1
Climate Change and Malaria in the Democratic Republic of Congo
SOS 444 - Climate Change, Society and Sustainability
ASU-Tempe Campus
September 28, 2020
ASSESSMENT TASK 2 2
Climate Change and Malaria in the Democratic Republic of Congo
Health issues Related to Climate Change in the Democratic Republic of Congo
The expansion of greenhouse gases through human activities worldwide is the primary
cause of climate change experienced today. As a result of these human activities, there have been
widespread changes in the earth's temperature, causing changes in various climates. Some of the
changes accompanying climate change include droughts, frequent heat waves, more floods, and
intense rainfall (Barry, 2018). Furthermore, climate change has brought about other effects
include effects on glaciers and the oceans. Oceans across the globe have become warmer, and
more turned acidic. The seas levels are also rising because of the melting glaciers. All these
changes have occurred, leading to more problems across the world. They have affected the way
people live and the way they approach various aspects of life. One of the countries where climate
change has brought about a significant difference in human life is the Republic of Congo.
Change in climate in this country has affected not only the environment but also human health.
Climate change is considered to cause various environmental changes related to different
health issues experienced in Congo today. According to Shavkatovna (2020), man-made, natural
causes, and more, climate change is a significant human health stressor in the United States. It
influences diseases in diverse ways. Shavkatovna (2020) adds that several infectious diseases in
the United States today are caused by flooding, temperature change, and other weather changes.
One of the health issues caused by climate change is water-borne diseases. Climate change in
Congo has caused increased rainfall, typhoons, tornados, and storms leading to floods, which has
increased the risks of infections. Barry (2018) asserts that flooding in the Congo has been a
common phenomenon leading to increased population displacements and water sources
contamination. As a result, Barry (2018) indicates that water-borne diseases such as diarrhea,
ASSESSMENT TASK 2 3
typhoid fever, hepatitis A, leptospirosis, and Cholera have become intense. An excellent example
is the major outbreak of diarrhea in the country in 1994 due to frequent floods.
Other common health problems caused by climate change in Congo include malaria.
Malaria and climate change have a close relationship since climate change causes an increase in
the transmission of malaria. Dasgupta (2018) indicates that climate change causes an incline in
rainfall, temperature, and humidity leading to the proliferation of mosquitoes carrying malaria in
regions with high altitude increasing malaria. The spread of this disease has been rampant in
Congo and other areas of central Africa.
Climate change also brings about other issues such as drought, which has adverse effects
on food production. It causes a rise in temperatures leading to a limited supply of rainfall and
water, leading to dry spell across various parts of the world. In Congo, drought is considered a
significant disaster that claims more than 2000 lives each year (von Uexkull, d'Errico & Jackson,
2020). The regions away from the rain forests in Congo experience low rainfall due to the
increasing temperatures leading to low harvests. Due to the droughts in Congo, there is an
increased number of children and adults' malnutrition and an increase in the number of deaths
due to famine. Further, Barry (2018) adds that the drought and famine caused by climate change
have increased in varying rainfall patterns in the Congo, affecting the supply of clean and
freshwater for human consumption. As a result, people use dirty water, leading to diseases such
as typhoid, Cholera, and amoeba, which is prevalent in Congo.
The fluctuations in climate in the Democratic Republic of Congo have similarly sped up
the propagation of neglected tropical diseases that are sensitive to changes in the environment.
As temperatures and rainfall patterns alter, the range of vectors is getting larger that is to say they
are crossing into territories that had been considered low-risk areas before. Lumbala et al. (2015)
ASSESSMENT TASK 2 4
indicate that Human African Trypanosomiasis has got to be less localized nature as the tsetse
flies have got the ability of changing habitats which is causing the disease to spread further.
Apart from that, the natural disturbances also change the location of fauna and human beings as a
result of that they are coming in close contact with each other and hence their chances of being
infected are doubling. Nkanga et al. (2017) argue that the pressure of the climate can be a factor
that makes it easier for the body of the weak especially the immune system to get attacked hence
they become susceptible to catching vector-borne diseases. These dangers become more
pronounced in areas, which are far off and are rural that have very few monitoring activities and
also treatment possibilities. Bele et al. (2014) illustrate that people who have been evicted from
their homes due to the environmental shocks can find themselves in areas where it is almost
impossible to keep an eye on the spread of diseases. The proliferation of these diseases may
become even more overwhelming without the implementation of concerted adaptation measures,
thus leading to the outbreak of the same diseases over and over again, which further divides the
already scarce medical resources.
Climate-related health complications caused by nature have an adverse economic impact
on families and public institutions in rural as well as urban areas of the Congo basin. In case
floods have polluted water supplies, cholera and other similar diseases may easily spread, which
in turn will require the use of emergency resources that will be taken from other areas. In their
study, Munyuli et al. (2013) have demonstrated that cholera outbreaks in Bukavu have brought
about large treatment costs as well as long-term financial difficulties for the local population.
Communities that are solely based on daily labor or subsistence agriculture find it difficult to
recover when illness breaks through income and mobility. In their study, Bele et al. (2014)
underline that the low adaptation capacity of local communities leads to increased dependence
ASSESSMENT TASK 2 5
on health services, which are already overburdened, during climate shocks. Nkanga et al. (2017)
further add that pollution and environmental stress weaken physiological resilience, thus making
treatment more expensive and less effective. The events of flood and contamination are recurring
and thus the costs for medicines, sanitation, and displacement support are piling up. In case there
are no structural interventions, the financial burden resulting from climate-sensitive diseases will
continue to negatively affect social welfare and public health stability.
