Living Health Systems

What if every financial decision made the world a healthier place?

Does the Adaptation Fund fund Health?

This post was revised and edited on 1st July 2025.

The Adaptation Fund is an important source of grant money for developing countries. This post investigates if and how health systems could access their finance.

Like the GCF, the Adaptation Fund is a climate fund. Its aims are to “finance concrete adaptation projects and programmes in developing country Parties to the Kyoto Protocol that are particularly vulnerable to the adverse effects of climate change” [1].

The meaning of the word “concrete” will be explored later in this post.

Countries that have both ratified the Kyoto Protocol and are “particularly vulnerable” to climate change are eligible to apply for funds.

The Adaptation Fund only makes grants. It does not offer any other money type. Grants are given at 100% of cost and no co-financing is needed. Across the Adaptation Fund, access by Multilateral Implementing Entities (MIE) is capped at 50%. The Adaptation Fund claims that there are no prescribed sectors rather it takes a country-driven approach to accommodate different country priorities and adaptation reasoning.

Various grants are available across three areas:

  • Action;
  • Learning & Sharing;
  • Innovation.

The Adaptation Fund is supported by contributions from donor governments as well as a 2% levy on the sale of emission credits from the Clean Development Mechanism (CDM) created in the Kyoto Protocol. Following agreement at COP26 in Glasgow, the Adaptation Fund will receive 5% of sales of emissions credits under a future CDM-replacement scheme [2].

Before digging further into the Adaptation Fund, let’s first take a look at successfully funded projects for climate adaptation in health systems.

Adaptation Fund+Health

By August 2024, 229 projects were listed on the Adaptation Fund website as having successfully obtained funding [3]. Total funding approved was US$1,221,169,897 (not necessarily disbursed).

Out of these,

  • 99 were implemented by a Multilateral Implementing Entity (MIE) such as the UNDP, UNESCO, UN Habitat, UNEP and so on;
  • 109 implemented by a National Implementing Entity (NIE) such as a government department;
  • 21 implemented by a Regional Implementing Entity (RIE) such as a bank.

From the total number of projects, 64 were in the Asia-Pacific region (as defined by the Adaptation Fund). About half of these were implemented by an MIE (35) and 24 projects implemented by an NIE, and finally 4 by an RIE in the Asia-Pacific region.

A search of all projects listed on the Adaptation Fund website by keyword ‘health’ returned only one: “An Integrated Approach to Physical Adaptation and Community Resilience in Antigua and Barbuda’s Northwest McKinnon Watershed”. The project is not health system specific, rather by implementing changes to natural and constructed drainage and buildings to withstand tropical storm and tornado waters, it aims to increase resilience and reduce disease vectors. In other words, population health is included as a downstream effect of project activity [4].

There were no health system projects currently under consideration by the Adaptation Fund by August 2024.

Across the Adaptation Fund, the five largest sectors that account for almost two-thirds of all grants were agriculture (15%), food security (14%), disaster risk reduction and early warning systems (12%), rural development (11%) and water and sanitation (11%). While these projects can yield important health co-benefits, to date there have been no explicit focus on health systems nor direct health system grants approved [6].

The WHO became the first health-focused implementing entity after official Board approval on 24th November 2023. Following WHO accreditation, the Adaptation Fund said it was “eager to support … climate adaptation in the health sector and scale up its actions to address elevated health risks associated with urgent global adaptation needs” [7].

Grants Available

The grants available from the Adaptation Fund focus on different types of access across three areas: action, learning, innovation.

The table above [8] was accurate in August 2024.

What do all these grants mean?

Let’s work through them one by one:

Area: ACTION

Single Country Grant is the total amount of grant that one country that can obtain. The amount is capped at US$10 million but eligible countries could access up to US$20 million. However, the US$20million can only be accessed in stages: the first grant should have been at least US$8 million for an earlier concrete single country project/programme, and four years have passed since the Board approved that country’s first project.

