stakeholders, interventions were prioritised over a five-year period, from 2025 – 2030, in line with the timeframe for the HNAP. Priority interventions were then split into two inter-connected and time-based categories; those which will build “readiness” and those that will build future “resilience” of Nigeria’s climate change and health programme at the Federal, State and Local Government Authority (LGA) levels. Criteria Financing M u l t i s e c t o r a l c o - benefits Alignment to Government policies and plans Definitio n How feasible is it to get funding? To what degree is the intervention beneficial to other sectors? To what degree is the intervention aligned to the current government policies? Criteria Gender and vulnerable groups Scalability Feasibility Definitio n To what degree are gender and vulnerable groups impacted? To what degree can the intervention be scaled to the different t iers of governance/ intervention? H o w f e a s i b l e i s i t t o implement the intervention? Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 2. HNAP framework OFFICIAL OFFICIAL 1. Introduction This chapter outlines the core framework of the HNAP, highlighting the priority interventions required to achieve its overall delivery. These interventions are strategically designed to fulfil the mission and vision of the HNAP. The framework is underpinned by a dedicated Theory of Change (ToC), cost requirements and resource mobilisation considerations, a governance and implementation framework, and a MEL framework, which are provided in the subsequent chapters. The HNAP summary framework is presented in Figure 5 and further details are provided below. HNAP vision Resilient health systems and health outcomes to the impacts of climate change HNAP mission To build climate-resilient health systems that mitigate the risks, enhance preparedness and equitably safe guards the well-being of Nigeria’s people from the impact of climate change Figure 3. Nigeria’s HNAP summary framework Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 2.2 HNAP interventions The HNAP vision and mission are underpinned by a series of validated and approved interventions which are presented in the HNAP as two inter-connected and time-based categories which will build “readiness” and future “resilience” of Nigeria’s climate change and health programme at the Federal, State and LGA levels, as outlined in Figure 4 and Table 6. While the interventions are presented as distinct categories, it is important to note that readiness and resilience-building intervention categories are, to some degree, integrated and overlapping, meaning that some resilience interventions are already underway in Nigeria and others are expected to be starting within the first year of the delivery of the HNAP in order to ensure that as many people’s health outcomes are protected from climate change as quickly as possible. Such interventions are marked with * in Table 5. Figure 4. Summary of the HNAP’s “readiness” and “resilience” interventions Table 6. Nigeria’s short-term adaptation priorities, years 0 - 2 Components Priority interventions Multisectoral and multilevel health- c l i m a t e leadership and governance Support the National Council on Climate Change (NCCC), Federal Ministry of Environment (FMoEnv) and the FMoH&SW to integrate the HNAP into the NAP and NDCs processes to ensure health is included in the national climate change priorities Assess the technical and operational capacity of national and sub- national sectoral policymakers, leaders, managers and climate change and health units to plan for and improve resilience in the health sector and system Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Readiness” interventions These interventions will enhance the capacities and institutional frameworks in the health sector and system to build essential foundations and future resilience against climate change. Readiness interventions fall under the following key themes: a. Initiating multisectoral and multilevel hea l th -c l imate l eadersh ip and governance - and delineate clear roles and responsibilities between institutions and stakeholders b. Identifying and securing financing for HNAP implementation to support programmes at the Federal, State and LGA levels c. Building the capacity of national and sub-national sectoral institutions and stakeholders to plan for and improve climate resilience in the health sector and system d. Further assess key climate and health priorities at the Federal, State and LGA levels and develop plans that can be delivered to strengthen future climate resilience “Resilience” interventions These interventions will build from the foundational “readiness” interventions by responding to and addressing climate threats to Nigeria’s health system over the longer-term. Resilience interventions fall under the following key themes: a. Improving the provision of climate- responsive and disaster-resilient health care at the Federal, State and LGA levels b. Strengthen ongoing evidence- g a t h e r i n g a n d k n o w l e d g e - m a n a g e m e n t f o r i d e n t i f y i n g , understanding and addressing climate- induced health risks and climate- s e n s i t i v e d i s e a s e s a n d h e a l t h programmes c. Reinforcing the resilience of public h e a l t h a n d e n v i r o n m e n t a l in f rast ructure and addressing vulnerabilities in the health supply chain , inc lud ing re t ro f i t t ing the BEmONCs and CEmONCs to improve their climate resilience. d. M a i n t a i n i n g a n d i m p r o v i n g community-level health outcomes OFFICIAL OFFICIAL Table 6. Nigeria’s medium-long term adaptation priorities, years 3 - 5 Establish multi-sectoral coordination mechanisms with clear responsibilities between the FMoH, State MoH and sector ministries and other agencies Develop performance and accountability measures for health leaders’ commitments to climate and health Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery roles and responsibilities B u i l d t h e capacity of key institutions and stakeholders Develop an education and capacity building campaign for the national and sub-national health workforce on the impact of climate change, including managing climate change events and public health emergencies Develop a national capacity building programme that will equip communities to respond to adverse weather events I d e n t i f y a n d secure financing Develop a domestic resource mobilization strategy that includes pooled funding, climate insurance, strategic purchasing and other financing options Work with international development partners to secure catalytic financing aligned to and directly supporting the implementation of the HNAP Further assess key climate and health priorities develop plans to s t r e n g t h e n future cl imate resilience Assess climate impacts on key health programmes (e.g. malaria/vector borne diseases, maternal and child health, TB, HIV, zoonoses, malnutrition and mental health) Develop climate informed intervention plans for key health programmes Assess the climate resilience of the procurement and supply chain to identify key vulnerabilities and adaptations, including exploring low carbon supply chain alternatives Assess the role and potential vulnerabilities of laboratory services in addressing the future impacts of climate change on health Develop health service delivery contingency plans for extreme weather events Develop climate-resilient health infrastructure models and blueprints by type/level of health infrastructure (*please note: at the time the HNAP was finalised this intervention for primary health care centres is ongoing. Develop climate-informed health indicators for inclusion in DHIS2 Develop one integrated climate change, health and environmental early warning system that is linked to other sectors and government departments Components Priority interventions Multisectoral and multilevel health- c l i m a t e leadership and governance Support the National Council on Climate Change (NCCC), Federal Ministry of Environment (FMoEnv) and the FMoH&SW to integrate the HNAP into the NAP and NDCs processes to ensure health is included in the national climate change priorities Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Components Priority interventions I m p r o v e t h e p r o v i s i o n o f c l i m a t e - responsive and disaster-resilient health care at the Federal , State and LGA levels Operationalise and provide ongoing support to the established Federal and State multi-sectoral coordination mechanisms that will strengthen multi-sectoral responses to climate change adaptations Roll out the education and capacity building campaign for the health workforce to enable them to understand and respond to the impacts of climate change Maintain and update integrated climate change, health and environmental early warning system Support and monitor service delivery contingency plans in response to extreme weather Train health workers and health information teams on how to collect, analyse, interpret and respond to new climate informed indicators Operationalise and provide ongoing support to track and monitor the defined performance and accountability measures and hold leaders to account Support States with technical capacity to deliver their adaptation plans for climate and health Build the technical and operational capacity of national and sub-national sectoral policymakers, leaders, managers and climate change and health units Support the delivery of climate informed health programme intervention plans (e.g., malaria/vector borne diseases, zoonoses, mental health etc) S t r e n g t h e n e v i d e n c e - gather ing and k n o w l e d g e - management Build a cadre of climate change health researchers e.g., on climate and health into master’s degree programmes; training and mentorship for early and established researchers and research teams; including climate and health as a priority research theme in national priorities; partnerships with research institutes specialising in climate and health in other countries. Rein force the r e s i l i e n c e o f p u b l i c h e a l t h in f ras t ruc tu re supply chain Support the modification of infrastructure in the highest-risk and highest priority facilities to ensure they are climate resilient (*please note: at the time the HNAP was finalised, this intervention was already underway) Support the upgrading of laboratories and staff capabilities, as directed by the assessment of laboratory systems climate vulnerability assessment Support the upgrading of the procurement and supply chain to be more resilient to climate change and introduce low carbon alternatives I m p r o v e community-level health outcomes Support the delivery of the community capacity building programme, building from the national community capacity assessment Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 3. Governance and implementation framework OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 3.1 Introduction The main objective of the governance and implementation framework for the HNAP is to ensure strong leadership, governance and management arrangements for Nigeria’s health sector and health system to effectively address the key climate related risks to health outcomes and to ensure the HNAP and Nigeria’s climate and health programme is effectively delivered. The governance and implementation framework outlines the operational modalities and plans to ensure the HNAP aligns with other similar coordination and management frameworks in the health sector, especially the Sector Wide Approach (SWAp). The governance and implementation framework also aligns with other key sectors that are impacted by climate change and which the health sector will partner with through an integrated “one-government” approach to effectively address climate change. The framework aligns with Nigeria's NAP and NDC to ensure synergy across sectors. 3.2 HNAP governance and implementation framework The governance structure provides the framework of authority, rules, practices, processes and accountability that will define the controls, outputs, and benefits from the HNAP. The governance and implementation arrangement employs horizontal (coordination of activities by MDAs at Federal and States levels), and vertical (all tiers of government – Federal, State, and LGAs; and all tiers of the healthcare delivery system – tertiary, secondary, and primary) integration in all aspects of the development, implementation, and MEL of the HNAP process. Box 2. Objectives of Nigeria’s HNAP governance 1. Provide oversight and set direction with regards to policy, strategy and implementation 2. Ensure alignment of the HNAP with national health, environmental, and climate change ambitions, including the NAP and NDC 3. Ensure accountability for the effective delivery of the HNAP 4. Define, coordinate and align roles, responsibilities, and decision-making authorities across the FMoHSW through the Public Health Department, Federal MDAs, State governments and MoHs, as well as the LGAs and community levels 5. Support the coordination of key partners and stakeholders across multiple sectors (beyond the health sector) and MDAs to deliver the HNAP 6. Establish effective financial controls by overseeing the establishment of a dedicated Financial Management Unit within the HNAP governance structure The key roles and functions of the HNAP governance and implementation framework are summarised in the text below and especially Figure 5 and Table 7. The framework is fully aligned with and supports Nigeria’s health SWAp governance and delivery arrangements – at both the Federal and State levels. This places a focus on coordination across multiple partners with an aligned focus on one plan, one budget and one MEL framework. The HNAP will be governed at the highest level by the HNAP National Steering Committee (NSC) which will be supported at the Federal level through a results-oriented HNAP TWG, under which thematic working groups will operate. At the State level, it is suggested that State Climate and Health Adaptation Plan Implementation Committee – or similar will be established, and also LGA Climate and Health Adaptation Plan Implementation Committees; although it is recognised that the governance and implementation frameworks may differ between the States. 3.2.1 National-level governance and implementation framework As outlined in Figure 7, the HNAP NSC will serve as the overall national-level governance and implementation mechanism. It will act as the oversight and accountability lead, Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL providing strategic direction and making high-level decisions. The HNAP TWG will drive HNAP operational activity and delivery and will be supported by technical and thematic working groups. Several stakeholders from relevant sectors will be involved in the national level governance and implementation arrangements, as outlined in Table 7 below. Details on the national level governance and implementation arrangements are provided in Table 8. Figure 5. HNAP governance and implementation framework Table 7. National-level stakeholder’s roles and responsibilities for the HNAP governance and implementation Agency Primary role Key responsibilities FMoH Lead policy, coordination, and implementation oversight of the HNAP delivery • Guides the implementation of key actions and interventions. • Responsible for oversight functions, helping to coordinate assistance to States in: developing their State Climate and Health Adaptation Plans, capacity development, and provision of technical assistance. • Supervise and serves as the lead for HNAP implementation • Identifies and helps to coordinate funding sources to support the HNAP delivery Nigeria Climate Change and Health Health National Adaptation Plan March 2025 HNAP technical and thematic working groups (e.g., finance/resource mobilisation, MEL, state liaison etc.) State Climate Health Governance / Implementation Committee Overall lead for the State Climate and Health Adaptation Plans FMoH&SW Health SWAp Steering Committee Public Health Dept. State Ministry of Health CC&EH Division HNAP National Steering Committee Overall lead for the HNAP governance and accountability Chaired by the Coordinating Minister, FMoH&SW (Alternate Chair: Minister of State, FMoH&SW) Secretariat provided by CC&EH Department HNAP TWG LGA Implementation Committees Drives operational activity and delivery of the LGA Climate and Health Adaptation Plans State Public Health Dept. OFFICIAL OFFICIAL Public Health Department Lead oversight for coordination and implementation of HNAP activities within the FMoH&SW • Primary responsibility for coordinating the HNAP activities • Coordination of climate--health activities with multi-sectoral agencies, key stakeholders, and development partners CC&EH Division Lead coordination and implementation of HNAP activities • Serves as the main division in the FMoH for the delivery of the HNAP • Provides secretariat for NSC • Routinely monitors the HNAP deliverables M u l t i - s e c t o r a l MDAs Provide inputs into the governance (NSC membership) and support for the delivery of the HNAP • Provide and share knowledge and data on climate change and extreme weather events challenges • Ensure inter-agencies technical and resource support for climate-risks interventions • Support the integration of HNAP interventions that are dependent on working across multiple-sectors and engage HNAP TWG and relevant governance bodies Development partners Provide inputs into the governance (NSC membership) and technical and financial support for the delivery of the HNAP • Expert and technical advisory support and interventions on different aspects of climate change adaptation, and mitigation interventions including addressing gender-based issues • Providing