One more emerging issue is the combined impact of pollution, demographic change, and
unstable weather patterns on disease vulnerability. Nkanga et al. (2017) bring out the link
between extreme temperatures, the decline of air quality, and the increase of blood-related
illnesses in aging populations. These environmental stressors not only raise the severity of
chronic conditions but also lower the rate of recovery. Bele et al. (2014) point out that rural and
peri-urban communities are devoid of formal systems of adaptation which makes the residents
depend on informal coping strategies that seldomly cover the issue of long-term health risks. The
disruption of the habitat and water scarcity can be the facilitators of indirect exposure to vector-
borne diseases in areas that are now considered stable. Lumbala et al. (2015) depict that the
changing ecological conditions have an impact on the range and density of tsetse fly populations.
Munyuli et al. (2013) go further to reveal how climate-driven sanitation failures have resulted in
the co-occurrence of diarrheal and vector-related diseases. These interconnected threats which
become worse with the progression of conditions, thus, are a source of additional pressure to
families, healthcare providers, and local governance structures that both financially and
logistically are overstretched.
Current Policies and Strategies against Malaria related to Climate Change
ASSESSMENT TASK 2 6
In conjunction with the World Health Organization (WHO), the Congolese government
has adopted various policies and strategies to address the health issues caused by climate change.
The strategies and policies are greeted to mitigate, prevent, and treat the spread of diseases
caused by climate change. The vulnerability to malaria in Congo made the government and the
United Nations address common problems such as Malaria, Cholera, malnutrition, and deaths
caused by climate change factors. According to Hassan and Tularam (2018), the best way to
address climate change's health issues is to address climate change, which is the causative agent.
Therefore, most of the policies and strategies in the Congo are geared towards preventing climate
change impacts. Below are the policies and strategies adopted in the Congo to address health
issues caused by climate change.
The Democratic Republic of Congo has adopted various policies and strategies, including
the United Nation's Convention on the Biological Diversity ratification. This convention aims to
ensure that the Congo's biodiversity is taken care of to mitigate the impacts of unsustainable
practices, causing an increase in climate change. The other intervention is the Convention for
Combating Desertification (CCD) (Hassan & Tularam, 2018). It ensures that desertification
caused by climate change in Congo is reversed so that forests remain intact and that new tree
plantations are set up to increase rainfall. It eradicates famine and drought causing health issues
such as malnutrition and deaths due to starvation (Hassan & Tularam, 2018). The government
ratified the Kyoto Protocol and took part in the signing of the Paris Agreement on Climate
Change in 2016 (Hassan & Tularam, 2018). It enforced it by January of 2018 to ensure that
climate change causes are addressed to reduce the Congolese people's health impacts.
Other strategies adopted by the Congolese government are geared towards preventing and
treating the health issues caused by climate change in the country. These strategies include
ASSESSMENT TASK 2 7
malaria control campaigns, flood risk management, and free and quick treatment for Cholera and
other health issues. According to Bouzid, Hooper, and Hunter (2013), the Congolese government
established the Public Health Act of 2012, which was geared towards addressing the population's
health problems, including malaria. Through this policy, the government established strategies to
empower people to change their lifestyles through anti-malaria campaigns. It has created
awareness by educating its people on the importance and ways of preventing malaria. They
include avoiding living in swampy regions, taking malaria mediation seriously, avoiding flooded
areas, and using clean water (Bouzid, Hooper & Hunter, 2013). The policy also ensured that
increased funding is realized in the health sector to finance Malaria and Cholera's free treatment.
The country also set up flood risk management strategies to prevent the spread of floodwater and
the effects of flooding. They including soil erosion, which causes diseases and caused crop
destruction, causing health issues such as malnutrition.
The country has also ensured that strategies to address pollution from carbon emissions
and the destruction of forests are addressed. Campbell-Lendrum et al. (2015) indicate that the
Congolese government has adopted cutting-on carbon dioxide production measures. They
include restrictions on charcoal burning and urging factories and businesses to adopt green
manufacture and packaging products. Campbell-Lendrum et al. (2015) also claim that the
government has also set up campaigns to rally people towards planting trees, setting up land for
tree plantations, creating laws that ban timber harvesting among indigenous rain forests. As a
result, there has been a significant reduction in diseases caused by climate change. However,
despite the decrease, there is still a concern that diseases such as malaria will continue to affect
its population.
ASSESSMENT TASK 2 8
Additionally, the climate change effects have brought the need to a higher level to health
infrastructures for fighting contending disease threats. In their paper, Bai et al. (2013) point out
that the number of diseases that are transmitted through mosquitoes will increase due to the fact
that a change in temperature and humidity will affect the breeding of the parasites. For example,
in the Congo, the healthcare facilities in peri-urban areas are usually deprived of laboratory
capacity and rapid diagnostic tools to be able to tell the difference between malaria, dengue-like
fevers, or bacterial infections that have been aggravated by floods. Cotter et al. (2013) state that
the new ways of treating malaria have to involve more than just the traditional methods of
medical intervention but also include community engagement, better medical logistics, and the
use of digital reporting networks. Local clinics have started to utilize the portable diagnostic kit,
which is a part of their initiative of training health staff who are supported by public health
organizations and international donors. Gachelin et al. (2018) also say that the adoption of
community health education alongside traditional vector control methods has been successful in
areas where the movement of people and the existence of informal settlements have contributed
to the high rate of exposure to the disease. World Health Organization (2015) assert that these
innovations become the most effective when they are aligned with other environmental health
measures like solid waste management and improved drainage to get rid of the water that is not
moving.