For example, by August 2024, according to the Adaptation Fund website:

  • Lao PDR has had 3 Single Country Grants approved (valued at US$12.6million) and all implemented by an MIE – UN Habitat;
  • Indonesia has had 5 Single Country Grants approved (about US$7.6million) all implemented by an NIE – the Partnership for Governance Reform;
  • Cambodia has obtained 3 Single Country Grants (totaling US$19.4million) and all implemented by an MIE – UN Habitat 2 projects, UNEP 1 project.

Single Country Grant – Project Formulation (NIE) can be sought after a project concept has been approved. This grant was for NIEs only. By August 2024, there were limits on the grant size (see below). A full proposal should get to the Board within 12 months of the NIE having received the Project Formulation Grant. If the final project proposal was rejected by the Board, any unused funds should be returned. The maximum funds for a Project Formulation Grants (including management fee) to help submit a Single Country Grant project documents were:

  • For Single Country projects seeking below US$2,000,000 – the limit for project formulation was set at US$50,000 including management fee;
  • For projects seeking between US$2,000,000 – US$5,000,000, the limit was US$100,000;
  • For projects US$ 5,000,000+, the limit was US$150,000.

Eligible expenditure includes [9]:

  • Local consultations, and/or workshops and/or contracts to discuss specific project/programme ideas (including translation into local languages, preparation of background papers, etc.,) or develop project/programme options;
  • Travel costs for experts, if required for consultations and discussions with interested parties and stakeholders, and local participation as needed in project design;
  • Country/region/site-specific risk assessments, including identifying hazards, vulnerabilities, developing scenarios and determining hazard mitigation options;
  • Gender and Environmental and Social risk analyses and formulating Environmental and Social Management Plans and Gender Action Plans;
  • Capacity assessments; identification of project/programme indicators; development of a monitoring and evaluation plan;
  • Costs of translating documents into and out of English.

The Adaptation Fund Board also made small grants to NIEs, such as Readiness Package Grants (<US$150,000 per country) and Technical Assistance grants for the Environmental and Social Policy and the Gender Policy, for up to a maximum of US$ 25,000 and US$ 10,000 respectively, and which fell outside of the country cap.

Regional Grants (MIE/RIE)

There was a maximum of US$14 million for a regional project or programme (these are not mutually exclusive).

Project Formulation Grants (RIE/MIE)

RIEs and MIEs could also apply for a Project Formulation Grant for regional projects. The eligible expenditures are the same as given earlier. As in other Project Formulation Grants, limits apply. These were:

  • Regional projects of US$5 million and above with less than three countries: US$150,000;
  • Increases of US$15,000 per additional country involved. Maximum US$250,000.

Locally Led Adaptation Grants

These grants were newly established in 2024 and aimed to support engagement and leadership of local stakeholders in adaptation projects at the grassroots [10].

These grants were for entities that are not accredited to the Adaptation Fund, such as community organisations, indigenous people organisations, local governments, and entrepreneurs, among others. These were available to all entities of up to US$ 5 million per project. 

LEARNING

Learning Grant. Learning and sharing adaptation experience is a core pillar of the Adaptation Fund. Every project must have use knowledge management to capture lessons learned and share those lessons widely.

Only NIEs could apply for this grant.

Learning grants could support transferring/sharing knowledge

  • between NIEs;
  • or between NIE and the wider climate adaptation community;
  • or developing knowledge and guidelines through partnerships.

Activities could be very diverse and specific to the NIE and each country.

The maximum learning grant was US$500,000.

Examples of previous learning activities include:

Knowledge ProductsRegular Monitoring and periodic Evaluation Reports, Briefing Notes, E-learning courses, Infographics & Flyers, Project stories & videos, Strategies and Studies, Training Manuals, Handbooks, Guidelines, Toolkits
Knowledge EventsFairs, Online meetings, Webinars, Conferences

INNOVATION

The Climate Innovation Accelerator was an open application micro-grant facility/window managed by multilateral organisations using money from the Adaptation Fund. The Accelerator was heavily oversubscribed on call for proposals. It targeted governments, non-governmental organizations, community groups, entrepreneurs, young innovators and other group applicants in countries with no NIE.

