Does the Green Climate Fund invest in Health?

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

The the Green Climate Fund (GCF) claims to be the largest global fund that helps developing countries respond to climate change. This post investigates if and how health systems can access that finance.

The GCF was established by the United Nations Framework Convention on Climate Change (UNFCCC) in 2010 in order to support developing countries to achieve their commitments under the Paris Agreement. In other words, the GCF is very much a climate fund. Its mandate is “to support developing countries raise and realize their NDCs (Nationally Determined Contributions): country climate action plans to cut emissions and adapt to climate impacts. Each country that signed up to the Paris Agreement must create an NDC and update it every five years [2]. The GCF mandate is important to remember, and we will return to it later in this post.

The GCF works in 8 sectors. The GCF calls these “results areas”, or investments. One of these areas is called ‘Health, Food and Water Security’. While connections between health can be made to all other 7 sectors in GCF, for this post, we will focus only on the health results area.

The GCF uses a mix of money types such as grants, contingent grants, concessional loans, equity, guarantees, and results-based finance. Grants can be awarded at full cost and can be used to support pipeline development, project identification, and project preparation as well as promoting awareness of climate change risks to health and opportunities for resilience across other sectors.

This post is only about grants from GCF for health.

The GCF can fully fund a project or co-finance with other institutions. For instance, the Asian Development Bank has co-financed several debt and equity based projects with GCF.

Before digging more into the GCF and health though, let’s take a look at existing and previous GCF projects in health.

Successful GCF+Health Applications

At date of this post, GCF awarded $US1.6billion to 128 projects under results area 8.

Out of these

51 were in the Asia-Pacific region.

Of the Asia-Pacific region projects:

7 included a domestic Direct Access Entity;
4 included a regional Direct Access Entity;
40 included an International Direct Access Entity.

More on Access Entities in the following sections.

Most projects in the ‘Health, Food and Water Security’ results area were/are on food, agriculture, water, and forestry.

To date, there is only 1 (one) GCF funded project listed on the GCF website that focuses on health systems. It is SAPO30 Strengthening Climate Resilience of the Lao People’s Democratic Republic (PDR) Health System. The total project value is $US28.2 million over 15 years. The GCF contributed grant, at US$24,978,084 with co-financing in the form of further grants from two donors and in-kind contributions from the Government of the Lao PDR. The applicant (the Accredited Entity) is an NGO called Save the Children Australia. That is to say, the applicant is not a dedicated health organisation although Save the Children have a strong track record of working in community health in Lao PDR. The project aims to strengthen national, regional, and community resilience through policy review, health and climate action planning at all levels of the health system, knowledge and awareness activities, and infrastructure upgrades in a selected number of health facilities in particularly vulnerable communities.

In November 2024, the GCF and Global Fund agreed to increase funding at the intersection of climate and health by aligning funding in specific areas. This ‘alignment’ is still new and there doesn’t seem yet to be information on how these agreements will be operationalised within funder programmes. Nevertheless, the announcement was a positive step towards increased finance for climate and health.

GCF+Health Basics

By way of background, the table below gives a quick summary of the GCF mandate and polices.

The GCF in Summary [4]
Mandate	“support developing countries raise and realize their NDCs ambitions towards low-emissions, climate resilient pathways” Health and Wellbeing is a target sector
Strategy & policy	Health is an adaptation-focused results areas
Funding approaches	Existing GCF sectoral guide to Health and Wellbeing that supports development of funding proposals
Country-level partnership	Only accredited entities can apply to the GCF
Track record	128 projects, US$1.6billion approved under the Adaptation theme, at date of this post

The GCF’s Health and Wellbeing Sectoral Guide gives two “paradigm shifting pathways” that could enable “transformation towards climate adaptive, low emissions health systems” through “highest climate impact projects and programmes” [1].

PATHWAY 1 is “Promoting climate-resilient, nature-positive health systems and services – anticipate, respond to, cope with, recover from, and adapt to climate-related shocks and stress”.

This means preparing for the consequences of a changed climate, while ensuring population health and inclusivity [1].

PATHWAY 2 is “Facilitating climate-informed advisory and risk management services and community action – strengthening information and advisory systems and promoting community action”.

This means collecting information through early warning systems and actually using that information to change policy and services. This seems to be envisaged as electronic because the Guide states that “data security and privacy issues need to be considered, as well as the accessibility and affordability of related services” [1].