Policymakers have widened cross-border working relationships, which are designed to
harmonize adaptation policies in those areas where climate variability has been identified as a
major cause of transboundary disease dynamics. According to Caminade et al. (2014) disruption
of ecosystems that are next to the borders has made malaria vectors move across national
borders, hence, it is not enough to fight the disease by only following the strategies of one
ASSESSMENT TASK 2 9
country. The World Health Organization (2015) proposes that besides other things, regions
should share and compare insecticide resistance data as well as treatment outcomes besides
meteorological data. Besides this, Cotter et al. (2013) emphasize the need to coordinate the
disease reporting standards so that the response to border areas where there is seasonal migration
can be better facilitated. Negev et al. (2015) point out that the Mediterranean countries have
adopted similar data-sharing models for managing vector-borne disease risks. In the case of the
Congo, this kind of unification allows for the reduction of the time taken in the identification of
new hot spots and also ensures that interventions are well synchronized in those places where
displacement of people has led to the overlapping of disease burdens. These joint efforts not only
significantly improve malaria management but also build up the community's capacity to
withstand other climate-sensitive threats such as cholera and water-borne infections (Caminade
et al., 2014).
One more closely related aspect to malaria climatic changes is the aspect of
environmental planning upgrading to cut down on exposure risks and simultaneously support
food security and people's livelihoods. Land-use changes, irrigation practices, and deforestation
are the major contributors to the shift of the geographical distribution of mosquitoes, as pointed
out by Bai et al. (2013). In the Congo, if the agricultural projects aimed at enhancing food
production under the changing rainfall conditions are not well managed, they can double the
breeding sites of mosquitoes without being aware of it. According to Gachelin et al. (2018), the
history of successful malaria control strategies is the case when drainage systems were combined
with community planning and local labor participation. The authors El Shinnawi et al. (2017) are
also of the opinion that integrated urban water resource management (IUWRM) could be a key
factor in achieving climate-resilient cities. Besides, the Negev et al. (2015) also maintain that
ASSESSMENT TASK 2 10
policies for green infrastructure promotion, such as wetland restoration and sustainable water
storage, can be a means of controlling vector growth as long as there is a component of public
sanitation paired with such green structures. Cotter et al. (2013) articulate that malaria
elimination strategies are more and more putting emphasis on ecological resilience measures that
are in harmony with the adaptation goals for other infectious diseases. The Congolese
government through combining agricultural planning with environmental health interventions
can not only reduce the risks of the disease but also easily deal with food insecurity.
Advertising and public awareness programs directed at the association between climate
change and disease vulnerability have become indispensable in maintaining progress over time.
Gachelin et al. (2018) explain that historically, the fight against malaria was largely dependent
on the community's participation and the local knowledge base. In Congo, the different ways by
which culture, trend of movement, and unplanned dwellings have altered exposure to mosquitoes
in the various regions. The World Health Organization (2015) advise that communication
methods should be adapted to the local languages, the traditional authorities, and the pattern of
risk of each gender. Bai et al. (2013) report that the health education related to the climate in
different situations has brought the use of bed nets, the giving and receiving of treatment, and
also hygiene to be improved. Negev et al. (2015) say that the campaigns that are most successful
in terms of inclusiveness are the ones that are connected to the overall adaptation policies that
deal with the accessibility of water, sanitation, and food security. These combined initiatives
support the communities in understanding how changes in the environment are the causes of
malaria and thus, they become involved in the prevention programs for a long period. Gradually,
this tactic becomes the one that builds up the resilience to the climate-sensitive diseases.
ASSESSMENT TASK 2 11
Climate change adaptation to keep malaria under control requires, equally, adaptive
financing mechanisms and planning that is driven by the data. According to Cotter et al. (2013),
flexible resource allocation that can react quickly to the outbreak forms the base of modern
eradication strategies. The authors (2014) of the study also state that a predictive model relying
on a temperature and precipitation trend is the best example for governments on how to give the
vector control resources to the places that are becoming hotspots. The World Health
Organization (2015) speaks for it in these words: 'We must put our money in surveillance
systems that can fuse climate data, health indicators and mobility patterns in one platform.'
Gachelin et al. (2018) explain that a historical track of the successful reduction of malaria has
always depended on the regular supply of well-trained personnel, correct diagnostics, and the use
of insecticides. Negev et al. (2015) tell us that without the funding that can be relied on in all
situations, adaptation results can be reverted by such incidents as an extreme weather event,
displacement, or the disruption of agriculture. In a Congolese context, malaria-budget
reallocation in support of climate resilience initiatives that is more efficient in the distribution of
the scant resources while also increasing capacity to deal with health issues that overlap, would
be an excellent strategy.
Epidemiology of Malaria in Congo
Malaria is the most significant cause of deaths in the Democratic Republic of Congo than
any other country in the world. Riveron et al. (2019) indicate that Congo, compared to other
countries worldwide, has the highest number of people affected by malaria. Malaria-related
deaths account for 11% of the 12% globally. Malaria is also considered the primary cause of
mortality and morbidity in the country. Riveron et al. (2019) add that it accounts for over 40% of
all the country's hospital outpatient visits. Also, Riveron et al. (2019) found out that between the
ASSESSMENT TASK 2 12
years 2016 and 2019, the burden of malaria cases fell by 3.9% from 330 to 310 per 1000 of the
country's population at risk disease. Also, the number of deaths in the country resulting from
malaria fell by about 11% from 0.69 to 0.63 per 1000 of its population at risk. Therefore, it is
clear that even though the Congolese people are at a higher risk of Malaria related deaths, the
decrease in its effects gives a glimpse of hope.
The most affected DRC population regarding malaria disease are young children below
the age of five years. It is indicated that in 2019, 20% of the deaths occurring due to malaria in
the country are children under the age of five years (Kunuanunua et al., 2019). Furthermore,
about 40% of the malaria episodes in 2016 in Congo occurred in children below the age of five
(Kunuanunua et al., 2019). Studies by Riveron (2019) also found out that severe Malaria in
Congo is attributed to 78% of hospitalization, of which 55% are children below the age of five
years. Therefore, the data above deduces that children below five years are the most vulnerable
population to Malaria in DRC.