Innovation Small Grants was only available to NIEs. A maximum of US$250,000 per grant was possible. These grants were for:

  • Testing, evaluating, piloting new innovations and/or speeding up diffusion of such innovations.
  • Generating evidence of effective/efficient practices, products and/or technologies and how these can be adapted to the local context that could be subsequently assessed for piloting.

Innovation Large Grants were grants available to all types of implementing entities (NIE, MIE, RIE). Grants of up to US$5 million per project/program and did not count towards Single Country Grant funding cap.

This grant was aimed at rollout and scale. Specifically:

  • Innovative adaptation practices, tools and technologies that have demonstrated success in one country spread to (are rolled out to) new countries/regions;
  • Innovative adaptation practices, tools and technologies that have demonstrated viability at a small scale piloted at larger scales.

There was also an option to request a Project Formulation Grant under Innovation Large Grants. This follows the tiers for Project Formulation Grant on the single country grant.

The Adaptation Fund claims to work across different sectors and be open to different approaches. However, all grants must report against outcomes in the Fund’s results framework. It is recognised that not every project/programme outcome would align directly with each and every outcome, but any project should align with at least one outcome and output indicator from the Strategic Framework.

“Concrete”

Throughout the Adaptation Fund website and webinars, the word “concrete” is constantly repeated.

What does this really mean?

The mandate of the Adaptation Fund comes from the UNFCCC. Similar to GCF, the Adaptation Fund is, therefore, very much a climate fund. It aims to ensure ‘visible, tangible’ efforts on the ground in developing countries. It claims to respond to urgent needs and priorities ‘on the ground’ and seeks projects that are clearly aligned with country strategies, plans, approaches, and ways of thinking. Regional projects should demonstrate the regional added value of having 2 or more countries working together.

The focus of the Adaptation Fund is therefore on vulnerability at the very local level and providing funds for responding to that vulnerability that could be scaled up.

Sustainability is critical. Sustainably means maintenance and/or continuation of process in all senses of the word sustainable. Projects should identify complementary activities taking place at the grassroots and funds channelled into a country, province, or locality and demonstrate linkages and synergies without overlapping [8].

The Adaptation Fund Board meet twice a year and decisions on funding allocations and grant types can change quite quickly.

Overall, then, while the grants available can be complex to figure out, the Adaptation Fund could be used to finance a practical mix of human resources, physical infrastructure, and the wider institutional, financial, and natural ecosystems. And the grants seem relatively flexible especially when compared to the Green Climate Fund or the Global Environment Facility.

However, what is the reality?

Reality Bites

There are a number of steps to go through to obtain funding and then manage any successful grants.

Step 1 – Get Accredited or Find an Implementing Entity to Work With.

To apply for project/programme funding, countries must submit proposals through an accredited institution. There are three types of accredited institutions: national or NIE, regional or RIE, multilateral or MIE. Accreditation lasts for 5 years. Institutions can apply for re-accreditation thereafter.

Only an NIE, or an RIE, or an MIE can submit applications to the Adaptation Fund and receive money. The entity receives a management fee for overseeing projects, currently 8.5% of total project grant.

  • NIEs are domestic institutions. By August 2024, there were 32 NIEs listed on the Adaptation Fund website at date of this post (a mix of government departments, agencies, and NGOs). Given the flexibility of the grants available, this number is surprisingly low;
  • RIE are regional institutions. There were 9 RIEs listed by August 2024 being banks and research centers.
  • MIE are multilateral institutions. There were 15 listed by August 2024 including the Asian Development Bank, World Bank – International Bank for Reconstruction & Development, and World Health Organization.

The application to become accredited means demonstrating competencies and commitments across four broad categories: legal status, financial and management integrity, institutional capacity, and transparency, self-investigation and anti-corruption. Demonstrating means having policies, procedures, documented processes in place and evidence that these have been followed [11].