international best practices and technical expertise • Financing of selected HNAP interventions • Coordinate and align support to deliver HNAP priorities • Engage HNAP TWG and NSC Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Table 8. National-level institutional arrangements Struc ture Prima ry role Description K e y responsibilities Key positions Meeti n g frequ HNA P NSC Overall lead for the HNAP governa nce and account ability The NSC will serve as the primary oversight and accountability lead, providing strategic direction and making high- level decisions. Membership shall be multi-sectoral and bring together senior level leadership. • Ensuring an effective HNAP accountability mechanism • Ensure coherence of HNAP implementation with national policy ambitions including the NAP and NDCs, health sector blueprint and international climate commitments • Leverage high-level partnerships in multiple sectors and with various Chair • Coordinating Minister for FMoH&SW Alternate Chair: • Hon. Minister of State/Permanent Secretary, FMoH&SW Secretariat *Environmental Health and Climate Change (EH&CC) Division, FMoH *The HNAP NSC will Every six month s TWG Core task group that drives operatio nal activity and delivery of the HNAP In line with the health SWAp, the TWG will be very task focused and not serve as a traditional TWG model. The TWG will be responsible for the routine delivery of the HNAP and will report on progress to the NSC. It will comprise of key agencies and development partners focused on delivery and implementation, • Oversight for delivery of all HNAP implementation activities • Provides direction and guidance on approach to implementation of HNAP actions • Provides upwards technical advice to the NSC • Coordination and lead for the sourcing of HNAP finance and funding • Coordination and lead for sourcing for technical and Co-chairs • Director of Public Health, FMoH&SW • Development partner representative Secretariat EH&CC Division, FMoH&SW Monthl y Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 3.2.2 State-and LGA-level governance and implementation framework In late 2024, the interventions of the HNAP - as described throughout this document – were agreed with all States via a memo that was ratified with the National Council for Health. Under this memo, States agreed to domesticate the HNAP to the subnational level by developing State Climate and Health Adaptation Plans. These plans will guide the priorities and delivery of interventions in the States and LGAs in order to support Nigeria’s localised health systems, health sectors, health determining sectors and communities to adapt to climate change to reduce the impact on health outcomes. Each State in Nigeria will develop their own State Climate and Health Adaptation Plans - and supporting governance and implementation frameworks – in the manner that they deem to be most effective given their local context. The rest of this chapter makes suggestions for the State governance and implementation frameworks. These suggestions should be considered as minimum standards rather than prescriptive directives. In all cases, guidance on developing State Climate and Health Adaptation Plans and governance and implementation frameworks will be provided by the Federal levels to the States for consideration. It is suggested that the governance and implementation of the State Climate and Health Adaptation Plans should also mirror the SWAp arrangements and be coordinated through a State Climate and Health Adaptation Plan Implementation Committee or similar, which will be supported through LGA Implementation Committees. Table 9 and Table 10 provides summary details on the suggested key stakeholder roles and responsibilities at the State and LGA levels. Table 9. State- and LGA-level stakeholder’s roles and responsibilities for the HNAP governance and implementation Agency Primary role Key responsibilities SMoH Lead policy, coordination, and implementation oversight of the State Climate Health Adaptation Plans • Oversight and overall governance for climate change and health actions in the States and LGAs • Domestication of the HNAP into specific State Climate and Health Adaptation Plans • Coordination of support to LGAs’ in developing their respective adaptation plans • Oversight and coordination of Implementation of State Climate and Health Adaptation Plans • Coordinate with other MDAs across sectors to integrate multi-sectoral HNAP interventions LGAs Coordination of climate change health adaptation and resilience- building at LGA and communities • Oversight and overall governance for climate change and health actions in the LGAs • Adaptation of the State Climate and Health Adaptation Plans • Plans into specific LGA context specific priorities for implementation • Coordination of support to communities and health facilities to deliver and monitor the LGA delivery • Coordinate with other MDAs across sectors to integrate multi-sectoral HNAP interventions • Awareness creation, advocacy, and education on climate change and health Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Table 10. State- and LGA-level institutional arrangements Agenc y Pr imary role Description Key responsibilities K e y position s Meeting frequen cy S t a t e H e a l t h Adaptati o n P l a n s Impleme nta t ion Committ ee Overall lead for the State Climate and Health Adaptation Plans’ governance and accountabili Will serve as the primary oversight and accountability lead, providing direction and decisions on the State Climate and Health • Ensures an effective accountability mechanism for the State Climate and Health Adaptation Plans • Ensures coherence of State Climate and Health Adaptation Plans implementation and alignment with the HNAP • Routine monitoring of the Chair Commissio ner of SMoH Secretaria t Public Health Dept., Every six months LGA Impleme ntation Committ ee Task groups that drive operational activity and delivery of the LGA Climate Health Will be responsible for the routine delivery of the LGA interventions at the community • Delivery of LGA Climate and Health Adaptation Plans • Routine monitoring of the State Climate and Health Adaptation Plans • Liaison and support to interventions at the Chair LGA Chairman Secretaria t Public Health Every two months Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 4. Financing OFFICIAL OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 1. Introduction It is estimated that up to $355 million is required to fully implement the agreed HNAP interventions, i.e., to implement all proposed activities and interventions. The HNAP's financing component, while outlining an ideal scenario, is inherently dependent on the fluctuating landscape of government and development partner funding, both within Nigeria and globally. Therefore, the HNAP financing chapter presented should be understood as a flexible framework requiring potential adjustments based on evolving financial and delivery contexts. It is also important to recognize that many HNAP interventions, while critical for climate resilience, offer significant co-benefits, such as strengthening primary healthcare systems, thereby maximizing the overall value of these investments. Against that backdrop, the summary HNAP budget is presented in Table 11 below, and the fully detailed budget is available in Annex 1. The majority of funding to support HNAP implementation is required between year 2 and year 4, peaking in year 3 as shown in Figure 8 and Table 11. This represents a stable financial and delivery context for Nigeria, with strong government and development partner funding support for the HNAP. The investment profile can be adjusted to reflect the context across the years of implementation. Figure 8. Nigeria's required investment for climate and health, 2025/6-2030 Table 11. Nigeria's required investment for climate and health, 2025/6-2030 Figure 2 and Figure 3 below show the allocation of the HNAP budget relative to the programme theme and the WHO’s 10 building blocks of climate-resilient health systems. Figure 2 and Figure 3 below disaggregate the USD 355 million HNAP budget according to these building blocks to illustrate the spread of required resources. It is anticipated that the vast majority of the required funds (approximately USD 311 million or 88% of the total budget) is required for interventions under the climate-informed health programmes (USD 241 million, 68%) and technology and infrastructure (USD 70 million, 20%) building blocks/themes. This spread is driven by the former theme’s focus on tangible service delivery, i.e., supporting climate- informed health programme intervention plans covering waterborne, vector-borne, malnutrition, and food-borne diseases. Respiratory ailments, zoonoses, non-communicable diseases, mental health, and reproductive, maternal, newborn, and child health are also USD millions Year 1 Year 2 Year 3 Year 4 Year 5 Total 7,057,382 93,132,459 115,764,000 83,435,000 56,009,000 355,397,841 50 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 U SD m ill io ns 0 30 60 90 120 Year 1 Year 2 Year 3 Year 4 Year 5 The vast majority of the HNAP budget (USD 340 million, 93%) is linked to resilience activities, with the remaining USD 25 million (7%) of the budget allocated to readiness interventions. OFFICIAL OFFICIAL included in interventions under the climate-informed health programmes theme. The technology and infrastructure building block interventions are similarly characterised by a focus on tangible interventions including improving infrastructure in healthcare facilities, improving laboratory infrastructure and systems to enable them to support the needs of the population under future climate changes, improving staff technical capacity, and upgrading the procurement and supply chain to become more climate-resilient. Figure 9. Cost breakdown by health building block/programme theme T h e HNAP summary budget is presented below in Table 12 and the full budget is presented in Annexe 1. 51 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 T h e m e Climate-informed health programmes Technology & infrastructure Leadership & governance Emergency preparedness & management Health workforce Implementation/secretariat Health & climate research Integrated risk monitoring & early warning Climate & health financing USD million 1 10 100 1,000 1.8 2.2 2.5 2.8 5.0 9.3 20.6 70.2 240.8 OFFICIAL OFFICIAL Table 12. HNAP summary budget Buildin g Prioritised Interventions Year 1 Year 2 Year 3 Year 4 Year 5 Total (USD Leader ship & govern ance Assess the technical and operational capacity of national and sub-national sectoral policymakers, leaders, managers and climate change and health units to plan for and 579,70 0 204, 000 85,00 0 868,7 00 Build the technical and operational capacity of national and sub-national sectoral policymakers, leaders, managers and climate 648,00 0 593, 000 312,0 00 176, 000 136,0 00 1,865, 000 Establish multi-sectoral coordination mechanisms and clear roles and responsibilities between the FMoH, State MoH, LGAS, SWAp coordination group, NPHCDA, NCCC and NCDC and other sector MDAs (this will include the development of 317,00 0 197, 000 237,0 00 197, 000 237,0 00 1,185, 000 Operationalisation of climate and health units 170,00 0 100, 000 90,00 0 90,0 00 90,00 0 540,0 00 Operationalise and provide ongoing support to the established multi-sectoral coordination mechanisms 344,00 0 52,0 00 17,00 0 17,0 00 17,00 0 447,0 00 Operationalise and provide ongoing support to track and monitor the defined performance and accountability measures and hold leaders 104,00 0 405, 000 197,0 00 706,0 00 Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery 373,00 0 205, 000 205,0 00 783,0 00 Support States to develop and deliver on their implementation plans for climate and health 1,430,0 00 4,47 5,00 0 340,0 00 285, 000 285,0 00 6,815, 000 Total: Leadership & governance 3,965,7 00 6,03 4,00 1,483, 000 765, 000 765,0 00 10,19 1,700 Climat e & health financi ng Develop a domestic resource mobilization strategy (and other innovative financing mechanisms and PPP e.g., climate insurance for marginalised communities, CDM, Specialized Financial Institutions) that 155,00 0 95,0 00 40,00 0 45,0 00 20,00 0 355,0 00 Secure climate change and health co-funding opportunities (national, regional, and global) to support Nigeria’s climate change and health 112,00 0 297, 000 25,00 0 195, 000 15,00 0 644,,0 00 Total: Climate & health financing 267,00 0 392, 000 65,00 0 240, 000 35,00 0 999,0 00 Health workfo rce Develop an education and capacity building campaign for the national health workforce on the impact of climate change, including managing climate change events and public 320,00 0 335, 000 45,00 0 300, 000 45,00 0 1,045, 000 Roll out the education and capacity building campaign for the national health workforce 111,00 0 111,0 00 83,00 0 83,0 00 83,00 0 471,0 00 Total: Health workforce 431,00 0 446, 000 128,0 00 383, 000 128,0 00 1,045, 000 Vulner ability, capacit y & adaptat Support the NCCC, FMEnv and FMoH to integrate the HNAP into the NAP and NDC processes to ensure health is included in the 30,000 15,0 00 15,00 0 15,0 00 15,00 0 90,00 0 Total: Vulnerability, capacity & adaptation assessment 30,000 15,0 00 15,00 0 15,0 00 15,00 0 90,00 0 Integra ted risk monito ring & early warnin g Develop climate-informed health indicators for inclusion in DHIS2 632,00 0 740, 000 520,0 00 520, 000 520,0 00 2,932, 000 Develop one integrated climate change, health and environmental early warning system that is linked to other sectors/MDAs 60,000 295, 000 355,0 00 Train health workers and health information teams on new climate informed indicators 90,000 515, 000 235,0 00 235, 000 90,00 0 1,165, 000 Total: Integrated risk monitoring & early warning 782,00 0 1,55 0,00 755,0 00 755, 000 610,0 3,287, 000 Health & Assess climate impacts on key health programmes (e.g. RMNCAH, malaria/vector borne diseases, zoonoses, mental health etc) 115,00 0 130, 000 100,0 00 100, 000 100,0 00 545,0 00 52 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Health & climate researc h Develop climate informed intervention plans for key health programmes 40,000 282, 000 55,00 0 40,0 00 40,00 0 457,0 00 Build a cadre of climate change health researchers and Career Specialists 150,00 0 185, 000 190,0 00 445, 000 120,0 00 1,090, 000 Total: Health & climate research 305,00 0 315, 000 345,0 00 585, 000 260,0 00 2,092, 000 Techno logy & infrastr ucture Develop climate-resilient health infrastructure models and blueprints by type/level of health infrastructure and vulnerabilities that will be faced (i.e., extreme weather events) 490,00 0 885, 000 145,0 00 65,0 00 65,00 0 1,650, 000 Support the modification of infrastructure in the highest-risk facilities, Basic Emergency Obstetric and Newborn Care (BEmONCs) and Comprehensive Emergency Obstetric and Newborn Care (CEmONCs) to ensure they 27,9 40,0 00 27,97 0,000 19,6 10,0 00 30,00 0 75,55 0,000 Assess laboratories and staff capacity to respond to the impacts of climate change 5,000 800, 000 805,0 00 Support the upgrading of laboratories and staff capacity 400, ,000 4,198, 000 4,19 8,00 8,796, 000 Assess the climate resilience of the procurement and supply chain, including exploring low carbon supply chain alternatives 200,00 0 1,20 0,00 0 300,0 00 1,700, 000 Support the upgrading of the procurement and supply chain to be more resilient to climate change and introduce low carbon alternatives 840, 000 840,0 00 Total: Technology & infrastructure 695,00 0 30,7 80,0 00 32,61 3,000 23,8 73,0 00 95,00 0 13,79 1,000 Emerg ency prepar edness & manag ement Develop health service delivery contingency plans for extreme weather events 600,00 0 745, 000 680,0 00 680, 000 600,0 00 3,305, 000 Support and monitor service delivery contingency plans in response to extreme weather 570,00 0 4,47 0,00 0 2,400, 000 7,440, 000 Develop national capacity building programme that will equip communities to respond to adverse weather events 260,00 0 960, 000 1,660, 000 260, 000 260,0 00 3,400, 000 Support the delivery of the community capacity building programme 2,73 0,00 200,0 00 2,930, 000 Monitoring & evaluation framework & feedback mechanism 50,0 00 400,0 00 150, 000 150,0 00 750,0 00 Total: Emergency preparedness & management 1,430,0 00 8,95 5,00 5,340, 000 1,09 0,00 1,010, 000 17,82 5,000 Climat e- inform ed health progra mmes Support the delivery of the climate informed health programme intervention plans - waterborne diseases 1,150,0 00 14,1 20,0 00 14,12 0,000 1,21 0,00 0 1,210, 000 31,81 0,000 Support the delivery of the climate informed health programme intervention plans - vector borne diseases 3,000,0 00 15,8 50,0 00 13,11 0,000 7,85 0,00 0 5,110, 000 44,92 0,000 Support the delivery of the climate informed health programme intervention plans - malnutrition and food borne diseases 3,560,0 00 7,13 0,00 0 5,560, 000 5,13 0,00 0 5,560, 000 26,94 0,000 Support the delivery of the climate informed health programme intervention plans - respiratory 2,780,0 00 4,81 0,00 0 5,030, 000 3,81 0,00 0 2,780, 000 19,,21 0,000 Support the delivery of the climate informed health programme intervention plans - zoonosis 2,180,0 00 2,58 0,00 0 2,580, 000 2,58 0,00 0 2,580, 000 12,50 0,000 Support the delivery of the climate informed health programme intervention plans - NCDs 3,560,0 00 3,56 0,00 0 3,560, 000 3,56 0,00 0 3,560, 000 17,80 0,000 Support the delivery of the climate informed health programme intervention plans - mental health 4,050,0 00 3,30 0,00 0 4,800, 000 3,30 0,00 0 4,800, 000 20,25 0000 Support the delivery of the climate informed health programme intervention plans - RMNCAH 4,460,0 00 14,1 60,0 00 14,66 0,000 11,96 0,00 0 4,460, 000 49,70 0,000 Total: Climate-informed health programmes 24,740, 000 65,5 10,0 63,42 0,000 39,4 00,0 30,06 0,000 154,2 20,00 Buildin