Climate change has impacted the burden of Malaria in Congo. Malaria and climate
change are considered to be related to one another as climate change causes an increase in
malaria transmission opportunities. According to Dasgupta (2018), climate change causes an
incline in temperature, humidity, and rainfall, which leads to the proliferation of mosquitoes
carrying malaria in regions with high altitude. As a result, it leads to an increase in malaria in
place not known to malaria infestation and more deaths in areas frequently affected by the
disease. Breman, Alilio, and Mills (2016) articulate that Congo's economic instability has led to
low income among its population and low government revenue, causing low malaria intervention
funding. It has an increased prevalence of diseases and related mortality rates. It is also indicated
ASSESSMENT TASK 2 13
that the spread of malaria has intensified suffering and reduced the quality of life by changing the
people's lifestyles in the country (Breman, Alilio & Mills, 2016).
The rural and forest areas of the Democratic Republic of Congo still suffer from specific
epidemiological problems as many endemic zones overlap with areas where mining, logging, and
settlement expansion are done unofficially. According to Bele et al. (2014), localized livelihood
pressures resulting from climate variability influence people's behavior with the environment and
raise their exposure to malaria vectors. Some families in the eastern part of Congo migrate
seasonally to exploit the farmland or mineral sites, and they usually sleep in temporary shelters
without mosquito protection. Gachelin et al. (2018) highlight that the lack of prevention during
the mobility period makes the vector control campaigns less effective. Caminade et al. (2014)
mention that habitat changes due to climate produce new mosquito breeding grounds in
abandoned extraction pits and water pools. These changes in the environment provide the source
of continuous transmission cycles that are scarcely reported because of limited surveillance
networks. As people move more due to economic shocks and ecological stressors, the
management of malaria will have to include the planning of public health together with land use
monitoring and local adaptation strategies.
Urban and peri-urban malaria transmission in the DRC has been highlighted as an issue
of concern, among other things, by local populations' rapid growth and their changing settlement
patterns. Bai et al. (2013) supports the argument that the extension of the city without proper
drainage and waste management will increase the chances of mosquito breeding in the areas
where there is a high concentration of people. In the cases of cities like Kinshasa and
Lubumbashi, the sewage channels that are open and water storage systems that are temporary
have become the perfect places for mosquito larvae to develop. According to the World Health
ASSESSMENT TASK 2 14
Organization (2015), a different set of epidemiological features characterizes urban malaria as
compared to rural transmission. Hence, appropriately designed interventions that factor in
aspects like crowding, transport links, and the nature of housing are a must. Lumbala et al.
(2015) states that rural to urban migration in the midst of a malaria outbreak in the countryside is
one of the main sources for the introduction of new parasite strains into the city centers which
makes control efforts and the accuracy of surveillance even more complicated. Gachelin et al.
(2018) also add that the past methods of getting rid of malaria were not considering the return of
the disease when the health infrastructure could not keep up with demographic growth, thus the
urban malaria resurgence could still happen. Sanitation will not be coordinated in a city without
the improvements that are targeted toward vector control; hence urban epidemiology in the
Congo will remain a main barrier to national reduction of goals.
The change in the behaviors of the vectors, which are linked to ecological
transformations, is another emerging dimension in malaria epidemiology. The scientists state in
their paper (Caminade et al., 2014) that changes in rainfall and temperature have an effect on the
spreading of Anopheles mosquitoes, to the extent that they are able to live in mountain areas and
places near the poles that were impossible for them before. A report from Bele et al. (2014)
declares that the revelation of changing vector ecology, which has become the main reason for
health problems in the local communities living in the high area around the Kivu highlands
region, is what the unexpected outbreak describes there. Bai et al. (2013) suggest that analogous
cases in Asia give a clear example of mosquito adaptation which is capable of breaking old map
assumptions of disease distribution. In Congo, these changes overload the capacity for diagnosis
as most of the local health workers are not prepared for malaria in the areas which had very low
risks in the past. The WHO report (2015) states that the updating of surveillance instruments, and
ASSESSMENT TASK 2 15
the creation of predictive models, are very important in following these kinds of epidemiological
changes. As the old risk maps gradually become less accurate, the national programs will have to
use climate data along with entomological research so that they will be in a position to make the
outbreak anticipate.
The human movement caused by the desire for better economic situation or due to
environmental and social reasons plays a major role in the patterns of malaria transmission in the
Democratic Republic of Congo. Lumbala et al. (2015) report that people who are forced to leave
their places because of fighting and lack of resources for living will take the infection along with
them to places that have underdeveloped medical infrastructures. Those who are constantly on
the move have limited access to mosquito nets, prevention medication, and they do not get
treatment regularly. Gachelin et al. (2018) state that a) the history of malaria control, b) human
movement monitoring, and c) parasite spread stopping are main elements in the malaria fight.
Also, Caminade et al. (2014) bring a point that if the climate condition is favorable for the vector
population in the receiving area, then the returning or new populations can be the trigger to the
transmission cycle continuation. Bele et al. (2014) add that natural disasters related to water,
trees, and land such as flooding, deforestation, and land pressure not only aggravate these
dangers but also endanger by pushing families into new areas that have different ecological
characteristics. Hence, dealing with mobile and displaced communities requires the installation
of the surveillance systems that combine health data with migration and climate monitoring to
achieve better epidemiological accuracy.