The country “Designated Authority” is a real human in a government department that acts as point of contact for the Adaptation Fund within that country. Mostly these are senior staff within the department of Environment.

The Designated Authority is required to endorse:

  • applications to become an accredited entity by NIEs or RIEs before submission; and/or
  • proposals by NIE, RIE or MIEs to conduct adaptation programmes/projects in the country.

One country may have up to two NIE, at present most countries have one.

To become accredited the applying institution must get nominated.

  1. An NIE must be nominated by the country Designated Authority;
  2. An RIE must receive a letter of support from at least 2 of the countries in which they operate (RIEs typically consist of member countries from a certain region);
  3. An MIE is invited by the Board to apply and do not require an endorsement.

These hurdles may be the reason why around half of Adaptation Fund grants are awarded to MIEs. The endorsement from the Designated Authority is from the person named as the Designated Authority on a list held by the Adaptation Fund. If the Designated authority changes and the country did not inform the Adaptation Fund of that change, the list would not be updated and therefore the endorsement would be not valid [8].

Then you would:

  • Fill out the application form (online);
  • Submit to the Adaptation Fund Accreditation Panel;
  • Pass initial screening for completeness of the form;
  • Obtain advice/suggestions from an Assessment Panel that will help strengthen the Institution. A recommendation is made by the Panel;
  • Finally, the Adaptation Fund board approves the recommendation.

Palli Karma-Sahayak Foundation (PKSF) successfully applied to become an NIE (Bangladesh). PKSF stated that they attached 77 documents to their application and that comments of the Secretariat and the Accreditation Panel were constructive for improving the quality of their documentation and to comply with requirements. They considered the process to be slow with considerable patience and commitment needed [12]. A timeframe of 6-24 months, or 18 months on average, dependent on each country’s situation and process [13] is likely.

Some of the costs to accreditation are staff time, document development/collation, translation of essential documents [13].

There is a streamlined process for small NIEs that take into account the limited capacities of smaller institutions.

To become a Regional Implementing Entity (RIE), an organization must be an intergovernmental organization (that is, not an NGO) serving at least two countries within a UN region or continent. An intergovernmental treaty confirming country membership to the organization is required as part of the initial assessment (applicants complete an Adaptation Fund Certified Self-Assessment to confirm that it is indeed an intergovernmental organization). If the entity is deemed eligible, the Secretariat requires endorsement/nomination letters from at least two Designated Authorities from countries that are:  (i) members to the regional organization (i.e. the entity seeking accreditation) and (ii) parties to the Paris Agreement and/or the Kyoto Protocol.

Step 2 – Make an Project Proposal.

Having become accredited, the next step is to submit a project proposal.

The Adaptation Fund claims to cover full cost of adaptation activities and applicants must justify that full cost. Co-financing is not required but if co-financing is included, the applicant should demonstrate that loss of co-financing will not endanger the project.

Project management arrangements for each proposal at implementing internal, national and if relevant regional levels will be checked.

Applicants are required to identify risks and align activities against the Adaptation Fund Strategic Results Framework.

All proposals must show a comprehensive consultation process before and during project design including how environmental, social, and economic benefits will be captured. Regional projects must show cost-effectiveness of a regional (rather than national) approach. All proposals should align with national priorities (e.g., healthcare strategies, poverty reduction and so on) as well as meet relevant national technical standards (e.g. national water regulatory minimums and so on). Technical feasibility has to be ensured for core parts of the project design [8].

There are two ways to apply:

  • one step, meaning the applicant creates a full proposal for submission from the outset;
  • two steps, in which a concept or preconcept document can be submitted for approval before a full proposal is created. A project formulation grant can be requested at the concept stage.

Project proposals must be endorsed by the Designated Authority.

Projects proposals can be made on a rolling basis. The applicant will get feedback on the proposal (or concept) within in 3 weeks and has a further 3 weeks to revise their documents. If the Secretariat technically recommend the project, that proposal (or concept) will be referred to next closest board meeting.