g Prioritised Interventions Year 1 Year 2 Year 3 Year 4 Year 5 Total (USD 53 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL HNAP secreta riat Dedicated project staff 365,00 0 365, 000 365,0 00 365, 000 365,0 00 1,825, 000 Equipment & consumables 210,00 0 155, 000 155,0 00 155, 000 155,0 00 830,0 00 Audits & evaluation 100,0 00 80,00 0 180,0 00 Total: HNAP secretariat 575,00 0 520, 000 720,0 00 520, 000 680,0 00 2,835, 000 Total 7,057,3 82 93,1 32,4 115,7 64,00 83,4 35,0 56,00 9,000 354,7 35,70 Buildin g Prioritised Interventions Year 1 Year 2 Year 3 Year 4 Year 5 Total (USD 54 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 55 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 5. Resource mobilisation OFFICIAL OFFICIAL 56 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 1. Introduction This chapter outlines the resource mobilisation framework for the HNAP, ensuring alignment with national health priorities and sustainable financing. Building on the HNAP budget, the chapter details the processes for securing necessary funding. It emphasizes that resource mobilisation, alongside stakeholder engagement, is critical for transitioning from adaptation planning to concrete action, as illustrated in Figure 10. Recognising this need, a dedicated HNAP intervention in year one will develop a detailed resource mobilisation strategy. Finally, the chapter annexes provide draft terms of reference for this strategy and guidance on accessing climate finance. It is important to note that the HNAP includes a priority intervention specifically focused on climate and health financing, supported by a dedicated budget. This specific intervention, 2 expected to commence in year 1 will develop a fully-fledged and detailed resource mobilisation strategy for the HNAP. Box 3. Recommendations for the full HNAP resource mobilisation plan The full HNAP resource mobilisation plan should include a thorough assessment of funding needs, a comprehensive gap analysis, and a targeted strategy for engaging with potential funding sources. It should also outline clear mechanisms for financial management, monitoring, and evaluation to ensure transparency and accountability in the use of resources. It is also important to recognise that resource mobilisation is an ongoing process that requires new challenges and opportunities to emerge; the HNAP resource mobilisation framework and plan should be regularly reviewed and updated to ensure its continued effectiveness and relevance. Figure 10. Adaptation planning to action roadmap for Nigeria's health sector and system 3 5.2 Guiding principles for HNAP resource mobilisation Guiding principles are central to the HNAP's resource mobilisation framework and will inform the detailed resource mobilisation strategy developed during implementation. Based on stakeholder input and international best practices, five key principles will guide the The development of the domestic resource mobilisation strategy is within the “readiness” category of 2 interventions. The intervention will develop a domestic resource mobilisation strategy (and other innovative financing mechanisms e.g. climate insurance for marginalised communities, PPPs???, the Clean Development Mechanism, and specialised financial institutions) that includes pooled funding, health insurance, strategic purchasing, and other financing options such as green bonds. Other financing considerations will be considered as the domestic resource mobilisation strategy is developed further. Source: Adapted from: World Resources Institute. (2021). Mainstreaming Climate Adaptation Planning and 3 Action into Health Systems in Fiji, Ghana, and Benin. [Online]. Available: https://publications.wri.org/ mainstreaming-climate-adaptation-fiji-ghana-benin 57 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 https://publications.wri.org/mainstreaming-climate-adaptation-fiji-ghana-benin https://publications.wri.org/mainstreaming-climate-adaptation-fiji-ghana-benin OFFICIAL identification and selection of external funding and support for Nigeria’s health sector: catalytic investment, harmonised partner support, government ownership, domestic resource mobilisation, strategic partnerships, and leveraging existing support. These principles ensure that funding aligns with HNAP objectives and contributes to the long-term sustainability and impact of Nigeria's climate adaptation efforts in health. Prospective funding sources should be evaluated against these principles. Table 14. Guiding principles for resource mobilisation of the HNAP R e s o u r c e mobilisation principle Relevance to Nigeria’s HNAP The resource mobilisation framework will initially focus on attracting catalytic investments from donors and development partners to launch and accelerate the implementation of the HNAP. These initial investments will demonstrate the HNAP's impact and potential for sustainability while building the capacity of government, partners, and other stakeholders in the health sector and system to plan for, implement, manage funds, and report on resources received. A critical innovation in Nigeria's HNAP resource mobilisation approach, this principle emphasizes the establishment of an aligned and coordinated funding mechanism, driven by health development partners, to effectively support the Nigerian government in achieving its HNAP priorities. Rather than fragmented funding streams, this approach fosters a unified and synergistic effort amongst partners, ensuring resources are strategically channelled to maximize impact and reduce duplication. This collaborative model strengthens government ownership and leadership, while leveraging the collective expertise and resources of development partners to efficiently and effectively implement the HNAP. While initial donor support is crucial, the long-term sustainability of the HNAP hinges on the commitment and ownership of federal and State governments. The resource mobilisation plan will outline a strategy for progressively transitioning funding responsibility to these domestic partners as the HNAP gains momentum and achieves critical mass. This approach will help to strengthen institutions, establish fiduciary safeguards, and demonstrate a track- record of successful resource mobilisation to facilitate further investment in future phases of the HNAP. A strong domestic resource mobilisation approach will reduce dependence on external funding, which can be unpredictable and subject to competing priorities. This strategy will involve leveraging existing and new domestic sources, such as government budgets (including new efficiency measures such as procurement reform), potential new taxation schemes for certain unhealthy products, and innovative financing mechanisms like green bonds. This approach will promote greater autonomy and control over financial resources, enabling Nigeria to prioritize and address its unique climate-health challenges effectively. Collaboration with donors will extend beyond financial support. The resource mobilisation plan will emphasize building strategic partnerships to leverage technical expertise, modalities of implementation, share best practices, strengthen institutional capacity, and establish sustainable implementation processes with domestic partners. C a t a l y t i c investment D o m e s t i c r e s o u r c e mobilisation Government ownership S t r a t e g i c partnerships Harmonised p a r t n e r s u p p o r t 58 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 5.3 Potential financing sources for the HNAP While there are some partners already funding key HNAP interventions, it is evident that Nigeria needs to mobilise significant resources to finance the delivery of the HNAP. This will likely require tapping into a diverse range of funding streams, as health adaptation remains a relatively new and still developing area for dedicated financing in Nigeria. It is recommended that financiers of the HNAP should consider pursuing a ‘fund agnostic’ or diversified funding strategies, carefully matching interventions to the most appropriate financing sources based on their specific needs, circumstances, and long-term development goals. When considering financing sources for the HNAP interventions and delivery, it is essential to compare the relative merits of potential partners and/or funders and the different types of financing that they can provide. Each type of funder and type of finance has its own advantages and disadvantages that must be carefully evaluated. With this in mind, an analysis of potential funders, their advantages and advantages, and the types of finance that they provide is summarised in Table 16 below. The full HNAP resource mobilisation strategy will build upon these summary details when it is developed early into the implementation of the HNAP. The resource mobilisation process will capitalize on existing donor support in cross-sectoral services and planning. The framework will facilitate the identification of existing funding streams relevant to HNAP activities, enabling a comprehensive gap analysis and the development of targeted resource mobilisation strategies. R e s o u r c e mobilisation principle Relevance to Nigeria’s HNAP L e v e r a g i n g e x i s t i n g support 59 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Table 16. Potential sources of finance for the HNAP Funder Advantages Disadvantages Types of finance provided Climate funds (e.g. Green Climate Fund, Adaptation Fund, etc) • Climate funds offer dedicated funding specifically for climate change initiatives • Grants are often allocated at the country level so there is scope for large projects • Technical • Climate fund applications often involve complex and lengthy processes • Securing funding requires federal coordination, which can increase the complexity of implementation and governance • Available funding may • Grants (funding provided without the expectation of repayment) • Concessional loans (offering below-market interest rates) • Commercial loans (market-rate interest) • Guarantees (a commitment to cover Developm ent finance institutio ns (DFIs) (local and internation al e.g. the Nigerian Investmen t Bank, World Bank, African • Often provide substantial funding, enabling support for large-scale projects and initiatives • Offer flexibility in the types of projects they fund, considering a wide range of sectors and technologies, which can foster innovation • Often have established relationships with • May prioritize sectors other than climate change and/or health, potentially limiting funding opportunities for HNAP interventions • Primarily offer loans, rather than grants, which require repayment and may not be suitable for all projects, especially those with limited revenue streams • Climate-resilient health systems may not be a primary focus for all • Commercial loans (market-rate interest) • Equity investments (providing capital in exchange for a share of future profits) • Guarantees (a commitment to cover losses in case of default or other specified events) Bilateral donors (e.g., FCDO, GIZ) • Engaging with bilateral donors is often on the back of established relationships and track records, fostering collaboration and partnerships in the global health arena. This can facilitate the sharing of knowledge, best practices, and resources, leading to improved health outcomes • Often have • Over-reliance on external funding can create dependency, making it challenging to sustain health programs if donor priorities shift or funding is withdrawn • While external funding can provide much- needed resources, it may not always foster local ownership and in- house capacity development. This can limit the sustainability of health programs and hinder the development of strong, self-reliant • Grants (funding provided without the expectation of repayment) • Concessional loans (offering below-market interest rates) • Commercial loans (market-rate interest) • Guarantees (a commitment to cover losses in case of default or other specified events) • Debt relief Philanthr opies (e.g., Rockefelle r Philanthro pies, Gates Foundatio n, Wellcome • Innovative financing (green bonds, challenge funds, etc.) can target specific climate- induced health challenges in flexible ways • New and “big” ideas and innovations can be funded through less formal processes, • Funding is rarely of a scale/size needed for large-scale interventions • Philanthropies may have specific thematic priorities and funding criteria that don’t fully consider the complex and multifaceted nature of climate-health challenges. This can limit the scope of fundable projects and • Grants (funding provided without the expectation of repayment) • Charitable donations (donations from individuals, corporations, and other foundations to support philanthropic work) • Endowments (long- term investment funds that generate income to 60 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Combine d/ blended funding approach es • Synergy and optimisation - combining different funding sources allows for leveraging the strengths of each while mitigating their weaknesses. This can lead to more comprehensive and effective financing • Managing multiple funding sources with different requirements and procedures can be complex and burdensome • Aligning the objectives and priorities of different funding sources can be challenging and require careful negotiation. • Combinations of all of the financing sources listed above Funder Advantages Disadvantages Types of finance provided 61 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 62 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 6. Monitoring, evaluation and learning OFFICIAL 63 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL 6.1 Introduction Adaptation in Nigeria’s health sector, health system and health outcomes is an ongoing process which requires routine and effective Monitoring, Evaluation and Learning (MEL) and knowledge management to continuously understand how, and to what extent, interventions are offsetting worsening climate risks and managing its impacts. Understanding the implications of climate change on Nigeria’s health sector, health system and health outcomes on an ongoing basis is especially critical as impacts are expected to intensify more rapidly and become harder to predict over time. The HNAP’s MEL framework and plan provides a structured, accessible, practical and straightforward approach for the FMoH&SW, NSC and stakeholders at the national and sub- national levels to routinely monitor progress, evaluate results, and facilitate learning for HNAP processes and interventions to achieve the intended results. The full objectives of the HNAP MEL plan and framework are outlined in Box 4. The MEL plan and framework cover all the HNAP interventions which are presented in full in section 2 and the HNAP ToC summarised in section 6.2 below, although recognising that some interventions (particularly those that are scheduled to start during the later years in the “resilience” stage of the HNAP delivery) will continue to evolve. In such cases the indicators and respective MEL framework elements will, therefore, need to be updated to reflect such changes and modifications. The MEL plan also outlines the framework and processes required to be adaptive and responsive to changes in contexts, intensifying climate risks, and the latest information and understanding of the situation on Nigeria’s health sector, health system and health outcomes. The MEL plan and framework is intended to support national iterations of the HNAP that are expected to occur over the life of the delivery of the HNAP and can be adapted for use to support the planned development and delivery of State adaptation plans, sectoral frameworks and other complementary activities and programmes. This MEL plan and framework will be overseen and implemented by the FMoH&SW, specifically the Division for CCEH with oversight and guidance by the Department of Planning, Research and Statistics Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Box 4. HNAP MEL objectives MEL of Nigeria’s HNAP is conducted to monitor activities, assessing the outputs, key milestones, outcomes, and impacts of the HNAP to: 1. Identify and address barriers, blockages, and challenges in real time, to avoid maladaptation and unintended negative consequences; 2. Report on the progress and effectiveness of the HNAP, by leveraging insights from continuous tracking, assessment, and learning activities; 3. Collate learnings to inform periodic updates on the implementation of HNAP, serve as a guide for updates of allied documents (NAP, NDC, etc.) and direct additional research; 4. Support accountability and transparency, including donor and domestic spending and financial flows; 5. Catalyze actions of other stakeholders, including sub-national counterparts, to pursue resilience building population’s health and health system in order to maximise impacts; 6. Leverage demonstrated outcomes to support the mobilization of international finance; and 7. Align and integrate HNAP MEL with other climate and health sector processes, systems and reporting structures, including the health SWAp, NAP and NDCs, as well as HMIS and DHIS2 OFFICIAL OFFICIAL (DPRS) led by its Director, with inputs and contributions from other MDAs (including FMoEnv and NCCC) as outlined in the roles and responsibilities outlined throughout this chapter. 2. Theory of Change The MEL plan and framework is informed by, and aligned to, the theory of change (ToC) for the HNAP (see Box 5 and Figure 11), which describes the internal logic of the HNAP, demonstrating how the activities, outputs and outcomes combine to achieve the HNAP’s goal and impact. The ToC guides the MEL plans (see Annex 3) to determine the corresponding, collective and cumulative indicators for measuring impact at different levels. Indicators are aligned and cumulative across interventions and outputs, to induce necessary transformation of the health sector, health system and health outcomes. Additionally, coherence and coordination between and across implementing actors supports converging discrete results to the HNAP’s core outcomes and impact. 