Constraints within the health system are the factors that determine the epidemiological
aspects of malaria in the DRC. This is especially true for the areas severely affected by climate-
related disruptions. The World Health Organization (2015) emphasizes that the foundations of
ASSESSMENT TASK 2 16
the malaria eradication plan are continuous diagnostic testing, the availability of treatment, and
dependable reporting mechanisms. Bele et al. (2014) reveal that the shortage of trained staff in
rural clinics in Bukavu is such that they are barely able to provide essential services during the
occurrence of extreme weather events, like heavy rains and floods. Gachelin et al. (2018)
demonstrate that capacity building and infrastructure investments, along with preventive
campaigns, were the main reasons for the better outcomes of past malaria control efforts. Bai et
al. (2013) are of the opinion that the shortage of resources in the DRC is similar to the situation
in other developing countries where the stress caused by the climate leads to an increase in the
number of diseases but the readiness of institutions to tackle them is reduced. Caminade et al.
(2014) emphasize the point that the absence of early detection tools for climate-driven mosquito
population surges results in interventions being delayed and consequently the rate of death being
higher. Strengthening the health system is therefore crucial in the fight against the changing
trends of malaria (Bai et al., 2013).
Malaria epidemiology is already complex due to socioeconomic inequities that, among
other things, extend the difference between the disadvantaged populations and the resources
available for adaptation as a result of climate changes. Bele et al. (2014) point out that low-
income households depend on such exposure-prone livelihoods as artisanal fishing and small-
scale farming close to the breeding sites. Lumbala et al. (2015) state that the degree of variation
in access to cheap treatment is so great that, in some regions, there are communities that are
entirely left out and hence exposed to the occurrence of fatal complications. Gachelin et al.
(2018) stress that the failure of some of the historical interventions may be attributed to the fact
that the overlooked structural inequalities that influence the risk of disease. Bai et al. (2013)
agree that through climate change, the disparities become deeper as water security, food
ASSESSMENT TASK 2 17
production, and sanitation all are affected. The World Health Organization (2015) points out that
strategies based on equity, such as subsidized treatment and the use of locally adapted prevention
instruments, form the necessary conditions for national malaria reduction. Public health efforts
without concerted addressing of the socioeconomic factors that strengthen transmission will
always experience epidemiological failures in the Congolese context.
Recommended Strategies top Tackle Malaria in DRC
There are numerous ways to address the effects of Malaria in Congo. The
recommendation on addressing malaria's effects includes reducing the burden caused by the
disease and issues relating to climate change that intensifies its prevalence. The people also play
a critical role in the mitigation and adaptation of strategies and interventions in addressing
malaria. Below are the recommendations on how to handle the rampant cases of Malaria in
Congo.
Mitigation
Universal Health Coverage
A significant policy implication on access to health services should be established in
Congo. It is indicated that 30% of the population in Congo have access to health care. It is
recommended in this paper than the country (Riveron et al., 2019). This policy should ensure that
health care is free for its population to ensure that every citizen has access to malaria treatment.
In doing so, it will eradicate its impact by a more significant percentage.
Expanding universal health coverage in the Democratic Republic of Congo requires not
only free access to treatment but also stronger health system infrastructure, especially in malaria-
endemic and climate-vulnerable regions. Bai et al. (2013) note that climate change intensifies
ASSESSMENT TASK 2 18
mosquito-borne disease risks when primary care services are poorly distributed or under-
resourced. In the Congolese context, universal coverage should involve decentralizing services
so that remote populations can receive timely diagnosis and treatment without traveling long
distances. Cotter et al. (2013) emphasize that malaria elimination efforts succeed when health
systems invest in rapid testing, community health workers, and medical supply chains. Negev et
al. (2015) further argue that preparedness policies must integrate climate adaptation planning to
anticipate increased transmission during rainy seasons or temperature fluctuations. One of the
methods through which Congo can build healthier and more climate resilient communities is
integrating malaria services in their climate-health policies. This will create a system that places
healthcare services within the reach of those populations who have been the least accounted for
and at the same time, it will prevent the number of deaths that are caused unnecessarily. Hence,
the issue of inequality in the distribution of healthcare resources should be addressed if universal
coverage is to become more than a mere policy declaration.
One essential point that has to be considered while discussing universal health coverage
as a tool to fight malaria is the question of financing mechanisms. Negev et al. (2015) point out
that the management of climate-sensitive diseases should be funded consistently, and the funding
should be able to reflect the changes in the seasons and the environment. Often the government
budgets in the DRC are so tight that collaborations with NGOs and international donors may be
necessary to support the malaria treatment that is subsidized and the insurance schemes. Cotter et
al. (2013) emphasize that the flexible financing could be combined with the community-based
interventions to improve the responsiveness during the outbreak surge. Moreover, Bai et al.
(2013) say that the use of various preventive methods, such as the distribution of treated nets,
houses being sprayed, and the general public being made aware, if integrated into funded health
ASSESSMENT TASK 2 19
cover, will certainly lessen the burden on hospitals in the long run. Strengthening the fiscal
planning not only ensures that the treatment is always available but also that it can reach those
areas which supply chains may have been affected by climate events or populations who have
been displaced. In the absence of dependable resource allocation, the fight against malaria in the
whole country will be at risk to universal health coverage, thus it will be more of an aspiration
than a radical change.
Funding for more hospitals
The Congolese government should also focus on creating policies geared towards
increasing funding to its health ministry. Riveron et al. (2019) indicate that the country
subdivides its 11 provinces into 26 new provinces in 2015, leading to a few hospitals in the new
provinces. Ye et al. (2017) recommend that policies for funding the bundling of hospitals will
increase access to health care.
