What does building a climate-resilient health system mean? Foundation S’s longtime partner Friendship has been writing history on the topic since 2002.

According to the WHO, “the climate crisis threatens to undo the last fifty years of progress in development, global health, and poverty reduction, and to further widen existing health inequalities between and within populations.” In order to counter this effect, multiple actors, including Foundation S - The Sanofi Collective are taking action and have identified effective solutions.

“This requires sustainability and better capacities for health systems through the contribution of local communities in order to be in prevention mode whenever possible”, says Foundation S Director Vanina Laurent-Ledru.

That is why the Foundation has been partnering with Friendship, an NGO created in 2002 by French-Bangladeshi social entrepreneur Runa Khan, and Friendship France, created in June 2015 by Khan along with William Lebedel, its president, and Marc Elvinger (current president of Friendship Luxembourg). Friendship’s mission is to develop scalable solutions to strengthen marginalised communities and empower people to transform their lives and reach their full potential through access to health, education, energy and other vital services. Friendship works in the most remote areas of Bangladesh as well as in the Rohingya camps on the border with Myanmar.

A unique approach rooted in lived experience in Bangladesh

Since the floods of June 2022, which affected an estimated 7.2 million people and submerged over 53,000 hectares of agricultural land, the world is acutely aware of the way Bangladesh has been dramatically hit by climate change. Caught between the melting snows of the Himalayas in the North and the rising waters of the Bay of Bengal in the South, the country suffers increasingly devastating effects of climate change, which are causing widespread damage to infrastructure, water and sanitation facilities, agriculture. According to the World Bank, by 2050, an estimated 13 million Bangladeshis could need to flee their lands. In this context, the health risks of climate change are very clear and immediate; that’s where Friendship comes in.

"When a community is in pain and suffering, you cannot work towards emancipation. First you must alleviate the pain. If you have a splitting headache, you cannot think, let alone make any progress. That is why healthcare was the first thing we started. After you tend to the hurt or the wounded, then you can start to build resilience and empower the community" says Runa Khan.

In order to provide the right services in these dire circumstances, Friendship first came up with an adaptive solution when fixed health infrastructures seemed ill-fitted: a floating hospital built in a transformed French oil tanker that could treat populations in isolated islands. The first of these boats, the Lifebuoy Friendship Hospital, set sail for Gaibandha, in the north of the country. Today, two floating hospitals treat thousands of patients every year, and five more are preparing to begin operations.

“I just realized that if we were not ensuring that the way we were working took into consideration the climate and geography of that region. It couldn't work. You have to always be aware that you can't work against the way that nature works. You need to work with this approach. Otherwise, you don't get impact.”

An emphasis on community

But at the heart of Friendship’s approach is also how it centers communities and their needs. “When these communities are impacted by climate, we need to start with exactly what they need at the right time, in the right amount and in the right way. It depends on identifying the needs very deeply. We have to listen to what the people say and you have to listen to what the people don't say”, Khan explains.

“We needed to ensure that we made a package deal of care so that no one could be left behind”, she goes on. “We had to build people from the community as community health workers.” It is a way to adapt to the community’s social and environmental circumstances and provide more access to basic immediate care in urgent situations.

However, this package approach encompasses much more than just health services. “Sustainable adaptation to climate change will require coming up with a more comprehensive package of services, which will include education, empowering women and other vulnerable populations,” adds Daouda Diouf, Head of Climate action and health resilience at Foundation S.

“You cannot develop community resilience on climate and forget nutrition, agriculture or education. One common mistake seen nowadays is to come up with fragmented approaches. But the reality is that communities are not fragmented. They're one, and facing multiple challenges. So any approach to support them towards building sustainable, local resilience should also integrate a broader approach of development itself.”

An open partnership for collective impact

Friendship and Foundation S have a longstanding partnership. In March, Daouda Diouf participated in a field visit alongside other funders of the NGO to see firsthand Friendship work its positive effects and challenges. “We always try to make people come and see because it is really as you walk through the fields, as you walk through the hospital, that you can understand what it means to work in these remote areas”, says Khan.

“I wanted to be in the field with them to see what building and supporting community resilience to climate crisis so planetary crisis threatening the health and life of people looks like concretely: how it manifests and what is takes also to work alongside the community to build their capacity to prevent, to protect and to adapt to the effects of climate change”, Diouf adds.

“I had a chance to have several conversations with people directly. One of the women I was talking to about climate change said, ‘You know, we don't ask ourselves whether the climate crisis exists. That's part of our daily life. However, we ask ourselves, what is going to happen? How severely will we be hit and what will be the damage? We have got to prepare ourselves.’”

Diouf thus got the chance to observe closely the depth of the adaptation and local solutions at hand. “The way they build houses, dismantable school, satellite clinics. Even the latrines have evolved in such a way that they’re not affected in case of a flood. 

Community healthcare infrastructures (satellite clinics and boat hospitals) supported by a vast network of well-trained health workers selected from communities deliver immediate and accessible services to improve health conditions.

We spoke with farmers who explained that the seasonality of the farming has changed in recent years.”

The visit confirmed the essential nature of the work and how advanced its implementation already is in this area. Foundation S’s contribution for the next few years can then support its scaling up and the dissemination of that expertise on adaptive and resilient health systems for the benefit of other zones that feel the strong effects of climate change. “This is important knowledge and internal understanding of how climate change can impact people's life and health in particular. Existing Community to community exchange has been reinforced to facilitate sharing of good practices in mapping risk and level of vulnerabilities, information, and early action when the unplanned events occur. Key lessons I have learnt here is how important it is to invest more on community health workers and support local response”, Diouf explains.

“They're the first line responders. Having community engagement at the center of the solution reorganizes the system. What I've seen in Bangladesh is not that a fixed health system for all but it is an organized ecosystem for health adapted to the seasonality and the different way climate hits and the way communities themselves are the first line of the response”

Foundation S has thus committed to supporting a 3-year project with Friendship around climate-adapted health systems in the Gaibandha region in Bangladesh, ushering in a new era of deep collaboration in their partnership.

“I think this is going to be the next generation of how partnerships work”, says Daouda Diouf. “This ‘donor-recipient’ dynamic has to go in favor of a relationship where we learn from them, you know, they have certain knowledge, can better our work and create synergies.”