3. Guiding principles The HNAP MEL plan and framework is underpinned by key guiding principles and best practice standards that are outlined in Box 6 below. These principles and standards will support the management and delivery of the HNAP’s MEL plan and framework throughout the duration of the HNAP. Further information on these principles is included in Annex 3. Figure 11. HNAP MEL Guiding Principles • Partnership and shared responsibility • Vertical and horizontal integration • Accountability and transparency • Open and inclusive learning • Data clarity and quality Nigeria Climate Change and Health Health National Adaptation Plan March 2025 Box 5. HNAP ToC narrative IF policies, plans, frameworks, mechanisms and technical capacity are in place AND climate threats to Nigeria’s health sector, health system and health outcomes are identified and addressed THEN the capacity and institutional frameworks for building resilience will be enhanced AND the vulnerability of Nigeria's health sector, health system and health outcomes (adaptive capacity, sensitivity, resilience) will be reduced IN ORDER TO reduce climate change-related morbidity and mortality in Nigeria. OFFICIAL OFFICIAL Figure 11. HNAP ToC Outputs Outcome Impact Multisectoral and multilevel health-climate leadership and governance established with clear roles and responsibilities between institutions and stakeholders > Enhanced capacity a n d i n s t i t u t i o n a l f r a m e w o r k s f o r building resilience in the health sector, health system and h e a l t h o u t c o m e s (READINESS) > > > > > Climat e chang e- related morbid ity and mortali ty reduce d Capacity of national and sub-national sectoral institutions and stakeholders built to plan for and improve climate resilience in the health sector > Financing identified and secured for HNAP implementation to support programmes at the Federal, State and LGA levels > Key climate and health priorities assessed at the Federal, State and LGA levels and plans developed that can be delivered to strengthen future climate resilience > Improved provision of climate-responsive and disaster-resilient health care at the Federal, State and LGA levels > V u l n e r a b i l i t y o f N i g e r i a ' s h e a l t h sector, health system and health outcomes (adaptive capacity, sensitivity, resilience) r e d u c e d (RESILIENCE) Strengthened ongoing evidence-gathering and k n o w l e d g e - m a n a g e m e n t f o r i d e n t i f y i n g , understanding and addressing climate-induced health risks and climate-sensitive diseases and > Increased resi l ience of publ ic health and environmental infrastructure and addressing vulnerabilities in the health supply chain, including retrofitting the highest-risk facilities, BEmONCs and > Improved community-level health outcomes through climate-informed health programming and capacity- building > Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 4. MEL plan Acknowledging the evolving circumstances of funding and implementing the HNAP, a set of core priority indicators was selected by HNAP stakeholders to inform the initial 2 years of the MEL Plan, to be reviewed and expanded during implementation. These indicators will track the initial progress and development of the HNAP, as well as ensure alignment with ongoing projects and processes. Targets and ambition are to be confirmed with government and donors on the basis of funding availability. These indicators map onto some of the outputs of the Theory of Change, although not comprehensively, as certain outputs refer to interventions only taking place in the later years of implementation. Table 17. HMAP MEL plan, years 0 - 2 Priority Interventions Core indicator (target) Means of verificatio n Frequency of reporting Support NCCC, FMoEnv and the FMoH&SW to integrate the HNAP into the NAP and NDCs processes to ensure health is included in the national climate change priorities c. HNAP priority interventions and data included in NAP and NDCs updates (target: x% of interventions included) d. Health mainstreamed in NAP and NDC updates (target: health priorities discussed in reflected/discussed in NAP and NDC updates) NAP; NDC Alongside NDCs, NAP update timeline Establish multi- sectoral coordination mechanisms with clear responsibilities between the FMoH&SW, State MoH and sector ministries and other agencies c. Multi-sectoral climate-health coordination mechanism (Task Group and HNAP National Steering Committee) established with respective TOR (target: # in place by X date) d. Functional chair/deputies in place and regular meetings taking place (target: in place by X date) TOR, meeting minutes Once off, ongoing operation reviewed annually Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery roles and responsibilities b. State Change and Health Adaptation Plans on climate change and health (target: developed, costed, and validated for 36+1 States by X date) Note: Aligns with HOPE-PHC DLR 10.1-10.4: Climate and health adaptation plan developed, costed, and validated (number) State Change and Health Adaptation Plans Once off, and as plans are revised/ updated Develop climate- informed intervention plans for key health programmes b. Climate-informed intervention plans for key health programmes developed, costed, and validated (target: completed for X key health programmes by X date) Note: Aligns with HOPE-PHC DLR 10.1-10.4: Climate and health adaptation plan developed, costed, and validated (number) Climate- informed intervention plans Reviewed as needed Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annex 3 includes indicative output- and intervention-level MEL indicators and targets for monitoring the HNAP, including additional indicators, targets (with milestones), means of verification, and frequency of reporting. As implementation progresses, these indicative indicators, targets etc may be used to shape and direct the evolving HNAP, including where certain indicators may be upgraded and added after the first 2 years of implementation. 6.5 Implementation of the MEL plan and framework The oversight and implementation of the HNAP MEL plan and framework is fully aligned with the HNAP governance and implementation framework which is outlined in section 3. Building on this framework, the HNAP MEL plan and framework will be delivered as outlined below. The MEL plan and framework will be overseen and implemented by the FMoH&SW, specifically the Division for CCEH with oversight and guidance by the DPRS led by its Director, with inputs and contributions from other MDAs (including FMoEnv and NCCC). The FMoH&SW will coordinate the deployment and use of relevant data tools (including training personnel on their use), such as DHIS2; coordinate the use and sharing of relevant climate and health data from other multi-sectoral climate risks mitigation and adaptation stakeholder partner MDAs (e.g., FMoEnv, NCCC, NIHSA, NIMET, NEMA, NCDC, etc.) to support the overall implementation and management of the HNAP MEL plan and framework. The FMoH&SW will support the coordination and integration of HNAP MEL into other climate-risk interventions of multiple stakeholders and sectors — including States’ own climate and health adaptation plans and MEL frameworks aligned to the HNAP — to monitor the delivery of the HNAP, and for information sharing, exchange of best-practices and learning, and evaluations of the HNAP delivery. 6. Timing and milestones MEL is part of the iterative process of managing the implementation of the HNAP and understanding its impact on reducing health related risk from climate change. . To this end monitoring and reporting should be regularly fed into daily operations, with regular meetings Develop climate- resilient health infrastructure models and blueprints by type/ level of health infrastructure d. Climate-resilient health infrastructure models and blueprints (target: completed for TYPE by X date) e. Guidelines for facilities developed from the Smart Hospitals Toolkit (target: xx by X date) f. CRIBS Framework, guidance and tools published and accessible (target: completed by X date) Note: Aligns with HOPE-PHC PDO Indicator: PHC facilities achieving service readiness assessment criteria (%) Note: Aligns with HOPE-PHC DLR 1.1: Improved primary healthcare facility readiness, quality, and climate resilience in participating states (%) Note: Aligns with HOPE-PHC DLR 1.2: Increased empanelment and refurbishment of CEmONC facilities that demonstrate service readiness and climate resilience and energy efficiency (number) Final models and blueprints One off Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL and fora (i.e., included in meeting agendas) reflecting on progress being made, pending targets and any necessary adaptions or adjustments needed. Ongoing monitoring and tracking of the HNAP interventions will deploy a “traffic light” colour system to easily track progress made on interventions and indicators, as presented in Table 17. Table 17. Proposed traffic light system for monitoring of HNAP interventions Discrete MEL milestones will include internal annual HNAP reviews, as well as independently administered “mid-term” and “final impact” evaluations after 3 and 5 years, respectively. Considering that understanding and managing the climate-health nexus is relatively new to Nigeria, these milestones will ensure oversight and accountability, increase the ownership and use of this MEL plan, reinforce learning, and provide a regular opportunity for reflection, revision, and iteration of the HNAP. 4 Green Complete Amber In progress Red Dropped/removed/substantially behind schedule Grey No update received/Not yet started Although it is not expected that the HNAP will be revised annually, annual reviews provide a regular opportunity 4 for doing so, if required. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 7. Annexes OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annex 1. Comprehensive HNAP budget Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Buil ding Bloc Prioritised interventions Key activities PY1 PY2 PY3 PY4 PY5 Total (USD ) Assess the technical and operational capacity of national and sub-national sectoral policymakers , leaders, managers and climate change and health units to plan for and improve resilience in the health sector Stakeholder Groups identification and stratification for awareness creation, knowledge 163,2 00 163,2 00 Appointment of National Consultant (Firm) for development of climate resilience goals and climate-related risks capacity enhancement, 238,0 00 238,0 00 Development of specialized IEC materials (social media, FGDs, television, radio, etc.), and training modules for different categories of personnel in the health 178,5 00 127,5 00 Conduct of a National knowledge and capacity enhancement training- of-trainers workshop (academics and technicalities of climate change and its impacts), development of specialized and localized action 204,0 00 85,0 00 289,0 00 Totals 579,7 00 204,0 00 85,00 0 868,7 00 Build the technical and operational capacity of national and sub-national sectoral policymakers , leaders, managers and climate change and health units Conduct of National and Zonal baseline assessment workshops to identify existing skills, knowledge gaps, and resources needed for effective 180,0 00 180,0 00 Develop and rollout a capacity building/mentorship program for CCEH division team based on a needs assessment of capabilities 60,00 0 60,00 0 Establish a joint learning network for ongoing collaboration that includes FMoH, SMoH and policymakers 100,0 00 40,00 0 40,00 0 180,0 00 Organisation and Implementation of National, States, LGAs, and communities’ continuing awaren ess programmes on climate change impacts challenges and their role in 272,0 00 408,0 00 272,0 00 136,0 00 136, 000 1,224 ,000 Develop and implement methodology for the integration of climate change education into health 85,00 0 85,00 0 Develop and implement an M&E plan with indicators for assessing the effectiveness of the intervention 136,0 00 136,0 00 Totals 648,0 00 593,0 00 312,0 00 176,0 00 136, 000 1,865 ,000 Operationalis ation of climate and health units Conduct a needs assessment of the staffing, capacity, equipment, and resource needs of National and State level desk Climate and Health 25,00 0 25,00 0 Develop a Climate Change and Health model to help project and mainstream activities of the climate and health departments at Federal 15,00 0 15,00 0 Ensure annual refresher training programs for staff of the division to equip them with necessary capacities to effectively respond to 30,00 0 30,00 0 30,00 0 30,0 00 120,0 00 Collaborative meetings and interactions with other stakeholder government MDAs to guaranty multi- sectoral actions in mitigatory, adaptive, and resilience building actions on climate change 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Refurbish the CCEH division office in the Federal Ministry of Health and the State offices 80,00 0 20,00 0 10,00 0 10,00 0 10,0 00 130,0 00 Totals 170,0 00 100,0 00 90,00 0 90,00 0 90,0 00 540,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Lead ershi p & gove rnan ce Operationalis e and provide ongoing support to the established multi- sectoral coordination mechanisms Equip the Climate Change and Environmental Health division of the FMoH and SMoHs with requisite technologies to guaranty efficient delivery of their 222,0 00 222,0 00 Develop operational framework/ procedures for CCEH division at all levels 35,00 0 35,00 0 Provide digital tools and establish a data repository for the CCEH division to track progress on climate- health challenges, adaptation and resilience building initiatives, and to integrate climate data with health 105,0 00 105,0 00 Provide comprehensive business support/secretariat support to the CCEH TWG 17,00 0 17,00 0 17,00 0 17,00 0 17,0 00 85,00 0 Totals 344,0 00 52,00 0 17,00 0 17,00 0 17,0 00 447,0 00 Establish multi- sectoral coordination mechanisms and clear roles and responsibiliti es between the FMoH, state MoH, SWAp coordination group, NPHCDA, NCCC and NCDC and other sector MDAs Establishment of a Technical Working Group (TWGs) that will comprise of expertise from relevant sectors – academia, industry, ministries, NGOs, Donor Groups, 80,00 0 80,00 0 Host 2-day Annual national health- sector meetings/workshops that brings together Federal health-sector MDAs, and States health-sector MDAs to deliberate on, share ideas, identify challenges, and ensure coordination of activities on the 80,00 0 80,00 0 80,00 0 80,00 0 80,0 00 400,0 00 Annual national inter-ministerial meeting/workshop that brings together Federal stakeholder MDAs (Environment, NCCC, Water Resources, Agriculture, Education, National Planning, Meteorological department etc.) to deliberate on, 15,00 0 15,00 0 15,00 0 15,00 0 15,0 00 75,00 0 Work with all stakeholder groups (MDAs, States, NGOs, Academia, Research institutions, Health donor groups, etc.) to organise and celebrate an annual “Health-climate 102,0 00 102,0 00 102,0 00 102,0 00 102, 000 510,0 00 Train personnel, procure equipment and tools, and set up a health- climate digital platform for information and data management system (challenges, early warning systems, emergencies), -including GIS mapping in FMoH, and develop 40,00 0 40,00 0 40,0 00 120,0 00 Totals 317,0 00 197,0 00 237,0 00 197,0 00 237, 000 1,185 ,000 Operationalis e and provide ongoing support to track and monitor the defined performance and Create a bi-annual (dry-season, and rain-season) updated climate health risks maps and database (LGAs’ and Communities) in each State for key 74,00 0 74,00 0 148,0 00 Develop key performance indicators (KPIs)/metrics (health impacts, environmental impacts, community engagement, etc.) for tracking progress for identified climate-health risks (diseases burdens, health 25,00 0 25,00 0 Assigning responsibilities including tasks, supervision, M&E, and enforcement at all tiers of 5,000 5,000 Development and implementation of an accountability framework for HNAP (Federal) and Climate Change Resilience and Adaptation Implementation Plans (States) with 38,00 0 108,0 00 493,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL and accountabilit y measures and hold leaders to account Development and implementation of a Reporting mechanism for tracking and update of information and data on KPIs 20,00 0 20,00 0 Incorporate findings from the health- sector V&A Assessment into the development, update and review of the NAP and the development of health-sector specific indicators that will be incorporated into the NAP M&E, including reporting indicators and tools, to track climate challenges 15,00 0 15,00 0 Totals 104,0 00 405,0 00 197,0 00 0 0 706,0 00 Develop costed and measurable state implementati on plans for climate change and health, with clear Development of a National Climate- Health Policy, and States Climate- health Policies 205,0 00 205,0 00 205,0 00 615,0 00 Printing of HNAP 55,00 0 55,00 0 Launch and disseminate HNAP including state and LGA representatives 113,0 00 113,0 00 Totals 373,0 00 205,0 00 205,0 00 0 0 783,0 00 Support states to develop and deliver on their implementati on plans for climate and health Conduct advocacy on HNAP across all tiers of Governance 55,00 0 55,00 0 55,00 0 165,0 00 Development and conduct of annual Awareness campaign on climate challenges, and climate change adaptation and resilience building 205,0 00 205,0 00 205,0 00 205,0 00 205, 000 1,025 ,000 Support the conduct of climate- health risk assessments (demography, climate data, disease burdens, etc.) and mapping (climate risks, disease prevalence), for the States, including the identification of 170,0 00 170,0 00 Build capacity of state-level CCEH desk officer to develop State Health Adaptation Plans and effectively steer State-level CCEH actions 150,0 00 150,0 00 300,0 00 Develop a State Health Adaptation Plan/ Implementation Plan/Action Plan for the Implementation of the HNAP at the sub-national level (cost 3,060, 000 3,060 ,000 Print State Health Adaptation Plan/ Implementation Plans (IPs) (per state) 615,0 00 615,0 00 Disseminate State Health Adaptation Plan/ Implementation Plans (IPs) (all states) 310,0 00 310,0 00 620,0 00 Conduct of zonal workshops and trainings on HNAP and State Implementation Action Plans 460,0 00 460,0 00 Conduct of periodic TWG Meetings 80,00 0 80,00 0 80,00 0 80,00 0 80,0 00 400,0 00 Totals 1,430, 000 4,475, 000 340,0 00 285,0 00 285, 000 6,815 ,000 Develop a Domestic Resource Mobilization Strategy (wit h an M&E plan) that includes pooled Monitor unit performance and adjust improve efficiency and outcomes. 