Table 1.

Prioritized climate solutions.

SOLUTION	CATEGORY	DESCRIPTION
1	Infrastructure, technology, and products	Additional multi-functional structure to increase the reception capacity of peaks
2	Infrastructure, technology, and products	Renovate/repaint internal hospital surfaces to improve infection control
3	Infrastructure, technology, and products	Reduce overall indoor temperatures with reflective paint on roofs
4	Infrastructure, technology, and products	Improve ventilation through ventilation chimneys and slatted windows/shutters
5	Infrastructure, technology, and products	Improve O2 management to ensure resilience in the case of peaks (efficient concentrators/bridging system)
6	Energy	Improve energy infrastructure to ensure resilience and stabilize the ICU/ pharmacy temperature; solar system expansion; upgrade battery housing with suitable bridging system; motion sensors to reduce lighting usage
7	Energy	Develop and implement an energy management protocol to reduce consumption
8	Wash and waste	Strengthen medical waste infrastructure through a communal waste zone
9	Wash and waste	Assess the possibilities for recycling waste (e.g., plastics) in Ndjamena
10	Workforce	Implement a hospital Hygiene Committee (entire hospital)
11	Workforce	Staff training in self-care and sustainable healthcare, energy management, waste management, effects of heat on patients, modification of ID distribution, etc.
12	Workforce	Promote or develop a disaster management committee at the local/hospital level
13	Health services	Reinforce community sensitization activities around malaria, heat, non-communicable diseases, diarrhea, etc.
14	Health services	Strengthen the blood bank, including raising awareness for donor recruitment and providing testing reagents
15	Health services	Extend the current (free) ambulance service (including boat transfer) for children under 5, to include older children and pregnant women
16	Health services	A package of preventative nutritional interventions (including nutri-vacc) 3 m before the peak of malaria
17	Health services	Review and realign vaccination, malaria, and malnutrition prevention activities to reduce missed opportunities
18	Health services	Distribution of mosquito nets and indoor residual insecticide spraying.
19	Governance and financing	Implement a seasonal risk calendar to help hospital leadership anticipate needs and plan buffer stocks accordingly.
20	Governance and financing	Review and strengthen facility emergency plans (EPREP) to cover all risks, including climate and pandemic risks.
21	Governance and financing	Rigorously monitor and evaluate implementation to adjust activities and demonstrate “best buys”
22	Governance and financing	Integrate this project into national (or organizational) action plans and roadmaps to ensure sustainable funding and increase scalability.