Enlarging the hospital infrastructure in the Democratic Republic of Congo has to be
mindful of the rising number of climate-sensitive diseases that have the capacity to impact both
rural and urban populations. For instance, Munyuli et al. (2013) mention that the money-wise
expenses of diseases related to natural environmental changes, specifically waterborne
epidemics, are the cause of additional community burdens which are already confronted by
systemic poverty. In situations where health facilities are far or not even there, the citizens are
the ones who go to get treatment much later, and hence the number of morbidities and mortalities
increases. Rural populations, according to Bele et al. (2014), are the most at risk because the
destruction of nature and the instability of the climate not only make their lives difficult but also
hinder their access to services that have become indispensable. Nkanga et al. (2017) also state
that pollution and climate factors are adding to the health risks that are already chronic, so
ASSESSMENT TASK 2 20
hospitals not only have to be ready for infectious diseases like malaria but also for the new
diseases that have been aggravated by environmental exposure. Appropriated financing through
strategic means targeted at building hospitals that are well spread out will lessen the load on
those already overcrowded centers in the urban areas, improve the process of early diagnosis as
well as the reduction of the impact of climate-driven health crises. Besides that, such ventures
would enhance the national resilience and decrease the dependency on emergency foreign aid
during the times of peak transmission.
It is not only about construction, though. Their sustained operational funding is very
important. So, new hospitals must be adequately staffed, supplied, and connected to broader
disease surveillance efforts. Bele et al. (2014) point out that adaptation measures in Congo
communities need institutional support for a long time rather than aid for just a short time. In the
absence of trained personnel and essential drugs, these new facilities will, at best, be inactive or
underutilized. Nkanga et al. (2017) assert that changing climatic conditions are contributing to
the rise in the number of infectious and non-infectious diseases, thus, clinics that lack diagnostic
technology are further strained. Munyuli et al. (2013) bring in the point that health costs for poor
families increase significantly when treatment delays exacerbate disease progression, particularly
during floods or droughts. The funding policies should, therefore, go beyond the proportions of
the budget for equipment procurement, workforce training, health supplies, and emergency
preparedness. In this way, supporting hospital systems would be the guarantee that climate-
related epidemics do not overcharge the frontline health services. The strategic investment in the
operation of hospitals is as important as their physical expansion in lowering the health
vulnerability overall.
Domestic and trade policies
ASSESSMENT TASK 2 21
The emission of greenhouse gases in Congo coupled with deforestation for charcoal
burning, timber harvesting, and farming is a significant cause of climate change. Ye et al. (2017)
indicate that introducing domestic and trade policies potentially reduces CO2 emissions. Ye et al.
(2017) has also introduced a tax on charcoal trade, timber harvesting, and marketing on
businesses that cause climate change reduces the impacts of climate change. Doing this will
allow it to mitigate the effects of climate change, causing the malaria burden.
For the Democratic Republic of Congo to reinforce domestic and trade policies it is
necessary that malaria prevention objectives be incorporated directly into environmental
governance frameworks. The World Health Organization (2015) stresses that to bring down the
transmission of malaria, the action has to be more comprehensive and goes beyond the health
sector, specifically in those nations where the two factors, environmental degradation, and
economic problems come together. Bai et al. (2013) claim that the unregulated agricultural
expansion and the cutting down of trees for charcoal, are the two major causes that the breeding
of mosquitoes be accelerated because through these two activities the stagnant water pools are
created and the ecosystems are changed. The trade rules that reward sustainable land
management could not only reduce deforestation but also help stabilize rainfall patterns which is
critical for disease control. Negev et al. (2015) state that other areas with climate-sensitive
disease burdens have implemented cross-sector regulations that include setting limits on
emissions, the preservation of biodiversity, and lowering exposure to risks. Through the
implementation of environmental regulations that are consistent with malaria reduction targets,
the Congolese government can be certain that the climate and health objectives are
complementing each other and not operating separately. The implementation of these measures
ASSESSMENT TASK 2 22
would also stop illegal logging as well as the clearance of land that is not managed which would
both negatively affect climate outcomes and the health of the people living in the area.
There is also another policy path that deals with the redesign of trade incentives with the
aim of encouraging the use of renewable energy sources and environmentally friendly practices
in the countryside. Gachelin et al. (2018) demonstrate that, in the past, malaria interventions
became more effective when they were supported by social and economic reforms that lowered
the population's exposure to mosquito-prone areas. Bai et al. (2013) note that the use of charcoal
and wood as the main energy sources leads to the destruction of natural habitats and contributes
to the emission of greenhouse gases. The subsidies or tax cuts for clean energy technologies can
be a step towards the saving of forests at the same time that climate changes which drive the
occurrence of malaria are being limited. Negev et al. (2015) point out that climate adaptation
strategies in other areas have connected trade actions with community-based development
projects, thereby deepening local resilience. The World Health Organization (2015) suggests
multi-sector coordination as a means of lowering transmission risks that are linked to
environmental instability. When trade policies are in favor of sustainable production and there
are restrictions on destructive land practices, malaria reduction is more feasible and financially
acceptable.
According to the World Health Organization (2015), the reduction of the malaria burden
depends on long-term planning as well as governance structures that are capable of coordinating
various stakeholders. Bai et al. (2013) propose that public health aspects should be intrinsically
integrated into environmental licensing and trade agreements so as to eliminate the unchecked
exploitation of ecosystems. Negev et al. (2015) point out that climate resilience can be
incorporated in trade policy in order to lessen the exposure of people living in deforested areas or
ASSESSMENT TASK 2 23
those dwelling by polluted water bodies. Gachelin et al. (2018) also state that local participation
gives more weight to the policy and is a way of ensuring that the strategies reflect the needs and
practices of the community. The creation of incentives for such activities as reforestation,
controlled logging and businesses with low emissions would not only lessen environmental
degradation but also promote the livelihoods of people. World Health Organization (2015) state
that by associating ecology with the advantages of trade, domestic policies have the potential of
not only reducing the risks of malaria caused by climatic changes but also of making sustainable
development possible in different areas, which in turn, can have a positive effect on the entire
regions.