10,00 0 5,000 5,000 5,000 5,00 0 30,00 0 Liaise with the leadership of FMoH/ SMoH to ring-fence funding for CCEH division 25,00 0 10,00 0 10,00 0 10,00 0 10,0 00 65,00 0 Ascertain budget performance for CCEH activities 5,000 5,000 5,000 5,00 0 20,00 0 Conduct retreat with targeted financial institutions, investors, businesses and partners to provide technical team with the knowledge and tools necessary for climate and health related initiatives e.g. 25,00 0 25,00 0 50,00 0 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Clim ate & healt h finan cing pooled funding arrangement s, health insurance, strategic purchasing and other financing options (such as green bonds) Conduct a financial gap analysis to determine funding needs for climate- health initiatives. 25,00 0 25,00 0 Identify potential domestic revenue streams (e.g., taxes, levies) to support climate-health programs. 20,00 0 20,00 0 Develop a comprehensive resource mobilization strategy with clear funding targets. 30,00 0 30,00 0 Engage with private sector companies to explore public-private partnership opportunities for HNAP 30,00 0 30,00 0 20,00 0 80,00 0 Create an M&E framework to track the performance of resource mobilization efforts. 35,00 0 35,00 0 Totals 155,0 00 95,00 0 40,00 0 45,00 0 20,0 00 355,0 00 Secure climate change and health co- funding opportunities (national, regional, and global) to support Nigeria’s climate change and health priorities Conduct training on climate/ green financing for health workers (Zonal) 180,0 00 180,0 00 360,0 00 Create a robust relationship with NCDC on emergency preparedness and response plan implementation 10,00 0 5,000 5,000 5,000 5,00 0 30,00 0 Ensure regular review and updates of the indicators to reflect evolving climate-health issues. 10,00 0 10,00 0 10,00 0 10,0 00 40,00 0 Develop a comprehensive database of funding sources related to climate and health. 20,00 0 20,00 0 40,00 0 Host workshop with relevant government ministries and NGOs to identify co-funding opportunities. 45,00 0 45,00 0 90,00 0 Support FMoH and States in preparing proposals for submission to regional and global climate-health 20,00 0 20,00 0 40,00 0 Partner with international organizations to co-fund and implement climate-health initiatives. 17,00 0 17,00 0 10,00 0 44,00 0 Totals 112,0 00 297,0 00 25,00 0 195,0 00 15,0 00 644,0 00 Heal th work forc e Develop an education and capacity building campaign for the national health workforce on the impact of climate change, including managing climate change events and public health emergencies Monitor the impact of the dissemination on policy shifts and adaptation measures. 10,00 0 10,00 0 10,00 0 10,00 0 10,0 00 50,00 0 Develop National training modules focused on climate change and health impacts for training health workers (GIS, climatology, prediction 35,00 0 35,00 0 Conduct capacity building workshops for Health workforce on the impact of climate change on health (CCEH Desk officers) and retraining of National, State and Local Government Health workforce 275,0 00 275,0 00 275,0 00 825,0 00 Conduct nationwide seminars and webinars to share knowledge on climate-health linkages. 20,00 0 20,00 0 20,0 00 60,00 0 Collaborate with professional health associations to embed climate health education into Continuing Professional Development (CPD) 15,00 0 15,00 0 15,00 0 15,00 0 15,0 00 75,00 0 Totals 320,0 00 335,0 00 45,00 0 300,0 00 45,0 00 1,045 ,000 Roll out the education Promote case studies of health facilities already impacted by climate change to highlight the urgency of 15,00 0 15,00 0 15,00 0 15,00 0 15,0 00 75,00 0 Regularly update health workers with new research and trends in climate- health impacts. 8,000 8,000 8,000 8,000 8,00 0 40,00 0 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Roll out the education and capacity building campaign for the national health workforce Launch and ensure sustainability of annual communication and awareness campaigns on international climate change day, world earth day, world environment day, National environmental Health 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Advocacy visit to policy makers to create a national climate change and health day- to foster annual awareness and sensitization on 28,00 0 28,00 0 56,00 0 Totals 111,0 00 111,0 00 83,00 0 83,00 0 83,0 00 471,0 00 Vuln erabi lity, capa city & adap tatio n asse ssm ent Support the FMoH to Integrate the HNAP into the Wider NAP process and NDCs to ensure health is included into the overall Government of Nigeria climate change priorities Hold annual cross-sectoral (Environment, Health, Agriculture, Water Resources, Transport, etc.) National Climate Change Coordination and Planning meeting 10,00 0 10,00 0 10,00 0 10,00 0 10,0 00 50,00 0 Incorporate findings from the health- sector V&A Assessment into the development, update and review of the NAP and the development of health-sector specific indicators that will be incorporated into the NAP M&E, including reporting indicators and tools, to track climate challenges 15,00 0 15,00 0 Bi-annual (wet-season, and dry- season) update of the NAP, and the NDC to show current status of national response to health risks 5,000 5,000 5,000 5,000 5,00 0 25,00 0 Totals 30,00 0 15,00 0 15,00 0 15,00 15,0 90,00 0 Support the delivery of the climate informed health programme intervention plans - waterborne diseases National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on WASH 330,0 00 330,0 00 330,0 00 330,0 00 330, 000 1,650 ,000 Training (annual) for healthcare workers (Federal, States, and LGA) on waterborne diseases management and Emergency Response Actions during outbreaks 500,0 00 500,0 00 500,0 00 500,0 00 500, 000 2,500 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, 60,00 0 60,00 0 60,00 0 60,0 00 240,0 00 Support to States and LGAs for the implementation of an annual (rain- season) waterborne disease surveillance with consistent update 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Provision/Construction of Rain-water harvesting system in healthcare facilities 1,200, 000 1,200 ,000 2,400 ,000 Construction/Maintenance of boreholes in healthcare facilities without reliable public water supply 1,200, 000 1,200 ,000 2,400 ,000 Provision of water purification systems such as solar thermal water disinfection (SODIS), and Fibreglass water treatment system. 1,500, 000 1,500 ,000 3,000 ,000 Construction/Upgrade of toilets (water cisterns. and Improved pit latrines 1,250, 000 1,250 ,000 2,500 ,000 Support for retrofitting (drainages, concrete barriers, waterproofing materials, etc.) of healthcare facilities to withstand flooding 760,0 00 760,0 00 1,520 ,000 Support to healthcare facilities in potential waterborne diseases risk communities for stockpile of essential medical supplies, water purification tablets, and oral 100,0 00 100,0 00 100,0 00 100,0 00 100, 000 500,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Provision of Water tankers (2 per LGA) for supply of safe water during epidemics and emergency situations 7,000, 000 7,000 ,000 14,00 0,000 Totals 1,150, 000 14,12 0,000 14,12 0,000 1,210, 000 1,21 0,00 31,81 0,000 Support the delivery of the climate informed health programme intervention plans - vector borne diseases National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on Malaria 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Training (annual) for healthcare workers (1 National and 6 Zonal (States and LGAs)) on vector-borne diseases (malaria, dengue, leishmaniasis, Lassa fever, etc.) 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, 60,00 0 60,00 0 120,0 00 Support to States and LGAs for the implementation of annual vector- borne disease surveillance, tracking and management of vector populations, (mosquitoes, sandflies, rats, etc.) with consistent update of 180,0 00 180,0 00 360,0 00 Establishment, training, and equipping of ‘Emergency Response Teams’ in FMoH, State MoH, and LGA health department. for vector- 1,000, 000 1,000 ,000 1,000, 000 1,00 0,00 0 4,000 ,000 Support to healthcare facilities (FMoH, State MoH, and LGA Health Departments) on vector control programs to eliminate breeding grounds around healthcare facilities 360,0 00 360,0 00 360,0 00 360, 000 1,440 ,000 Support to healthcare facilities (FMoH, State MoH, LGA health Department) with supplies of vector control materials (insecticide-treated nets, indoor residual spraying, 750,0 00 750,0 00 750,0 00 750, 000 3,000 ,000 Support for Stockpiling of vaccines (malaria, yellow fever, rabies), and essential medicines for use in periods of high disease outbreaks 2,500, 000 2,500, 000 2,500 ,000 2,500, 000 2,50 0,00 0 12,50 0,000 Support for provision and maintenance of cold-chain systems in healthcare facilities 2,500, 000 2,500, 000 5,000 ,000 Support for the provision of Mobile Health Units (two per State – 74) for emergency interventions (diagnosis, and treatment) in vector-borne 8,000, 000 8,000 ,000 16,00 0,000 Totals 3,000, 000 15,85 0,000 13,11 0,000 7,850, 000 5,11 0,00 44,92 0,000 Support the National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Training (annual) for healthcare workers (Federal, States, and LGA) on monitoring, diagnosis, and management of malnutrition (stunted growth, kwashiorkor, marasmus, 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, flyers) on malnutrition and food- 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Clim ate- infor med healt h prog ram mes Support the delivery of the climate informed health programme intervention plans - malnutrition and food borne diseases Support to States and LGAs for the implementation of annual malnutrition and food-borne diseases surveillance, tracking and management in communities faced with extreme weather challenges 220,0 00 220,0 00 440,0 00 Establishment, training, and equipping of ‘Emergency Response Teams’ in FMoH, State MoH, and LGA health department. for medical interventions in malnutrition and 1,000, 000 1,000, 000 1,000 ,000 1,000, 000 1,00 0,00 0 5,000 ,000 Support for provision and maintenance of cold-chain systems in healthcare facilities 500,0 00 500,0 00 1,000 ,000 Support for the provision of improved and sustainable WASH facilities in all healthcare facilities 850,0 00 850,0 00 1,700 ,000 Support for stockpiling of essential medical supplies and high-quality (protein and calories) nutrition and 2,000, 000 2,000, 000 2,000 ,000 2,000, 000 2,00 0,00 0 10,00 0,000 Support for the establishment of back-up arrangements with local food suppliers for emergency food supplies in emergency situations 2,000, 000 2,000 ,000 2,00 0,00 0 6,000 ,000 Totals 3,560, 000 7,130, 000 5,560 ,000 5,130, 5,56 0,00 26,94 0,000 Support the delivery of the climate informed health programme intervention plans - respiratory National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Training (annual) for healthcare workers (Federal, States, and LGA) on monitoring, diagnosis, emergency preparedness, and management of emergencies caused by respiratory illnesses extreme especially those caused by weather conditions 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, flyers) on respiratory diseases 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Support to States and LGAs for the implementation of respiratory diseases surveillance, tracking and management in communities faced with extreme weather challenges 220,0 00 220,0 00 220, 000 660,0 00 Establishment, training, and equipping of ‘Emergency Response Teams’ in FMoH, State MoH, and LGA health department. for quick medical deployment and 500,0 00 500,0 00 500,0 00 500,0 00 500, 000 2,500 ,000 Support for the provision of adequate reserves of respiratory medications, PPEs (masks, etc.), essential drugs, and essential 1,500, 000 1,500, 000 1,500 ,000 1,500, 000 1,50 0,00 0 7,500 ,000 Support for the provision of indoor and outdoor air quality monitoring devices 1,000, 000 1,000 ,000 2,000 ,000 Support for retrofitting of healthcare facilities ventilation (windows, etc.) to improve air flow and quality 1,000, 000 1,000 ,000 1,000, 000 3,000 ,000 Support for ‘greening’ of healthcare facilities to improve cooling effect, air quality, and reduction of air 250,0 00 250,0 00 250,0 00 750,0 00 Totals 2,780, 000 4,810, 000 5,030 ,000 3,810, 000 2,78 0,00 19,21 0,000 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Healthcare Facilities Support for Resilience to Health Challenges from Extreme Weather Events - (Zoonosis) due to Climate Change National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on the link between Climate change and 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Training (annual) for healthcare workers (Federal, States, and LGA) on monitoring, diagnosis, emergency preparedness, and management of 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support for National workshop for training of personnel of health, agriculture, and environment sectors on an integrated ‘One Health’ 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to States and LGAs for the implementation of zoonotic diseases surveillance, tracking and management in communities faced with extreme weather challenges 400,0 00 400,0 00 400,0 00 400,0 00 400, 000 2,000 ,000 Establishment, training, and equipping of ‘Emergency Response Teams’ in FMoH, State MoH, and LGA health department. for quick medical deployment and 200,0 00 200,0 00 200,0 00 200,0 00 200, 000 1,000 ,000 Support to States and Communities for the procurement of vaccines and stockpiling of preventive and curative medical supplies, and treatments for known zoonotic diseases in 800,0 00 800,0 00 800,0 00 800,0 00 800, 000 4,000 ,000 Support for provision and sustenance of improved WASH practices to reduce disease 400,0 00 400,0 00 400,0 00 400, 000 1,600 ,000 Totals 2,180, 000 2,580, 000 2,580 ,000 2,580, 000 2,58 0,00 12,50 0,000 Support the delivery of the climate informed health programme intervention plans - NCDs National (annual), States (annual), LGAs’(biannual), and Communities (continuing) Public health awareness and education campaigns on the link between Climate change and non- communicable diseases (NCD) – 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Support for workshops and seminars for awareness creation and training of personnel of healthcare facilities on extreme weather events as a 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Support to States and LGAs for the implementation of NCDs surveillance, tracking and management in communities faced with extreme weather challenges 1,500, 000 1,500, 000 1,500 ,000 1,500, 000 1,50 0,00 0 7,500 ,000 Support for development of improved and reliable supply chain of essential medicines for NCDs, especially in vulnerable or remote 500,0 00 500,0 00 500,0 00 500,0 00 500, 000 2,500 ,000 Support for stockpiling of essential. medicines, and medical equipment for management of acute and 1,000, 000 1,000, 000 1,000 ,000 1,000, 000 1,00 0,00 0 5,000 ,000 Totals 3,560, 000 3,560, 000 3,560 ,000 3,560, 000 3,56 0,00 17,80 0,000 Support National, States, LGAs, and Communities (continuing) Public health awareness and education campaigns on the link between extreme weather vents as a result of 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Support the delivery of the climate informed health programme intervention plans - mental health Support to FMoH, State MoH, and LGAs for the conduct of annual healthcare workforce workshop/ seminar on psychosocial illnesses management and support for people 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, State MoH, and LGA Health Department, for the training and equipping of healthcare workers with skills for the identification and management of 450,0 00 450,0 00 450,0 00 450,0 00 450, 000 2,250 ,000 Support for workshops at federal, states, and LGAs for building coping skills and resilience in healthcare personnel in situations of extreme pressures from work-overload and 500,0 00 500,0 00 500,0 00 500,0 00 500, 000 2,500 ,000 Support for stockpiling of essential. medicines, and medical equipment for management of mental health challenges 500,0 00 500,0 00 500,0 00 500,0 00 500, 000 2,500 ,000 Support to States and LGAs in maintenance of access roads to healthcare facilities 1,500, 000 1,500 ,000 1,50 0,00 0 4,500 ,000 Support to healthcare facilities in flood prone communities with the provision of boats for emergency movement of patients and health 600,0 00 1,350, 000 1,350 ,000 1,350, 000 1,35 0,00 0 6,000 ,000 Totals 4,050, 000 3,300, 000 4,800 ,000 3,300, 000 4,80 0,00 20,25 0,000 Support the delivery of the climate informed health programme intervention plans - RMNCAH Support to FMoH, State MoH, and LGAs for the conduct of annual healthcare workforce workshop/ seminar on support for RMNCAH 280,0 00 280,0 00 280,0 00 280,0 00 280, 000 1,400 ,000 Support to FMoH, State MoH, and LGA Health Department, for the training and equipping of healthcare workers with skills for coping and managing of women, new-borns and 220,0 00 220,0 00 220,0 00 220,0 00 220, 000 1,100 ,000 Support to FMoH, States MoH, and LGAs in developing IEC materials (in English and local languages) for dissemination of information (radio, television, social media, billboards, flyers) in communities on risks 60,00 0 60,00 0 60,00 0 60,00 0 60,0 00 300,0 00 Support to States and LGAs for the training of community health workers to provide basic maternal and child health services during emergencies 400,0 00 600,0 00 600,0 00 400,0 00 400, 000 2,400 ,000 Support to flood prone States with procurement of boats for movement of healthcare personnel and patients in emergencies 2,000, 000 2,000 ,000 4,000 ,000 Support to LGAs for maintenance of access roads to healthcare facilities 1,000, 000 1,000, 000 1,000 ,000 1,000, 000 1,00 0,00 0 5,000 ,000 Support to LGAs for assistance to healthcare facilities for the stockpiling of essential drugs, delivery equipment, and foods 2,000, 000 2,000, 000 2,000 ,000 2,000, 000 1,00 0,00 0 10,00 0,000 Support and funding to NGOs and CBOs for provision of expertise, resources, and personnel for RMNCAH activities during 500,0 00 500,0 00 500, 000 1,500 ,000 Support to State MoH for the purchase and deployment of mobile clinics capable of reaching impacted communities and delivering essential RMNCAH services in situations of 8,000, 000 8,000 ,000 8,000, 000 24,00 0,000 Totals 4,460, 000 14,16 0,000 14,66 0,000 11,96 0,000 4,46 0,00 49,70 0,000 Procurement of Climate Change Health Impacts data detection tools 170,0 00 170,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Integ rate d Risk Moni torin g and Earl y War ning Develop climate- informed health indicators for inclusion in DHIS2 Integrate Climate Change health impact indicators on the DHIS2, NCP Reporting System, NDHI and SORMAS and ensure interoperability 35,00 0 35,00 0 Build the capacity of FMoH, NIMET AND National Hydrological Agency on interpreting and reporting climate change health impact indicators 20,00 0 20,00 0 Review of different programs and plans to reflect climate sensitivity 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Creation of checklists for CCEH data collection from the communities PHCs, LGAs, State and National 10,00 0 10,00 0 Creation of M&E unit of CCEH 30,00 0 30,00 0 Establish monitoring and feedback mechanisms to track the progress and effectiveness of awareness 20,00 0 20,00 0 Collaborate with DHIS2 developers to create and validate climate- relevant health indicators. 