The current average time is around one and a half years from submission of the project proposal to the point that that project is approved.

There is no rejection of a proposal as such by the Board. However, the Secretariat undertakes a technical review and will not present any proposal to the Board until certain that all relevant criteria have been met. Therefore, in reality a proposal goes through cycles of review between the applicant and the Secretariat until there are no further issues pending. At this point, the proposal is put to the Board at the next board meeting, when there is a very high likelihood of acceptance.

After successful Board approval, the applicant must sign a legal agreement with the Adaptation Fund within 6 months of approval. When the agreement is in force, the first disbursement is made within one week. Subsequent disbursements rely on annual monitoring.

Step 3 – Manage the Grant.

So, you got accredited and successfully obtained project funds. Now what?

The NIE/RIE/MIE supervise Executing Entities. Executing Entities are the organizations that carry out the work, under the oversight and management of the IE. The Executing Entity can be the IE though. For MIE-led projects/programmes, the Executing Entities could be one or more of government departments, national institutes, and national or community-based NGOs. The implementing entities track and monitor results of the Executing Entities in country. Implementation arrangements must be described in full in the project proposal. The IE takes a management fee of 8.5% of total grant.

Monitoring is ongoing, every year. M&E reports are publicly available on the Adaptation Fund website under each project if you would like to see the detail required in monitoring. The IE will usually send monitoring reports by project month 11, thereby allowing 1 month for review and clearance of the report and allowing annual disbursement.

The applicant states their preferred disbursement schedule in the project proposal. So disbursement could be front-loaded, end-loaded, or spaced out. The disbursement schedule should be coherent with the project design.  

A self-conducted mid-term project evaluation takes place with light external verification. However, a final external evaluation must be conducted and applicants must address the findings of the final evaluation.

Step 4 – Exit.

What happens to Adaptation Fund projects after they close is a question under examination in a series of ex-post pilot evaluations. These aim to learn and assess the impact of Adaptation Fund projects and programmes 3-5 years after project completion.

The series notes that most projects are developing or have developed exit strategies such as institutional support and financial commitments for work to continue post Adaptation Fund grant. Reports also noted that financial sustainability still requires more planning and resourcing from the outset. Since the Adaptation Fund replenishes and country caps have increased as well as criteria allowing for re-application being fulfilled, one option is to seek more funds for a persistent grant-seeking strategy.  

Weighing it up

The Adaptation Fund is a UN mandated fund that is replenished by High Income Countries and significantly spent by UN agencies. While NIEs are 60% of accredited entities they manage(d) just under one third projects approved by June 2022. MIEs are a quarter of total implementing entities and 60% of projects [15].

However, the Adaptation Fund has changed over time and sought to become more flexible, more egalitarian, and deliver more impact for adaptation. The flexibility of the Strategic Results Framework is important because it allows adaptation funds to be spent on soft (human resources) as well as hard physical items. This makes it more flexible than GCF for instance, where I’ve heard that there is a cap on human resource development.

Certainly, the resources (staff time, translation, new organisational policy development if needed) required for both accreditation and project proposal development are substantial. All of this requires senior commitment, and it can be difficult to get that buy-in from management if the leadership see an organisation’s future on a different trajectory.

Not least, obtaining one (for NIE) or two (RIE) endorsements from the Designated authority for accreditation and a further endorsement for each project developed might be politically difficult, depending on the local politics [13]. If the Designated Authority is not already part of your network, then relationship building will be necessary.

Weighing up the relative costs and benefits of Adaptation Fund grants must be convincing, for all areas of an organisation – operations, human resources, accounting, management, technical.

The Adaptation Fund is not perfect. And adaptation itself is a hard space to work in for many reasons – lack of participation by local governments and local organizations and weak capacity; lack of interest in coordinating work between many players as well as mistrust among and between local organisations and central government institutions; along with lack of willingness and capacity to ensure continuity and sustainability of project results.

