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Climate Resilient Infrastructure for Basic Services (CRIBS) in Nigeria

Categories: Climate change & health Vulnerability & Adaptation Assessments, Health National Adaptation Plans, Country experience, Africa, Climate Resilient Health Systems, Action Line 1: Surveillance and monitoring, Climate-related emergency preparedness and management, Integrated risks, monitoring, early warning, and GHG emissions tracking, Health systems wide resilience

Country: Nigeria

Organizations: UK Foreign, Commonwealth and Development Office (FCDO)

Context

Nigeria is one of the most climate vulnerable countries in the world and a global priority for climate adaptation. It is home to 10% of children living in the highest risk countries.[1],[2] Climate impacts are disrupting education and driving rising climate-related illnesses, deaths, and malnutrition. These risks undermine decades of development, with women and girls, and the most vulnerable populations being most affected.

In 2024, Nigeria released its first Climate and Health Vulnerability and Adaptation Assessment (CHVA). This comprehensive assessment highlighted the scale and severity of the impact of climate change on health outcomes, estimating that 21% of the burden of disease in Nigeria will be associated with climate change by 2030. It also highlighted the central role of the health sector in protecting the population against the most severe impacts of climate change. However, it also noted the vulnerability of the health system, and specifically health care facilities, to climate change. This will fundamentally and negatively affect the ability of the health system to deliver basic life-saving services to the most vulnerable.

In response to the current and expected impacts of climate change on health sector infrastructure and health service delivery, FCDO worked with a range of government and non-government partners to develop the Climate Resilient Infrastructure for Basic Services (CRIBS) programme. The programme has been implemented in two states in northern Nigeria, with ambitious plans for integration and scale up under the direction of the government of Nigeria.

 

[1] WHO, 2015: Health and climate change: country profile 2015: Nigeria (who.int)

[2] UNICEF, 2021: The climate crisis is a child rights crisis: Introducing the Children’s Climate Risk Index - UNICEF DATA

 

Implementation process

Core elements of CRIBS development and delivery

The CRIBS programme was conceived to develop and test a low-cost scalable model to improve climate resilience of primary healthcare (PHC) facilities and schools in low-resource settings. It aims to minimise the impact of climate change on access to quality health and education services through a comprehensive system with three core components:

  • Facility climate risk and vulnerability assessment and intervention selection: A novel approach and tool was developed for assessing the climate risks and vulnerabilities of PHCs and schools. A combination of secondary data analysis, primary observations, qualitative data collection including interviews and focus group discussions with facility staff, users/students, and community members, was used. The analysis of facility-level assessment data was used to select appropriate evidence-based interventions to address the climate vulnerabilities identified. The facility-level vulnerability assessment, and the tool to select interventions based on the vulnerabilities identified, was developed and validated by the CRIBS Expert and Oversight Group and through workshops with state and federal government representatives and key stakeholders.
     
  • Facility level intervention with specifications to address climate vulnerabilities: A set of specific interventions were identified to guide facility-level renovations to ensure resilience to key climate-related risks. These included; flood-resistant foundations; stormwater management; wide windows, doors and vents for natural ventilation; trees for shade, as windbreakers and to protect against erosion; raised and reinforced roofs; false ceilings; highly reflective roof materials; deep flood resilient bore holes to manage water table drops; among other context specific adjustments. Interventions in primary health centres also included installation of solar equipment to provide electricity throughout the facility for the delivery of core functions. The selection of interventions was agreed among experts in the CRIBS Expert and Oversight Group, insights from broader stakeholders at the federal and state levels, engagement with focus communities, and lessons learned from implementation experience.
     
  • Research component: This component, funded through FCDO’s West African Research and Innovation Hub (WARIH), evaluates the effectiveness of the CRIBS approach and outcomes of CRIBS specific interventions. It plays a critical role in gathering the knowledge generated through CRIBS and in disseminating lessons learned to contexts beyond Nigeria, where, prior to CRIBS, there was a gap in evidence and expertise in this field of growing global importance.

 

The two phases of CRIBS

  • Phase 1, developing and testing the approach and tools: The first year focused on developing the CRIBS concept and tools and field testing in two states; Kano and Jigawa. This is conducted through rehabilitation of existing buildings and facilities, rather than new construction.
  • Phase 2, scaling up CRIBS implementation: The second phase has been focusing on integration into wider government revitalisation programmes for health and education, representing a significant scale-up in ambition. This included the inclusion of CRIBS in the Government Health Sector Development programme, HOPE PHC, which is funded through a World Bank loan and funding from development partners. Core elements of the CRIBS approach have also been integrated into Nigeria’s national assessment tool for PHC functionality assessment.

The research component mentioned above will be operational throughout both phases.

 

Partnership approach to development

Partnership has been at the core of the CRIBS approach. The development and implementation of CRIBS has drawn on global experts through an Expert Oversight and Advisory Group, as well as targeted support from the World Health Organisation (WHO), FCDO, UNICEF, Crown Agents, World Bank, Jigsaw Consulting, Fab Inc and the Sextant Foundation, to improve the quality of the work and build a wider constituency aware of the work and invested in the approach. The main implementing partner for the implementation phase is UNICEF.