13,00 0 13,00 0 Develop training materials and workshops on DHIS2, focusing on the new indicators. 17,00 0 17,00 0 34,00 0 Provide continuous technical support for data entry, analysis, and reporting on climate-sensitive 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 Provide continuous technical support for data entry, analysis, and reporting on climate-sensitive 450,0 00 450,0 00 450,0 00 450,0 00 450, 000 2,250 ,000 Totals 632,0 00 740,0 00 520,0 00 520,0 00 520, 000 2,932 ,000 Develop one integrated climate change, health and environment al early warning system that is linked to other sectors/ MDAs Evaluate the campaign’s reach and effectiveness in increasing workforce awareness and engagement. 20,00 0 20,00 0 Establish a task force with environmental and public health specialists for health-meteorology 15,00 0 15,00 0 Develop standard operating procedures (SOPs) for integrating climate-related early warning systems (EWSs) with health 15,00 0 15,00 0 Conduct genomic study of vector surveillance 80,00 0 80,00 0 Pilot integrated surveillance in high- risk states prone to climate disasters (e.g., floods, heatwaves). 200,0 00 200,0 00 Create user-friendly dashboards for health and climate data to inform public health responses. 25,00 0 25,00 0 Totals 60,00 0 295,0 00 0 0 0 355,0 00 Train health workers and health information teams on Train health and environment officers on data analysis and usage of integrated systems. 30,00 0 30,00 0 Conduct workshops and capacity building programs (6 Zones) for health workers and relevant stakeholders on the integration of meteorological and climate relevant 145,0 00 145, 000 145,0 00 435,0 00 Establish a health-data collection, storage, and management system in the CCEH Division of FMoH 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Train staff of the Public Health Department of FMoH (including CCEH) on data collection, collation, analysis, interpretation and use for 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL teams on new climate informed indicators Develop mechanism to link-up health-climate data from the FMoH into the national centralized climate and early-warning system data management system that harnesses data from different institutions 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 Conduct of workshops with relevant stakeholders to Develop guidelines and procedures for strengthening public health and environmental infrastructure blueprints at Federal, 250,0 00 250,0 00 Totals 90,00 0 515,0 00 235,0 00 235,0 00 90,0 00 1,165 ,000 Heal th and Clim ate Rese arch Assess climate impacts on key health programmes (e.g. RMNCAH, malaria/ vector borne diseases, zoonoses, mental health etc) Identification of stakeholder health sector institutions, other climate impacted stakeholder MDAs, Funding/Donor sources (local and international, multi-lateral and 15,00 0 15,00 0 Organisation of a National sensitization workshop involving multi-sector Federal and States MDAs, TWG, stakeholders, and 100,0 00 100,0 00 100,0 00 100,0 00 100, 000 500,0 00 Establishment and funding for a research lead, and protocol development team in the FMoH 30,00 0 30,00 0 Totals 115,0 00 130,0 00 100,0 00 100,0 00 100, 000 545,0 00 Develop climate informed intervention plans for key health programmes Identification and collaborative research activities (including funding) with research institutions, international multi-lateral health and climate agencies, academia, NGOs, involved in Malaria and other 25,00 0 15,00 0 40,00 0 Advocacy (including proposals development and sharing) and Organisation of annual National workshop to sensitize Donor Partners and ensure alignment with 17,00 0 17,00 0 Procurement of modern research equipment and tools (disease tracking applications, modelling tools, disease pattern analytical instruments, etc.) 200,0 00 200,0 00 Organisation of an annual climate- health research and innovation day (seminars, research works and achievements, successes an data on health impacts achievement, 40,00 0 40,00 0 40,00 0 40,00 0 40,0 00 200,0 00 Totals 40,00 0 282,0 00 55,00 0 40,00 0 40,0 00 457,0 00 Build a cadre of climate change health researchers and Career Specialists Regularly review infrastructure blueprint updates and align them with evolving climate threats. 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 Determine research priorities from the assessment criteria of the V&A 30,00 0 30,00 0 Collaborate with academic institutions to develop climate-health research programs. 35,00 0 35,00 0 70,00 0 Identify and fund research fellows focused on priority areas from the V&A assessment. 20,00 0 20,00 0 Initiate scoping missions and workshops to build climate change and health research cadre/ framework to explore ways of increasing funding for research and 100,0 00 100,0 00 100,0 00 100,0 00 100, 000 500,0 00 Establish a National CCEH Taskforce to lead efforts in building research capacity 30,00 0 30,00 0 Sponsor post-graduate research on CCEH 75,00 0 75,00 0 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Organise a Conference on CCEH (regional) 250,0 00 250,0 00 Set up a research database to track ongoing studies and outcomes. 15,00 0 15,00 0 Totals 150,0 00 185,0 00 190,0 00 445,0 00 120, 000 1,090 ,000 Develop climate- resilient health infrastructur e models and blueprints by type/level of health infrastructur e and vulnerabilitie s that will be faced (i.e. extreme weather events) Set up National Healthcare Infrastructure Climate-Resilience Project Coordination Unit in FMoH; units will also, be set up at States and LGAs, with the federal unit 5,000 5,000 Procurement of National, and Zonal/ States Infrastructure Assessment Consultancies (firms consisting of architects, engineers, environmental experts, public health experts, – One 160,0 00 160,0 00 320,0 00 Conduct Climate-resilient Health Infrastructure awareness campaigns and engagement for Federal and Sub-Nationals 40,00 0 40,00 0 10,0 00 10,00 0 10,0 00 110,0 00 Assessment of health system infrastructure for climate-resilience by facility types – accessibility, structural resilience, environmental and climate resilience, WASH resilience, energy resilience (including constancy, environmental 190,0 00 450,0 00 640,0 00 Design, and costing of climate- resilient infrastructure blueprints by Zonal. States, and Communities health-climate resilience challenges. 40,00 0 180,0 00 80,00 0 300,0 00 Perform Annual review, updates and reports on state of infrastructure and blueprints 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 Organisation of annual national workshop - Annual review, updates and reports on state of infrastructure and blueprints, evaluation of achievements and progress on set goals and tasks at Federal, States, 35,00 0 35,00 0 35,00 0 35,00 0 35,0 00 175,0 00 Totals 490,0 00 885,0 00 145,0 00 65,00 0 65,0 00 1,650 ,000 Support the modification of infrastructur e in the highest-risk facilities, BE mONCs and CEmONCs to ensure they Perform retrofitting and repair work on existing buildings to enhance flood and stormwater management systems, install climate-appropriate roofing, and implement advanced ventilation systems for extreme heat management including the installation of alternative and 14,00 0,000 14,00 0,000 14,00 0,000 33,90 0,000 Retrofit lighting systems with energy- efficient bulbs and upgrade to energy-saving equipment across facilities to reduce dependence on 30,00 0 30,00 0 30,00 0 90,00 0 Establish reliable water supply systems, incorporating public water sources, rainwater harvesting setups, and boreholes. 6,000, 000 6,000 ,000 6,000, 000 18,00 0,000 Upgrade and maintain toilet and sanitation facilities to withstand climate-related impacts and ensure continuous service. 700,0 00 700,0 00 450,0 00 1,850 ,000 Develop and implement a healthcare waste management plan, including waste segregation and environmentally safe disposal 3,000, 000 3,000 ,000 3,000, 000 9,000 ,000 Integrate wastewater treatment systems that minimize environmental contamination and ensure facility compliance with climate resilience 1,000, 000 1,000 ,000 1,000, 000 3,000 ,000 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Tech nolo gy and Infra stru ctur e CEmONCs to ensure they are climate resilient Construct and rehabilitate access roads to ensure year-round accessibility, regardless of weather conditions. 1,200, 000 1,200 ,000 1,200, 000 3,600 ,000 Build and reinforce storage facilities that can resist adverse climate conditions, including floods, humidity, and temperature 1,500, 000 1,500 ,000 1,500, 000 4,500 ,000 Environmental greening and landscaping around the facilities 500,0 00 500,0 00 500,0 00 1,500 ,000 Conduct specialized training for facility managers and technical staff on proactive maintenance practices, sustainable resource use, and facility 30,00 0 30,00 0 30,0 00 90,00 0 Develop a consistent maintenance schedule and budget allocation to ensure long-term facility resilience and performance under climate- 10,00 0 10,00 0 20,00 0 Totals 0 27,94 0,000 27,97 0,000 19,61 0,000 30,0 00 75,55 0,000 Assess laboratories and staff capacity to respond to the impacts of climate change Perform advocacy and awareness workshop on development and management of quality and climate resilient laboratory systems - Federal healthcare stakeholder MDAs , Sub- nationals and Private sector laboratories and research 100,0 00 100,0 00 Assessment planning and design by the FMoH, in synergy with the SMoH, and LGAs 5,000 5,000 Assessment of public healthcare laboratory infrastructure for climate resilience 50,00 0 50,00 0 Procurement of specialist consultancy firms (One National coordinating Consultant, and Six 650,0 00 650,0 00 Totals 5,000 800,0 00 0 0 0 805,0 00 Support the upgrading of laboratories and staff capacity Implementation of findings from the Assessments of healthcare laboratory climate resilience challenges and capacities 50,00 0 50,00 0 100,0 00 Construction and retrofitting of laboratory infrastructure – improvement of the capacity of building infrastructure to withstand extreme weather events impacts 400,0 00 800,0 00 800,0 00 2,000 ,000 Provision of constant and sustainable energy (alternative power sources such as generators, and energy storage batteries); Renewable energy sources such as solar and wind turbines; refitting of 400,0 00 400,0 00 800,0 00 Provision of constant and Quality Water supply 250,0 00 250,0 00 500,0 00 Purchase of improved technical quality and environmentally sound laboratory equipment, tools, and reagents 1,500 ,000 1,500, 000 3,000 ,000 Provision of environmentally sound waste management system for hazardous and non-hazardous wastes (segregation, collection, 750,0 00 750,0 00 1,500 ,000 Conduct Training for hospital/ laboratory personnel on climate impacts on health, and the management of associated health challenges and diagnostic procedures for climate-change 180,0 00 180,0 00 360,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Provision of back-up funding for emergencies – increase in services requirements, logistics, reagents, back-up power. 200,0 00 200,0 00 400,0 00 Personnel training and provision of technical capacity for improvement of carbon footprints of laboratory services activities 68,00 0 68,00 0 136,0 00 Totals 0 400,0 00 4,198 ,000 4,198, 000 0 8,796 ,000 Assess the climate resilience of the procurement and supply chain, including exploring low carbon supply chain alternatives Conduct a Vulnerability, Capacity, and Adaptation Assessment for the country (already performed by Nigeria) 200,0 00 200,0 00 States conduct of detailed climate risk vulnerabilities, resilience and adaptive capacity with focus on the identification of climate hazards that may impact on logistics and supply chain management, especially in 800,0 00 800,0 00 Assessment of availability and resilience of logistics and supply chain systems (warehouses and storage facilities, access roads, transport vehicles, etc.) of SMoH, and LGA Health Departments, especially for deliveries of essential 400,0 00 400,0 00 Vulnerability Assessment for different tiers of healthcare facilities (Primary, Secondary, Tertiary) on resilience in cold-chain management, alternate power sources, transportation system, emergency medical stocks 300,0 00 300,0 00 Totals 200,0 00 1,200, 000 300,0 00 0 0 1,700 ,000 Support the upgrading of the procurement and supply chain to be more resilient to climate change and introduce low carbon alternatives Mapping of identified climate vulnerable healthcare facilities, areas, and communities 150,0 00 150,0 00 Assessment and recommendations on energy, and resource efficient, low carbon-footprint technology and supply options for warehousing, logistics, and supply chain delivery systems – low-emission fuel options (CNG, electric vehicles), localized 90,00 0 90,00 0 Conduct Training of healthcare personnel at all tiers of healthcare practice (according to the required sophistication) on mitigation (including green-procurement), and adaptation measures for the building of resilience to climate risk emergencies, response, 600,0 00 600,0 00 Totals 0 840,0 00 0 0 0 840,0 00 Develop health service delivery contingency plans in response to extreme weather State and LGA identification and analysis of likely extreme weather events - flooding, landslides, drought, accessibility challenges, extreme heat; and vulnerabilities – vector-borne and waterborne 80,00 0 80,00 0 80,00 0 240,0 00 Development of Health Emergency Response and Management Tools - IEC materials and SOP Manuals (including for climate risks health 50,00 0 50,00 0 Annual Federal, State, and LGA Awareness training programmes for key healthcare personnel on emergency preparedness and contingency planning; and Establishment of Emergency 600,0 00 600,0 00 600,0 00 600,0 00 600, 000 3,000 ,000 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Eme rgen cy Prep ared ness and Man age ment weather Development of standard Assessment check-list by FMoH, and SMoH for facilities vulnerabilities (infrastructure resilience, energy sufficiency and alternatives, WASH facilities, accessibility, mobility 15,00 0 15,00 0 Totals 600,0 00 745,0 00 680,0 00 680,0 00 600, 000 3,305 ,000 Support and monitor service delivery contingency plans in response to extreme weather Field assessment of facilities vulnerabilities, and climate adaptive and resilience capacity (including trainings and knowledge acquisition 570,0 00 570,0 00 1,140 ,000 Establishment of State and LGA Emergency Response Teams and Protocols (including emergency evacuation strategy, public and local communications strategy, patient 1,500, 000 1,500 ,000 Procurement of critical emergency medical equipment (ambulances, oxygen cylinders, nebulizers, ventilators), tools (PPEs, maintenance), backup utilities (power, water supply, 2,400, 000 2,400 ,000 4,800 ,000 Totals 570,0 00 4,470, 000 2,400 ,000 0 0 7,440 ,000 Develop national capacity building programme that will equip communities to respond to adverse weather events Establishment and coordination of a National Climate-health Emergency Training Program and Protocol by the FMoH – procurement of a National Coordinating Consultant, 200,0 00 200,0 00 400,0 00 National Workshop and Training for FMoH MDAs, and six Zonal