Walk up to a health facility in Tshwane, South Africa on a hot summer morning, and you are likely to find long, snaky queues of people, including pregnant women, waiting outside—in the full sun.
“It’s scorching, but they don’t have shady places,” said Pamela Tshandu, a Stakeholder Engagement Officer at Wits RHI, University of Witwatersrand, who regularly visits the Tshwane region’s facilities as part of her work for HIGH Horizons. “Even the staff, when they take a break, they don’t have shady places where they can go and sit.”
As research increasingly reveals how hotter temperatures lead to complications for pregnant and postpartum mothers and their newborns, including premature births, miscarriages, and dangerous maternal conditions such as pre-eclampsia, the task to keep people visiting clinics for services cool has never been more pressing.
One potential solution, backed up by HIGH Horizons research on adapting health facilities for heat from Technical University of Denmark and Wits RHI: planting more trees that provide shade.
That’s exactly what’s happening at two clinics, a hospital, and the surrounding community in Tshwane, thanks to collaborations between HIGH Horizons researchers at Wits RHI, members of the local Tswhane community, health facility managers, and the South African Department of Forestry, Fisheries, and Environment.
Together, they have planted fifty indigenous trees so far, generously donated from the government, that will eventually provide cooling shade for maternity care service users and health workers on maternity wards. The clinics include Stanza Bopape Community Health Centre and Laudium Community Health Centre. In February, fifty more donated trees will be planted at Mamelodi Regional Hospital around a car park that currently bakes in the hot sun, as well as at the Entokozweni Community Centre.
“It’s a great win,” said Celeste Madondo, Senior Program Manager at Wits RHI.
It started in July, when Wits RHI researchers held a workshop with members of the local community, including participants in a study looking into how to adapt facilities to heat, to decide what could be done to reduce heat in their community health facilities.
At the workshop, the group reviewed data prepared by HIGH Horizon researchers that showed simulations of the cooling effects of different possible interventions at health facilities. The participants, alongside health worker staff, decided on a variety of ways the health facilities could reduce indoor temperatures and help people receiving care at the facilities, as well as health workers, stay cool in the future. They decided to provide cooling vests for staff, install air conditioners and water coolers, paint the facility roofs white to reflect the sun, insulate the roofs, and plant trees.
Jørn Toftum, Professor in the Department of Environmental and Resource Engineering at the Technical University of Denmark, led the HIGH Horizons study that guided their decision making, which includes a simulation of what happens to the temperature in a clinic if the staff take these different actions.
After the workshop, the next task was to find some trees to plant, so Thembi Mahlango, a Wits RHI Community health worker, and Tshandu wrote a request for a donation to the Department of Forestry, Fisheries, and Environment. The government, in response, agreed to initially provide fifty trees, and has since provided fifty more.
In September, staff at the clinics planted the trees.
To Madondo, Mahlango, and Tshandu, the project has been a resounding success: “There are challenges often in implementing studies like the HIGH Horizons adaptation mitigation study, but in this case, you’ve had a really successful example of stakeholders coming in and saying, yeah, great, we’re actually going to run with this,” said Madondo.
Prof Toftum is happy to see the interventions in the study leading to real world change in South Africa. He said: “Trees are excellent for reducing heat exposure on buildings. Trees provide shading, which may reduce solar loads on buildings and cause lower indoor temperatures. Outdoors, greenery in cities also reduce temperatures by providing shaded areas and they help to avoid heat island effects.”
HIGH Horizons would like to thank Pandelani Dzhugudza, Mpho Patience Thenga, Boitumelo Modikoe, and Kukeka Noksi from the South African Department of Forestry, Fisheries, and Environment for their role in donating the trees.
Another big thanks to the staff of Stanza CHC and Laudium CHC, as well as Shobna Sawry of the Wits RHI Climate and Health Programmes Team for supporting the tree planting.