A close working relationship with federal and state governments, local government and communities has been maintained throughout the development process, to select facilities and design interventions. These elements will be crucial for both future uptake and the sustainability of facility-level CRIBS interventions.

 

CRIBS successes

Over the past 12 months, there has been an impressive rate of delivery through the CRIBS programme;  key achievements in the last year include:

  • The successful development and field testing of an approach (with corresponding tools) for vulnerability analysis and intervention selection at PHC and school facility level. The approach and tools were field tested and later validated at two levels – first by the state level authorities in Kano and Jigawa states of Nigeria, and second by the CRIBS Expert and Oversight Group.
     
  • Implementation of a package of climate resilient interventions in 84 Primary Health Care facilities and schools in Nigeria based on their climate vulnerabilities.
     
  • Integration and scale up through government programmes, in Nigeria and other countries. There has been substantial buy-in from government stakeholders, which is reflected through the integration of CRIBS into their programmes and policies, including the delivery of the government of Nigeria’s flagship health programme, HOPE PHC  and integration of key CRIBS components into the national PHC assessment tool. There has also been interest in adopting the CRIBS approach in other countries, which has resulted in government projects in both Sudan and South Sudan, with emerging interest from further countries.
     
  • Making the CRIBS guidance and tools available through an accessible online platform. Work is at an advanced stage to make all CRIBS resources, including the assessment tools, interventions specifications and risk assessment/intervention selection guidance available in a user-friendly and accessible format. This is expected to be released in August.

 

Lessons learned

  • Partnership working: The foundation of the development of CRIBS was partnership working- across government, local and international partners, and communities. Bringing together expertise from local and global partners was extremely important to develop a novel approach and tools, as it required a broad set of expertise and experiences. Bringing together expertise and agencies also ensured strong oversight which enabled confidence in development decisions and their application.
     
  • Planning for scale up from the onset: Starting from the concept development phase, CRIBS was designed with its potential for scale-up to achieve impact in low-resource settings. This focus was central to the approach; it needed to be something that could be integrated into government plans and ultimately funded through the public purse.
     
  • Ensuring government leadership: Government at state and federal levels were engaged in the CRIBS development and implementation from the beginning. Without government ownership, it would have been unlikely to achieve integration into wider plans and finances. We are already seeing this bear fruit. with expansion of ambitions in some states and integration through the Nigeria HOPE PHC health programme.
     
  • Context is king: There are common interventions that may be repeated in many facilities to improve climate resilience, but there is no ‘one size fits all’ set of climate resilience interventions that can be applied unilaterally to all facilities. The context of the community and the facility is key. Depending on the local context, the risk and severity of climate risks will be different, and even where the risk may be common, the solution to address the risk may be different. There is no way around a facility-level assessment.
     
  • Community involvement is central to acceptability and sustainability: The community must be carried along. They understand the context and will know what will ultimately succeed or fail. Also, once renovations are completed, facility maintenance will often fall onto the local community.
     
  • Sharing tools and learning: CRIBS sought not only to build on the existing evidence base for building climate resilience in health and education, but also to contribute to it. The experiences, tools and guidance developed from CRIBS will be made available through a digital platform. However, we will also look for ways to build on the experiences and practices as we (and others) use, learn, and, adjust the approach.

 

Challenges

  • Lack of global expertise – we were all learning together: We had incredibly useful global guidance from WHO, around which we built the CRIBS approach. However, there a comprehensive set of tools and guidance for carrying out the assessments and selecting evidence-based interventions at the facility level does not exist. A partnership approach with embedded expertise from a range of professions and organisations was fundamental to the development of CRIBS.
     
  • Scaling up climate resilience is difficult without a validated approach. From the beginning of its development, the focus was to derive a low-cost scalable approach that government and partners could integrate into their plans. One of our key development partners throughout was the World Bank, who also helped shape the focus of CRIBS so that it could be integrated in their large-scale health sector development financing plans, such as HOPE PHC.
     
  • Fear of ‘additional’ costs in a highly resource constrained context. One of the key challenges from any approach that includes integrating climate resilience measures into health or education renovation programmes is the fear of significant additional costs, especially when the setting is already resource constrained and where priority lies on the access to basic essential services. In fact, part of the solution to this was the implementation of CRIBS; it showed that climate resilience measures overlapped massively with general revitalization, which meant only marginal (if any) short-term additional costs.
     
  • Constant cycle of development – not being too ‘proud’ to change course and accept external guidance. CRIBS was built on an approach of partnership, accepting that no one organisation or profession held all of the answers or expertise. However, as the tools and approach are developed and people feel ownership, the focus can become on ‘defending’ them rather than ‘improving’ them. We have tried to tackle this by having a range of inputs across professions and sectors, and encouraging an environment of constructive criticism and partnership.

 

 

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