States on Climate Change and Health; climate risks prevention strategies; climate emergencies and critical care; climate and health data analytics, resources (personnel, equipment, tools, medicaments, 500,0 00 500,0 00 Conduct a State level Train-the- Trainers Programme on climate change and health issues and events 1,200 ,000 1,200 ,000 Annual States facilities health workforce training programme (Primary, Secondary and Tertiary healthcare facilities) 260,0 00 260,0 00 260,0 00 260,0 00 260, 000 1,300 ,000 Totals 260,0 00 960,0 00 1,660 ,000 260,0 00 260, 000 3,400 ,000 Support the delivery of the community capacity building programme Programme planning to oversee the progress in each State working in synergy with the LGA 30,00 0 30,00 0 Training of LGA department of environment and health on adverse climate events, climate change, climate change mitigation, 200,0 00 200,0 00 400,0 00 Conduct of vulnerability assessment to identify and generate baseline information/data on specific community climate challenges, gaps, knowledge, capacity, and needs analysis in climate risks and disaster 2,500, 000 2,500 ,000 0 2,730, 000 200,0 00 0 0 2,930 ,000 Monitoring & Community Awareness Building programmes by the LGA authorities (including stakeholders’ identification and mapping; production of Training modules, 50,00 0 50,00 0 100,0 00 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Monitoring & evaluation framework & feedback mechanism Training of Community Climate Champions/Trainers (Training-of- Trainers) 200,0 00 200,0 00 Development of an M&E Framework from National level, to be scaled down to State SMoH data base, and eventually unto the LGA level 150,0 00 150,0 00 150, 000 450,0 00 Totals 0 50,00 0 400,0 00 150,0 00 150, 000 750,0 00 Impl eme ntati on/ secr etari at National Project Coordinator & Admin 65,00 0 65,00 0 65,00 0 65,00 0 65,0 00 325,0 00 Finance Officer & Assistant 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Project Associate & Assistant 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 HR Officer & Assistant 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 M&E Officer & Assistant 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Gender Officer & 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 ESS Officer & Assistant 50,00 0 50,00 0 50,00 0 50,00 0 50,0 00 250,0 00 Office rent and running costs 110,0 00 110,0 00 110,0 00 110,0 00 110, 000 550,0 00 Office supplies 20,00 0 20,00 0 20,00 0 20,00 0 20,0 00 100,0 00 ICT equipment & 80,00 0 25,00 0 25,00 0 25,00 0 25,0 00 180,0 00 Evaluations & audits 100,0 00 80,0 00 180,0 00 Dedicated project staff 365,0 00 365,0 00 365,0 00 365,0 00 365, 000 1,825 ,000 Equipment & consumables 210,0 00 155,0 00 155,0 00 155,0 00 155, 000 830,0 00 Audits & evaluation 0 0 100,0 00 0 80,0 00 180,0 00 Totals 1,150, 000 1,040, 000 1,240 ,000 1,040, 000 1,20 0,00 5,670 ,000 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annex 2. Full implementation plan Table 19. Nigeria’s priority readiness interventions Readiness: Enhancing capacity and institutional frameworks for building resilience in the health sector Theme Details Priority interventions Year 202 5/6 202 6/7 2 0 2 202 8/9 202 9/30 I n i t i a t e multisecto r a l a n d multilevel h e a l t h - c l i m a t e leadership a n d governanc e - a n d del ineate clear roles a n d responsibi l i t i e s b e t w e e n institution s a n d stakeholde rs Achieving a climate- resilient health sector in Niger ia wi l l requi re unpreceden ted and robust multisectoral and multilevel coordination a n d c r o s s - c u t t i n g integration between the FMoH&SW, State MoH, SWAp coo rd ina t i on group, NPHCDA, NCCC and NCDC and other sector MDAs. This component wil l establish and maintain appropriate governance a n d a c c o u n t a b i l i t y structures, mechanisms a n d m a n d a t e s , t o institutionalise climate change mainstreaming into health planning and programming, and vice v e r s a ( s u c h a s integrating health into t h e N D C s ) . T h e s e structures will oversee Support the National Council on Climate Change (NCCC), F e d e r a l M i n i s t r y o f Environment (FMoEnv)and the Federal Ministry of Health (FMoH) to integrate the HNAP into the National Adaptation Plan (NAP) and Nat iona l ly Determined Assess the technical and operational capacity of national and sub-national sectoral pol icymakers, leaders, managers and climate change and health Establish multi-sectoral coordination mechanisms with clear responsibilities between the FMoH, State MoH and sector ministries Develop performance and accountability measures for health leaders’ commitments to climate and health D e v e l o p c o s t e d a n d m e a s u r a b l e S t a t e implementation plans for climate change and health, with clear governance and Build the capacity of n a t i o n a l and sub- n a t i o n a l s e c t o r a l institution s a n d stakeholde rs to plan f o r a n d To e n a b l e o n g o i n g institutionalisation of the HNAP, particularly at the State and sub-sectoral levels, targeted training, technical assistance and e q u i p m e n t w i l l b e provided to key units, offices and individuals to support State-level and sub-sector planning and Develop an education and capacity building campaign for the national health workforce on the impact of climate change, including managing climate change Develop a national capacity building programme that will equip communities to respond to adverse weather events I d e n t i f y a n d s e c u r e f inancing for HNAP Operational ising the HNAP will require a mix of domestic, regional and international funds and finance modalities. D e v e l o p a d o m e s t i c r e s o u r c e m o b i l i z a t i o n strategy that includes pooled funding, climate insurance, strategic purchasing and other Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL for HNAP implement a t i o n t o s u p p o r t programm es at the F e d e r a l , State and LGA levels (including and finance modalities. This will necessitate developing domestic resource mobilization strategies, as well as l e v e r a g i n g c l i m a t e c h a n g e c o - f u n d i n g opportunities beyond the health sector. Work with international development partners to secure catalytic financing a l i gned to and d i rec t l y supporting the implementation of the HNAP F u r t h e r a s s e s s k e y c l i m a t e and health pr ior i t ies a t t h e F e d e r a l , State and LGA levels a n d d e v e l o p plans that c a n b e del ivered t o strengthen f u t u r e c l i m a t e resilience N i g e r i a ’ s V & A assessment provides essential analysis of the main impacts of and vulnerabilities to climate change and the health s e c t o r a n d h e a l t h system. Additional and d e e p e r a n a l y s i s i s required for specific topics to inform the development of key intervention plans that will be supported and delivered at the Federal State and LGA levels in order to strengthen the future resilience of the health system. Assess climate impacts on key health programmes (e.g. malaria/vector borne d i s e a s e s , z o o n o s e s , Develop climate informed intervention plans for key health programmes A s s e s s t h e c l i m a t e r e s i l i e n c e o f t h e procurement and supply c h a i n t o i d e n t i f y k e y v u l n e r a b i l i t i e s a n d A s s e s s t h e r o l e a n d potential vulnerabilities of laboratory serv ices i n addressing the future impacts Develop health service delivery contingency plans for extreme weather events Develop climate-resilient h e a l t h i n f r a s t r u c t u r e models and blueprints by t y p e / l e v e l o f h e a l t h Develop climate-informed h e a l t h i n d i c a t o r s f o r inclusion in DHIS2 Develop one integrated climate change, health and e n v i r o n m e n t a l e a r l y warning system that is linked t o o t h e r s e c t o r s a n d Readiness: Enhancing capacity and institutional frameworks for building resilience in the health sector Theme Details Priority interventions Year 202 5/6 202 6/7 2 0 2 202 8/9 202 9/30 Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Table 20. Nigeria’s priority readiness interventions Resilience: Responding to and addressing climate threats to Nigeria’s health system Theme Details Priority interventions Year 202 5/6 202 6/7 202 7/8 202 8/9 202 9 / 3 0 I m p r o v e t h e provis ion of climate- responsive a n d d i s a s t e r - r e s i l i e n t health care a t t h e F e d e r a l , State and LGA levels This component will sensi t ise and bui ld capacity amongst the health workforce across all States and LGAs to m a n a g e c l i m a t e - induced health impacts. Strengthened systems will be empowered to anticipate and respond to both acute hazard events/emergencies and chronic/long-term disease and i l lness t r e n d s , t h r o u g h i n t e g r a t e d D H I S 2 - in formed mul t i leve l early warning and risk management system. Operationalise and provide ongoing support to the established Federal and S t a t e m u l t i - s e c t o r a l coordination mechanisms that will strengthen multi- Roll out the education and capacity building campaign for the health workforce to enable them to understand and respond to the impacts of M a i n t a i n a n d u p d a t e integrated climate change, health and environmental S u p p o r t a n d m o n i t o r s e r v i c e d e l i v e r y c o n t i n g e n c y p l a n s i n Train health workers and health information teams on how to col lect, analyse, interpret and respond to new Operationalise and provide ongoing support to track and monitor the defined p e r f o r m a n c e a n d accountability measures S u p p o r t S t a t e s w i t h technical capacity to deliver their developed and final State adaptations plans for Build the technical and operational capacity of national and sub-national s e c t o r a l p o l i c y m a k e r s , l e a d e r s , m a n a g e r s a n d Support the delivery of the climate informed health programme intervention plans (e.g. malaria/vector borne diseases, zoonoses, Strengthen o n g o i n g evidence- gathering a n d knowledge - manageme n t f o r identifying, understan d ing and addressing To ensure medium-long term resilience actions remain responsive to current circumstances, the HNAP will empower an in terd isc ip l inary cadre of researchers to conduct future research on key climate change impacts on the health sector. Build a cadre of climate change health researchers (e.g. on climate and health i n t o m a s t e r ’ s d e g r e e programmes; training and mentorship for early and established researchers and research teams; including climate and health as a priority research theme in national priorities; partnerships with research institutes specialising in climate and health in other Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Reinforce resilience of publ ic health and environme n t a l infrastruct u r e , inc luding retrofitting h i g h e s t - r i s k faci l i t ies, BEmONCs a n d C l i m a t e - p r o o f i n g Nigeria’s existing and f u t u r e h e a l t h infrastructure, through evidence-informed and s c a l a b l e d e s i g n , construction, operation a n d m a i n t e n a n c e m o d e l s . T h e s e standards will include support ive faci l i t ies (storage, warehouses, laboratories) as well as functions like waste m a n a g e m e n t , l o w - Support the modification of i n f r a s t r u c t u r e i n t h e highest-risk and highest priority facilities to ensure Support the upgrading of l abora tor ies and s ta f f capabilities, as directed by the assessment of laboratory Support the upgrading of the procurement and supply chain to be more resilient to climate change and introduce low carbon alternatives M a i n t a i n a n d i m p r o v e community - l e v e l h e a l t h outcomes t h r o u g h c l i m a t e - i n f o r m e d In addition to the direct provisioning of health p r o g r a m m e s f o r climate-sensitive risks, diseases and areas, this component wil l equip communities to anticipate and respond to health threats from climate change impacts. Support the delivery of the c o m m u n i t y c a p a c i t y building programme Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annex 3. Guiding principles for the HNAP MEL plan and framework The HNAP MEL plan and framework is underpinned by key guiding principles and best practice standards that are outlined in Table 21 below. Table 21. Guiding principles for the HNAP MEL plan and framework Guiding principle Description Partnership and shared responsibility The HNAP MEL plan and framework define roles and responsibilities for reporting, monitoring, and validation within the FMoH/National Steering Committee, as well as for other relevant institutions and stakeholders. Although the FMoH/National Steering Committee will lead on HNAP delivery, monitoring, evaluation — and particularly learning — should be a shared duty amongst stakeholders across the climate-health nexus, including other MDAs, development partners, academia, civil society and the private sector – as well as the States and LGAs. Collective participation at all levels to provide data, oversight, analysis and learning will ensure that proposed interventions are coordinated and interlinked for streamlined processes and outcomes, and that the desired impact (see Theory of Change in section X) can be measured, verified, and reported and learnings captured and used to iterate the HNAP and improve delivery of interventions. Vertical and horizontal integration Effective MEL will require ongoing and effective coordination between and amongst actors at local, subnational, and national levels. This will also require integration between the health sector and other key sectors and government departments to address the intersecting mandates to build climate resilience in the health sector. This will also mean using and strengthening existing data systems such as District Health Information Software 2 (DHIS2), Health Resources Availability Monitoring Software (HeRAMS) of WHO, and the Surveillance and Outbreak Response Management and Analysis System SORMAS) of the NCDC, thus aligning with the MEL frameworks and indicators of existing projects and initiatives for climate and health already underway, such as the World Bank HOPE-PHC programme. Accountability and transparency Approaches for greater accountability and transparency on the delivery and performance of the HNAP across multiple stakeholders will include regular reporting - including to the public - to ensure openness, oversight, and support from all relevant parties within and outside of government. This will facilitate greater accountability for all stakeholders, units, sections, departments, implementing partners and donor agencies responsible for implementing, monitoring, and reviewing the HNAP. Open and inclusive learning The HNAP MEL plan and framework is based on constructive, productive, and inclusive processes that capture success and failures but do not focus on blame, and take positive and negative outcomes as opportunities for lessons for growth and improvement. Rather than a ‘checkbox’ compliance exercise, MEL should be embedded with implementation (see Governance and Implementation Framework in section XXX) and continue to provide insights, supported by ongoing knowledge management and brokering, cross correction and collation of lessons learned. Data clarity and quality Indicators and associated milestones will be specific, measurable, attainable, relevant, and time-bound (SMART), to produce data that is clear, robust and of high quality and which can be used to make key decisions and to improve performance and delivery of the HNAP. The design and delivery of the MEL plan is intentionally straightforward and practical to ensure it is integrated into existing systems and processes to ensure it can be effectively managed and delivered. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annexe 4. Detailed MEL plans Table 22 below describes indicative output level MEL plans for monitoring the HNAP, including indicators, targets (with milestones), means of verification, frequency of reporting, and the lead institutions that are responsible for data collection, analysis and management. Detailed indicator reference sheets for each indicator will be developed during HNAP inception to objectively define each indicator, describe how they will be measured, relevant data sources, etc. Targets and milestones to be determined with donors to ensure appropriate levels of ambition. This is a comprehensive set of indicators. However, to manage data collection and monitoring a more manageable subset may be selected for purposes of monitoring. