The country of Togo this month approved its first National Strategy for Social and Behavior Change to address the health effects of climate change, developed by the Ministry of Health with technical support from the Johns Hopkins Center for Communication Programs (CCP) and GIZ.
The five-year strategy provides a national roadmap for helping communities reduce health risks linked to climate change by promoting six priority behaviors with updated guidance for today’s environmental and public health realities.
These include sleeping under insecticide-treated mosquito nets every night, even during extreme heat; consistent use of safe water, even during floods and droughts, attending prenatal care despite climate disruptions, and seeking timely care for malnourished children during heat waves. It also aligns government agencies, civil society organizations, donors and the media around shared communication priorities and evidence-based approaches to behavior change.
The strategy was informed by behavioral research, theoretical underpinnings, community engagement and human-centered design, and was developed through a 14-month process involving government agencies, technical partners and communities.
“Climate change is here, and it is worsening issues that we’ve always had, and is changing the way we need to look at how to address health issues,” said CCP’s Shannon McAfee, who led the work in Togo. “We can’t continue doing the same kind of public health work that we have been doing. It has to adapt to the evolving landscape.”
In Togo, that meant looking at familiar health behaviors through a climate lens, asking what was getting in the way of those behaviors and what kinds of support could make them possible.
Take mosquito nets.
Women and children need to sleep consistently under insecticide-treated nets, but climate change can make that more difficult. During periods of extreme heat, families may choose to sleep outside, where hanging a mosquito net requires a different setup. And while women and children may be the ones who need to sleep under the nets, they are not necessarily the people who can make that new arrangement work.
The team suggested men in each household should be key actors because they could provide the support and practical skills needed to hang nets outdoors. The strategy calls for building confidence and skills around how to protect their families by setting up mosquito nets outside and creating a social norm around continuing to use them even when families are sleeping outdoors. The program is also designed for fathers to share their own ideas of how to set up mosquito nets with their peers.
Handwashing was another familiar behavior that looked different through a climate lens.
During droughts, water can be scarce. So the team looked at how to overcome that barrier. One idea was to reuse water after handwashing for household tasks, such as washing a floor or courtyard.
The same approach produced a different kind of solution for prenatal care.
Pregnant women in Togo are encouraged to attend at least four prenatal care visits. But extreme heat can make the trip to a health facility difficult, particularly when they must walk along roads without shade to get there.
The strategy was not simply about encouraging pregnant women to get prenatal care. It was about identifying how a changing climate makes that behavior harder and who else could help make it possible.
The team explored ways fathers could help. A father could accompany his partner, carry a bottle of water or other supplies, make sure she has opportunities to rest in the shade, or help find shade along the way.
The strategy also envisions a WhatsApp network where fathers can share ideas and receive guidance from midwives. A “Papa Modèle” T-shirt would give fathers a visible way to identify with the role and create a sense of pride around supporting their partners during pregnancy.
“Climate change is changing the circumstances in which people make decisions about their health, including behaviors that public health has promoted for years,” says Debora B. Freitas López, CCP’s executive director. “We have to understand how these circumstances are affecting the barriers people face and adapt accordingly. Our work in Togo is helping us generate evidence that can inform efforts elsewhere.”
Says McAfee: “The world is evolving and we need to be able to evolve with it.”