Adaptation
Intensive Malaria Campaigns
Human behavior is critical in determining the impacts of interventions to address the
effects of diseases such as malaria. According to Sallis, Owen, and Fisher, E. (2015),
multivariate level factors must be considered when influencing health-related behaviors,
including interpersonal, community, public, and intrapersonal levels. Therefore, the Congolese
government should ensure that, unlike in the past malaria campaigns, the new one effectively
addresses malaria's impact. It can be achieved by creating awareness on prevention at
interpersonal, community, public, and intrapersonal levels to increase its impact.
One of the main requirements for a successful anti-malaria campaign in D.R. Congo
would be environmentally friendly behavioral strategies that are synchronized with the climate
changes. Bai et al. (2013) remind us that the altered rainfall, as well as the changing temperature
patterns, have an impact on the breeding habitats of mosquitoes which makes it difficult to
ASSESSMENT TASK 2 24
prevent the disease without education at a localized level. Many traditional campaigns tend to
focus on the distribution of bed nets and that alone without giving attention to the community
practices that may lead to accumulation of stagnant water or even deforestation. Negev et al.
(2015) argue that in areas where climate change-sensitive diseases such as vector diseases
prevail, behavioral interventions must include weather monitoring and adaptive messaging that
are seasonally relevant. Gachelin et al. (2018) also add that among the historical accounts of
malaria control, there is a very important lesson on how prevention programs need to be in line
with environmental changes, especially in the case of rural and peri-urban settlements. These
campaigns can go far from just delivering the same old messages and can actually motivate them
to take preventive measures by equipping the local leaders, teachers, and health volunteers with
the necessary skills to identify environmental triggers as well as the times of the year when the
situation is likely to worsen. Emergency response dependency is cut down by these adaptive
measures, and hence, the vulnerable households are assisted to develop their long-term
resilience.
Furthermore, campaigns must consider the influence of social structures on the
communication of risk and the interaction between communities, which differ in their literacy
level and cultural norms. As per Negev et al. (2015), adaptation policies in other climate-affected
areas have taken advantage of multilingual outreach and the use of culturally sensitive messaging
strategies. Gachelin et al. (2018) note that the engagement of the community was vital to the
achievement of the past malaria eradication, particularly when the local customs had an impact
on the daily habits and the exposure of the disease. Bai et al. (2013) also demonstrate that health
messaging becomes more efficient when it is directly linked to behavioral guidance, for example,
water storage, sanitation, and mosquito habitat reduction. Partnering with religious institutions,
ASSESSMENT TASK 2 25
women's associations, and youth groups might, for instance, bring about more trust in prevention
activities, as well as greater participation, in Congo. Campaigns that use storytelling, visual
demonstrations, or local monitoring are able to access the populations that are unreachable by the
previous top-down approaches. This multi-layered engagement approach allows interventions to
be felt by different audiences and thus, have a long-term effect.
Targeted Climate Change and Malaria Education
The government should understand that environmental contexts play a crucial role in
influencing the effectiveness of climate change and malaria eradication strategies. Sallis, Owen,
and Fisher, E. (2015) indicate that behavior can be predicted better depending on the situations
people are undergoing and individual characteristics. Therefore, in implementing malaria and
climate change education, the Congolese government should target specific regions in the
country and particularly groups of people such as mothers. It will increase the interventions'
effectiveness. Social and physical stations should be assessed to influence their behavior in
restricting and promoting actions and behaviors relating to climate change's malaria burdens.
Creating focused educational initiatives in the Democratic Republic of Congo also means
understanding that each region has to deal with different climate and disease stressors. The
adaptation capacities are different even in neighboring areas. So the climate effects in a
community like Bukavu will be very different from those in a similar highland area. Bele et al.
(2014) state that climate impact in the highland areas varies due to local adaptation capacities.
Environmental degradation caused by deforestation, population displacement, and poor
infrastructure, will lead to the increase of mosquito habitats and the weakening of the public
awareness efforts. Caminade et al. (2014) explain that climate variability has allowed the malaria
vectors to move into areas that were previously considered low risk, therefore there are
ASSESSMENT TASK 2 26
knowledge gaps in the populations that are unfamiliar with the preventive practices. Lumbala et
al. (2015) point out that the same trends have been observed in the case of other vector-borne
diseases, indicating how the local vulnerability of the region determines the health outcomes.
Education programs should thus be tailored to factors such as altitude, land use patterns, local
livelihoods, and migration trends. Instructors and health personnel, once they have been trained
on how to adjust their material to each ecological zone, would find the interventions being more
relatable and hence, successful in both rural and semi-urban districts.
The other aspect worth mentioning is the customization of communication methods based
on the social roles of the people, especially the caregivers who take care of the children and the
elderly (World Health Organization, 2015). According to Caminade et al. (2014), the changes in
malaria transmission with respect to climate factors have a greater impact on those who are less
mobile and have limited access to health services. Bele et al. (2014) emphasize that in the
majority of Congolese families, women are the main managers of water, sanitation, and childcare
and thus prevention activities revolve around them. Lumbala et al. (2015) also argue that the
performance of caregiving during the outbreak of vector-borne diseases, frontline, decides
whether the symptoms will be early recognized or ignored. Misconceptions about symptoms,
prevention, and climate-related triggers could be addressed through the educational programs
designed for mothers, teachers, and community health volunteers. These programs, inter alia,
must reflect local languages, use real-life scenarios, and be delivered through radio or mobile
platforms to widen the audience. Education can lead to more profound and lasting changes in
behavior by partnering with those who hold sway in the everyday lives of households.