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Table 22. Output level indicators and targets Table 23 below describe the indicative intervention level MEL plans for monitoring the HNAP, including indicators, targets (with milestones), means of verification, frequency of reporting, and the lead institutions that are responsible for data collection, analysis and management. Detailed indicator reference sheets for each indicator will be developed during HNAP Output Indicator (target) M e a n s o f verificati Freque ncy of reporti Multisectoral and multilevel health- climate leadership and governance established with clear roles and responsibilities between institutions Structures/mechanisms with TOR ( t a r g e t : e s t a b l i s h e d a n d operational by X date) T O R , m e e t i n g minutes Quarterl y o r biannuall y Capacity of national and sub- national sectoral institutions and stakeholders built to plan for and improve climate resilience in the health sector Technical capacity of institutions a n d s t a k e h o l d e r s ( t a r g e t : improved by X% by X date, improved by X% by X date) K P I / performan c e reporting, t r a i n i n g Annually Financing identified and secured for HNAP implementation to support programmes at the Federal, State and LGA levels Finance mobilised (target: $XX by X date; $XX by X date) Budgets, f i nanc ia l reporting Annually Key climate and health priorities assessed at the Federal, State and LGA levels and plans developed that can be delivered to strengthen future climate resilience [HOPE-PHC PDO Indicator: National climate and health adaptat ion plan developed, c o s t e d , v a l i d a t e d , a n d implemented (number)] Evidence-based plans (target: developed and implemented in X by X date) Percentage of medium and long- t e r m p l a n s f o r c o n t r o l programmes of climate-sensitive P l a n s , p r o j e c t reporting Bienniall y Improved provision of climate- responsive and disaster-resilient health care at the Federal, State and LGA levels Propo r t i on o f hea l t h ca re p rov i s i on t ha t i s c l ima te - responsive and disaster-resilient (target: xxx) X (baseline) vs Y B y b u d g e t ? By client/ programm Quarterl y Strengthened ongoing evidence- g a t h e r i n g a n d k n o w l e d g e - management for ident i fy ing , understanding and addressing climate-induced health risks and climate-sensitive diseases and health programmes K n o w l e d g e p r o d u c e d a n d managed f o r sha r i ng and adap t i ve l ea rn ing ( t a rge t : ongoing) Data from MEL incorporated into HNAP and State plan revisions Knowledg e products, H N A P and State p l a n updates Annually Increased resilience of public health and environmental infrastructure and addressing vulnerabilities in the health supply chain, including r e t r o f i t t i n g t h e h i g h e s t - r i s k facilities, BEmONCs and CEmONCs [HOPE-PHC PDO Indicator: PHC faci l i t ies achieving serv ice readiness assessment criteria (%)] [HOPE-PHC DLR 1.1: Improved primary healthcare facility readiness, quality, a n d c l i m a t e r e s i l i e n c e i n participating States (percentage)] [HOPE-PHC DLR 1.2: Increased Vulnerabili t y assessme n t s / indexes Biannual ly Improved community-level health outcomes through climate-informed health programming and capacity- building H e a l t h reporting/ data Annually Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL inception to objectively define each indicator, describe how it will be measured, relevant data sources, etc. Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Table 23. Intervention level indicators and targets Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Priority interventions Indicator (target) Means of verificatio n Freque ncy of reporti Support the National Council on Climate Change (NCCC), Federal Ministry of Environment (FMoEnv) and the Federal Ministry of Health (FMoH) to integrate the HNAP into the National Adaptation Plan (NAP) a n d N a t i o n a l l y D e t e r m i n e d Contributions (NDCs) processes to HNAP Priority Interventions and data included in NAP and NDC u p d a t e s ( t a r g e t : X % o f interventions included) Health mainstreamed in NAP and NDC updates (target: health priorities discussed in NAP; NDC Alongsid e NDCP, N A P u p d a t e timeline A s s e s s t h e t e c h n i c a l a n d operational capacity of national a n d s u b - n a t i o n a l s e c t o r a l policymakers, leaders, managers and climate change and health Proportion of existing and new roles and positions reviewed/ assessed ( t a rge t : 100%, ongoing) Assessment report O n c e off, then biannuall y f o r n e w E s t a b l i s h m u l t i - s e c t o r a l coordination mechanisms with clear responsibilities between the FMoH, State MoH and sector ministries and other agencies Multi-sectoral coordination mechanism (Task Group and H N A P N a t i o n a l S t e e r i n g Committee) established with respective TOR (target: in place by X date) Functional chair/deputies in T O R , m e e t i n g minutes O n c e o f f , ongoing operatio n reviewed annually D e v e l o p p e r f o r m a n c e a n d accountability measures for health leaders’ commitments to climate Proportion of health leaders w i t h p e r f o r m a n c e a n d accountability indicators (target: K P I s , performanc e reviews Annual Develop costed and measurable State implementation plans for climate change and health, with clear governance and delivery roles and responsibilities State Implementation Plans (target: developed, costed, and validated for 36+1 States by X date) [HOPE-PHC DLR 10.1-10.4: Climate and health adaptation Plans O n c e off, and as plans a r e revised/ updated D e v e l o p a n e d u c a t i o n a n d capacity-building campaign for the national health workforce on the i m p a c t o f c l i m a t e c h a n g e , inc luding managing c l imate Campaign developed and included in professional training curricula, aligned with other existing health/environmental campaigns (target: completed Curriculum, materials Once off Develop a national capacity- building programme that will equip communi t ies to respond to adverse weather events Programme developed (target: completed by X date) Ma te r i a l s , c a p a c i t y b u i l d i n g strategy Once off Develop a domestic resource mobilization strategy that includes pooled funding, climate insurance, strategic purchasing and other financing options Domestic funding mobilised (target: $X by X date) International funding mobilised (target: $X by X date) % of national Federal, State and LGA budgets addressing risks posed by climate variability and S t r a t e g y , b u d g e t s , f i n a n c i a l reporting Annual W o r k w i t h i n t e r n a t i o n a l development partners to secure catalytic financing aligned to and d i r e c t l y s u p p o r t i n g t h e implementation of the HNAP Partner framework to coordinate development partner funding (target developed by X date) International funding mobilised (target: $X by X date) F i n a n c i a l reporting Annual Assess climate impacts on key health programmes (e.g. malaria/ vector borne diseases, zoonoses, mental health etc) Climate impacts on key health programmes assessed (target: completed by Year 1, reviewed biennially) Assessment r e p o r t s , publications , databases Bienniall y Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL D e v e l o p c l i m a t e - i n f o r m e d intervention plans for key health programmes Intervention Plans (target: completed for X key health programmes by X date) [HOPE-PHC DLR 10.1-10.4: Climate and health adaptation plan developed, costed, and Intervention Plans Reviewe d a s needed Assess the climate resilience of the procurement and supply chain to identify key vulnerabilities and adaptations, including exploring l o w - c a r b o n s u p p l y c h a i n Procurement and supply chain assessed (target: completed by X date) Assessment report Reviewe d a s needed Assess the role and potential vulnerabi l i t ies of laboratory services in addressing the future impacts of climate change on Laboratory services assessed (target: completed by X date) Assessment report Once off Develop health service delivery contingency plans for extreme weather events Plans (target: completed by X date) Assessment report Once off Develop climate-resilient health i n f r a s t r u c t u r e m o d e l s a n d blueprints by type/level of health infrastructure Models and blueprints (target: completed for type by X date) Guidelines developed from the Smart Hospitals Toolkit (target: X by X date) CRIBS Framework, guidance and too ls pub l i shed and Models and blueprints Once off Develop climate-informed health indicators for inclusion in DHIS2 Health indicators included in DHIS2 (target: aligned by X date) C l i m a t e i n f o r m e d h e a l t h Bienniall y Develop one integrated climate change, health and environmental early warning system that is linked to other sectors, government ministries and agencies Scoping and feasibility report on Federal and State level EWS baselines and opportunities (target: completed by X date) Pilot of EWS at Federal and State level (target: completed in X States by X date) Nat ional EWS plan/pol icy developed (target: completed by X date) F u n d i n g f o r E W S implementation (target: $$$ mobilised and ringfenced by X E W S framework Once off Opera t iona l ise and prov ide ongoing support to the established Federal and State multi-sectoral coordination mechanisms that will s t r e n g t h e n m u l t i - s e c t o r a l responses to climate change adaptations Number of Federal and State mult i-sectoral coordination m e c h a n i s m s e s t a b l i s h e d (target: xx by X date) Proportion of Federal and State mult i-sectoral coordination mechanisms receiving support (target: XX by X date) T O R , m e e t i n g m i n u t e s , reports, Proport ion o f K e y o u t p u t s f r o m coordinating Quarterl y Rol l out the educat ion and capacity-building campaign for the health workforce to enable them to understand and respond to the impacts of climate change Proportion of health workforce sensitised on climate change (target: X by X date) Number of education and capacity-building events held Engagemen t strategy, training and distribution reports Quarterl y Priority interventions Indicator (target) Means of verificatio n Freque ncy of reporti Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Support and monitor service delivery contingency plans in response to extreme weather N o o f s e r v i c e d e l i v e r y contingency plans in response to extreme weather developed (target: X by X date) Proportion of recommendations implemented (target: X date by Conduct of ISS Quarterl y Train health workers and health information teams on how to collect, analyse, interpret and respond to new climate-informed indicators Proportion of health workers and health information teams that received training (target: X by X date) Number of training events held T r a i n i n g a n d distribution reports; H C W s Biannual ly Opera t iona l ise and prov ide ongoing support to track and monitor the defined performance and accountability measures and hold leaders to account Proportion of health leaders d e m o n s t r a t i n g i m p r o v e d performance (target: xx% by MILESTONE) Performance in climate and health KPI metrics for leaders (target: improvements by XXX% A u d i t R e p o r t s ; performanc e reviews Annually Support States with technical capacity to deliver their developed and final State adaptation plans for climate and health Number of States receiving technical assistance (target: 36+1 by X by X date) R e p o r t s , assessment s , p l a n MEL, Annually Build the technical and operational capacity of national and sub- national sectoral policymakers, leaders, managers and climate change and health units Number of States receiving capacity building (target: 36+1 by X by X date) N u m b e r o f s u b - n a t i o n a l p o l i c y m a k e r s , l e a d e r s , managers that received training (target: xx by X by X date) Number of training events held T r a i n i n g a n d distribution reports; Biannual ly Support the delivery of the climate informed heal th programme intervention plans (e.g. malaria/ vector borne diseases, zoonoses, mental health etc) Incidence and prevalence of c l i m a t e - s e n s i t i v e h e a l t h outcomes (target: reduced by XX% by MILESTONE) Clients satisfied with health services provided (target: H e a l t h reporting Quarterl y Build a cadre of climate change health researchers (e.g. on climate and health into master’s degree p r o g r a m m e s ; t r a i n i n g a n d m e n t o r s h i p f o r e a r l y a n d established researchers and research teams; including climate and health as a priority research theme in national priorities; pa r tnersh ips w i th research Amount of new research funded (target: $xxx by X by X date) N u m b e r o f e a r l y c a r e e r researchers supported (target: xx by X by X date) Number of publications (target: xxx by X by X date) Number of presentations at con fe rences by N ige r i an researchers to present on Reports Annual Support the modif ication of infrastructure in the highest-risk and priority facilities to ensure they are climate resilient Proportion of key facilities upgraded (target: xx by X by X date) Avoided L&D in key facilities (target: $xxx by X by X date) Facilities deploying/practising Smart Hospitals Toolkit (target: Eng ineers H e a l t h F a c i l i t y r e p o r t s (assessmen t, inventory a n d Annual Priority interventions Indicator (target) Means of verificatio n Freque ncy of reporti Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL S u p p o r t t h e u p g r a d i n g o f laboratories and staff capabilities, as directed by the assessment of l abora tory sys tems c l imate vulnerability assessment Proport ion of laborator ies receiving climate resilience upgrades (target: xx by X date) Avoided L&D in laboratories (target: xxx by X date) Number of staff that received climate risk/resilience training Eng ineers r e p o r t s , assessment s; Training a n d distribution reports; Annual Support the upgrading of the procurement and supply chain to be more resilient to climate change a n d i n t r o d u c e l o w - c a r b o n alternatives Identified climate vulnerabilities in the supply chain addressed (target: completed by X date) Low emission improvements in supply chains (target: XX MtCO2e by X date) Proportion of sub-national supply chains that adopted F i n a n c i a l r e p o r t i n g ; s u p p l y C h a i n procuremen t reports Biannual Support the del ivery of the community capacity-building programme Number o f commun i t i es / population reached by capacity building programme (target: xx) Number of capacity-building events held (target: xx) T r a i n i n g a n d distribution reports Annual Priority interventions Indicator (target) Means of verificatio n Freque ncy of reporti Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL Annex 5. List of contributors Nigeria’s HNAP was developed through extensive consultations and multiple engagements with multiple stakeholders at the Federal level and with the States. The list of contributors to the HNAP are outlined below. Climate Change and Health TWG members 1. Honourable Minister, Federal Ministry of Health and Social Welfare – Dr. Muhammad Ali Pate 2. Honourable Minister, Federal Ministry of Agriculture and Rural Development –Mustapha Iyabo 3. Honourable Minister, Federal Ministry of Water Resources & Sanitation – Umezulike Robert A. 4. Honourable Minister, Federal Ministry of Budget and National Planning – Obikaonu U. Louis 5. Honourable Minister, Federal Ministry of Environment – Ezeude Uchenna 6. Federal Ministry of Health, Director Public Health – Dr Godwin Ndaton 7. Federal Ministry of Health, Director/Focal Point, Climate Change and Health – Dr Zakariya Mohammed 8. National Centre for Disease Control (NCDC), Director General – Dr. Jide Idris 9. Federal Ministry of Health, National Coordinator NCDs – Dr Ahmad Ozi 10. Federal Ministry of Health, National Coordinator, Mental Health – Dr. Tunde Ojo 11. Federal Ministry of Health, National Coordinator, National Malaria Control Programme – Dr.Godwin Ntadom 12. Federal Ministry of Health, National Coordinator, Neglected Tropical Diseases – Mr Fatai Oyediran 13. Federal Ministry of Health, DG NPHCDA – Dr. Aina Muyi 14. Federal Ministry of Health, DG National Health Insurance Authority – Dr. Kelechi Ohiri 15. National Population Commission – Aisha Kasuwa 16. National Council on Climate Change Rukayya Muhammed 17. National Meteorological Agency (NIMET) – Mr. Adeleke Oyegade 18. National Bureau of Statistics – Mr. Kehinde Julius Olagunju 19. Dr. Okara Dogara – FMoH 20. Mrs. Judith Onyeneke – FMoH Secretariat 21. Mrs. Okesade Ranti – FMoH Secetariat 22. Dr. Izu Edesiri – FMoH 23. Dr. Munirat Abdullahi – FMoH Secretariat 24. Mrs. Omolola Comfort – FMoH Secretariat 25. Dr. Jaggu Akolo Yohanna – FMoH Secretariat 26. Ms. Obile Uchendu – FMoH Secretariat 27. Mr. Richard Essien – FMoH Secretariat 28. Mrs. Margaret Dachak – FMoH Secretariat 29. Mr. Nankat Danjuma – FMoH Secretariat 30. Mr. Macdonald C. Onyejeakor – FMoH Secretariat 31. Mr. Akilu Abubakar – FMoH Secretariat 32. Mrs. Blessing Ashwe – FMoH Secretariat 33. Miss Amina Garba – FMoH Secretariat 34. Mrs. Justina Nathaniel – FMoH Secretariat 35. Mr. Jibrin Sheidu – FMoH Secretariat 36. Ms. Yemisi Soyode – FMoH Secretariat 37. Ms. Victoria Attah – FMoH Secretariat 38. Mr. Jacob Solomon – FMoH 39. Ms. Adaku B. David – FMoH 40. Ms. Jamilia Harmmarya – NPHCDA 41. Mr. Jaggu Akolo – FMoH 42. Ms. Omolola Comfort – FMoH 43. Mr. Jonah D. Barde – FMEnv 44. Dr. Iwot Ndaeyo – HSRC Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL 45. Mr. Ajayi Nwanke – FMEnv 46. Dave McConalogue, Head of Health – FCDO Nigeria 47. Anya Gopfert, Climate and Health team – FCDO London 48. Dr Ebere, Health Advisor – FCDO Nigeria 49. Jabulani Nyenwa, Senior Director – Palladium 50. Dr. Gwarzo Usman, Team Leader – Lafiya project 51. Salma Mijinyawa, Technical Advisor – Palladium 52. Edwin Isotu – WHO 53. Dr. Shola Dele-Olowu – AMP Health 54. Maruchi Wotogbe – DDP Health development partners 1. Antonios Kolimenakis– WHO 2. Brama Koné – WHO 3. Jean Nouboussi – Global Fund 4. Jessica Leete Werner Flannery – World Bank 5. Jo-Angeline Kalambo – Global Fund 6. Olumide Olaolu Okunola – World Bank 7. Seon Mi Choi – Global Fund 8. Tamer Samah Rabie – World Bank 9. Chidera Chukwu – FCDO Halcyon HNAP consulting team 1. Rob Wood – Team Leader 2. Luke Moore – Technical Director I 3. Emma Jones-Phillipson – Technical Director II 4. Dr Obi Anyadiegwu – National Team Lead 5. Dr Peter Tarfa – National Stakeholder Liaison 6. Dr Kiaka Kaegon – HNAP Consultant Nigeria Climate Change and Health Health National Adaptation Plan March 2025 OFFICIAL OFFICIAL Insert key DP logos OFFICIAL OFFICIAL Insert key DP logos OFFICIAL OFFICIAL Insert key DP logos