Clarity of commitment is therefore important. When you don’t have any money, you tend to focus on the dollars, but ultimately money is only part of the issue. Humans are motivated by meaning, connection, and community as well as ensuring financial security.

All of this points to the strategic nature of accrediting with the Adaptation Fund. Knowing your Why is important. Organisations that see themselves in the climate+health space for the long term are more likely to reap the benefits of the front-loaded work that is needed to successful access the Adaptation Fund as well as influence genuine impact at the grassroots.

The Adaptation Fund has been around since 2010 and is working through its Medium Term Strategy 2023-2027. In other words, it looks stable and will still be around in 2034. The number of NIEs is capped at two, and the number of RIEs is currently small (at date of this post). There may be a strategic window for your organization to apply for accreditation with the expectation that in 3.5 years (2 years for accreditation + 1.5 for project approval) you would receive 100% grant to implement adaptation activities in and for the health system and receive 8.5% of project grant as management fee.

Otherwise, since the number of NIEs are capped, partnering with an existing NIE, RIE, MIE would seem to be a way to find out what working with the Adaptation Fund is really like.

And so….

Should you get started on your Adaptation Fund accreditation application today?

  • Yes, if your long term organisational goal currently includes, or is in the process of changing to, climate mitigation and adaption within and for health systems for the next 10 years or more;
  • Yes, if your organisation is willing to go through the pain of changing now in order to be a stronger player in the climate+health space. The obvious starting point would be connecting with an existing implementing entity and sub-contract on an already funded project;
  • No, if you just want a large amount of one-off project funds in a short time. If you are looking for small amount of project funds, other smaller grants would be the more feasible option.  

References

[1] UN Climate Change www.unfccc.int

[2] Climate Funds Update https://climatefundsupdate.org/the-funds/adaptation-fund/

[3] The Adaptation Fund https://www.adaptation-fund.org/projects-programmes/project-information/projects-table-view/

[4] The Adaptation Fund https://www.adaptation-fund.org/project/integrated-approach-physical-adaptation-community-resilience-antigua-barbudas-northwest-mckinnons-watershed/

[5] The Adaptation Fun https://www.adaptation-fund.org/project/building-climate-resilient-health-systems-in-africa/

[6] UCSF Institute for Global Health Sciences & Open Consultants. (2023). Improving
Investments in Climate Change and Global Health: Barriers to and Opportunities for Synergistic Funding. USA.

[7] The Adaptation Fund News Release https://www.adaptation-fund.org/adaptation-fund-demonstrates-commitment-to-strengthening-health-adaptation-and-resilience-at-cop-28-in-dubai/-fund.org)

[8] WHO Webinar “WHO as an Accredited Implementing Entity of the Adaptation Fund; Accessing AF funding for Climate Change and Health” 30th April 2024 online.

[9] The Adaptation Fund https://www.adaptation-fund.org/wp-content/uploads/2024/04/AFB.PPRC_.33_40.pdf

[10] The Adaptation Fund https://www.adaptation-fund.org/adaptation-fund-board-enhances-funding-options-for-vulnerable-countries-over-us-80-million-in-new-projects-approved-new-windows-for-locally-led-adaptation-created/

[11] The Adaptation Fund  Accreditation_Process-Overview_April2018.pdf (adaptation-fund.org)

[12] The Adaptation Fund PKSFs-experience-with-AF.pdf (adaptation-fund.org);

[13] Training Workshop on Accreditation to the Adaptation Fund at the UNFCCC Asia Pacific Climate Week 2 – 3 September 2019 United Nations Conference Center, Bangkok, Thailand Report https://www.adaptation-fund.org/wp-content/uploads/2019/11/Report-Thailand-Accreditation-Workshop-Final.pdf

[14] Mongabay-India https://india.mongabay.com/2023/12/we-are-very-far-from-what-vulnerable-communities-need-for-climate-adaptation-says-adaptation-fund-head/

[15] Adaptation Fund – Technical Evaluation Reference Group (2024) Rapid Evaluation of the Adaptation Fund AF-TERG, Washington, DC.