ASSESSMENT TASK 2 27
References
Bai, L., Morton, L. C., & Liu, Q. (2013). Climate change and mosquito-borne diseases in China:
a review. Globalization and health, 9(1), 10.
Barry, R. G. (2018). Atmosphere, weather, and climate/Roger G. Barry and Richard J. Chorley.
Bele, M. Y., Sonwa, D. J., & Tiani, A. M. (2014). Local communities vulnerability to climate
change and adaptation strategies in Bukavu in DR Congo. The Journal of Environment &
Development, 23(3), 331-357.
Bouzid, M., Hooper, L., & Hunter, P. R. (2013). The effectiveness of public health interventions
to reduce the health impact of climate change: a systematic review of systematic reviews.
PloS one, 8(4), e62041.
Breman, J. G., Alilio, M. S., & Mills, A. (2016). Conquering the intolerable burden of malaria:
what’s new, what’s needed: a summary. The American journal of tropical medicine and
hygiene, 71(2_suppl), 1-15.
Caminade, C., Kovats, S., Rocklov, J., Tompkins, A. M., Morse, A. P., Colón-González, F. J., ...
& Lloyd, S. J. (2014). Impact of climate change on global malaria
distribution. Proceedings of the National Academy of Sciences, 111(9), 3286-3291.
Campbell-Lendrum, D., Manga, L., Bagayoko, M., & Sommerfeld, J. (2015). Climate change
and vector-borne diseases: what are the implications for public health research and
policy?. Philosophical Transactions of the Royal Society B: Biological Sciences,
370(1665), 20130552.
ASSESSMENT TASK 2 28
Cotter, C., Sturrock, H. J., Hsiang, M. S., Liu, J., Phillips, A. A., Hwang, J., ... & Feachem, R. G.
(2013). The changing epidemiology of malaria elimination: new strategies for new
challenges. The Lancet, 382(9895), 900-911.
Dasgupta, S. (2018). Burden of climate change on malaria mortality. International journal of
hygiene and environmental health, 221(5), 782-791.
Gachelin, G., Garner, P., Ferroni, E., Verhave, J. P., & Opinel, A. (2018). Evidence and
strategies for malaria prevention and control: a historical analysis. Malaria
journal, 17(1), 96.
Hassan, O. M., & Tularam, G. A. (2018). The Effects of Climate Change on Rural-Urban
Migration in Sub-Saharan Africa (SSA)—The Cases of Democratic Republic of Congo,
Kenya and Niger. Applications in Water Systems Management and Modeling, 2.
Kunuanunua, T. S., Nsibu, C. N., Bodi, J. M., Tshibola, T. K., Makusi Bura, M., Magoga, K., ...
& Aloni, M. N. (2019). Severe malaria in children: A descriptive report from Kinshasa,
the Democratic Republic of Congo. Journal of tropical pediatrics, 61(4), 272-278.
Lumbala, C., Simarro, P. P., Cecchi, G., Paone, M., Franco, J. R., Kande Betu Ku Mesu, V., ... &
Jannin, J. G. (2015). Human African trypanosomiasis in the Democratic Republic of the
Congo: disease distribution and risk. International journal of health geographics, 14(1),
20.
Munyuli, M. T., Kavuvu, J. M., Mulinganya, G., & Bwinja, G. M. (2013). The potential financial
costs of climate change on health of urban and rural citizens: a case study of Vibrio
cholerae infections at Bukavu Town, South Kivu Province, eastern of Democratic
Republic of Congo. Iranian Journal of Public Health, 42(7), 707.
ASSESSMENT TASK 2 29
Negev, M., Paz, S., Clermont, A., Pri-Or, N. G., Shalom, U., Yeger, T., & Green, M. S. (2015).
Impacts of climate change on vector borne diseases in the Mediterranean Basin—
implications for preparedness and adaptation policy. International journal of
environmental research and public health, 12(6), 6745-6770.
Nkanga, M. S. N., Longo-Mbenza, B., Adeniyi, O. V., Ngwidiwo, J. B., Katawandja, A. L.,
Kazadi, P. R. B., & Nzonzila, A. N. (2017). Ageing, exposure to pollution, and
interactions between climate change and local seasons as oxidant conditions predicting
incident hematologic malignancy at KINSHASA University clinics, Democratic Republic
of CONGO (DRC). BMC cancer, 17(1), 559.
Riveron, J. M., Watsenga, F., Irving, H., Irish, S. R., & Wondji, C. S. (2019). High Plasmodium
infection rate and reduced bed net efficacy in multiple insecticide-resistant malaria
vectors in Kinshasa, Democratic Republic of Congo. The Journal of infectious diseases,
217(2), 320-328.
Sallis, J. F., Owen, N., & Fisher, E. (2015). Health behavior: Theory, research, and practice.
Elektronis, 43, 65.
Shavkatovna, A. M., Shuhratovna, A. M., Abdunosirovich, R. R., & Shukhratovich, S. S. (2020).
Climate Change And Human Health. The American Journal of Medical Sciences and
Pharmaceutical Research, 2(10), 67-70.
von Uexkull, N., d’Errico, M., & Jackson, J. (2020). Drought, Resilience, and Support for
Violence: Household Survey Evidence from DR Congo. Journal of Conflict Resolution,
0022002720923400.
World Health Organization. (2015). Global technical strategy for malaria 2016-2030. World
Health Organization.
ASSESSMENT TASK 2 30
Ye, Y., Eisele, T. P., Eckert, E., Korenromp, E., Shah, J. A., Hershey, C. L., ... & Komatsu, R.
(2017). Framework for evaluating the health impact of the scale-up of malaria control
interventions on all-cause child mortality in sub-Saharan Africa. The American Journal of
Tropical Medicine and Hygiene, 97(3_Suppl), 9-19.