How does GCF imagine you could actually DO either of these pathways?

GCF thinks four approaches are the way to go here:

“Transformational planning and programming”
- meaning designing-in climate resilience, low-carbon, nature positivity, sustainability, accessibility, and inclusivity. GCF specifically mentions conducting Health National Adaptation Plans (HNAPs) and linking these with other sectoral National Adaptation Plans.
“Catalysing climate innovation”
- meaning using GCF money to strengthen capacity (individuals, communities, institutions) and directing that increased capacity towards building longer term project pipelines.
“Mobilizing finance at scale”
- meaning GCF money could be used to pilot new public, as well as private, business models, across the range of money types they offer.
“Coalitions and knowledge to scale up success”.
- meaning creating access to knowledge and data for vulnerable people/regions through activities like knowledge platforms, sharing best practices and lessons learned, and participatory monitoring & evaluation.

These are the ways that GCF think a “paradigm shift” in health and wellbeing can become reality.

When the GCF board come to assess a proposal from the health sector, six criteria are used by the Board as follows [1]:

Impact: the extent to which the project/programme contributes to climate adaptive low carbon health systems;
Paradigm shift: extent to which the project/programme has legacy and isn’t a ‘one-off’;
Sustainability: extent to which the project/programme aligns with national SDG priorities and expects environmental, social, gender, and economic co-benefits;
Vulnerability: extent to which vulnerability and financing needs of the beneficiary country and population is met;
Country ownership: Country ownership of, and capacity to implement, a funded project or programme, policies, climate strategies and institutions is clear;
Efficiency and effectiveness: economic and, if appropriate, financial soundness of the programme/project is clear.

So far so good.

However, to actually submit a proposal to the GCF, you must be what the GCF calls ‘an Accredited Entity’.

An Accredited Entity is the organisation in charge of presenting the application(s) to the GCF and then overseeing, supervising, managing and monitoring the implementation of any successful bid(s).

There are two types of accredited entities.

First is a Direct Access Entity, a domestic organisation within country that can use what GCF calls the ‘Direct Access modality’. These include government departments, local NGOs, or any other sub-national, national or regional organisations. These organisations must be nominated by the developing country National Designated Authorities (NDAs).

An NDA, also known as the country GCF focal point, connects the national government to the GCF. All GCF project/programme activities must get approval from the country’s NDA through a formal no-objection letter. GCF does this to ensure that any GCF funded activity follows national priorities (as found say, in national planning documents). For example, in

Cambodia, the NDA is the Ministry of Environment; and a Direct Access Entity is the National Committee for Sub-national Democratic Development;
Lao PDR, the NDA is the Ministry of Natural Resources & the Environment but there is no Direct Access Entity.
Vietnam, the NDA is the Ministry of Planning and Investment; and a Direct Access Entity is Vietnam Development Bank.
Maldives, the NDA is Ministry of Climate Change, Environment & Energy but there is no Direct Access Entity.

International entities (organisations) can also access the GCF, using what GCF calls the International Access modality. International Access Entities do not need to be nominated by the NDA. The International Access Entities currently include regional development banks, private commercial banks, private capital investment funds both commercial and impact investing focused; international NGOs like Save the Children and International Union for Conservation of Nature, as well as United Nations organisations.

The accreditation process is long and resource heavy. The process will assess whether the applying organisation is capable of strong financial management; can meet GCF financial standards, environmental and social safeguards, and gender policies; and as well as having a clear and detailed pipeline of projects/programmes to present to the GCF.

If successful, the Accredited Entity is accredited for specific:

funding size;
fiduciary functions, which will shape how it uses GCF money;
category of environmental and social risk of intended activity.

This means that after becoming Accredited Entity, you cannot implement any project with GCF, rather you would apply for, and implement, approved activities that are consistent with your organisational mandate and consistent with the parameters on funding size; fiduciary function; and environmental risk that you agreed with GCF during the accreditation process. An Accredited Entity can also apply to upgrade its accreditation (for size, financial complexity, or risk) at any time.

Accreditation is valid for five years. Accredited Entities can then request re-accreditation. Some Accredited Entities don’t seek re-accreditation and drop off the list of GCF Accredited Entities. The GCF is piloting a fast-stream version of accreditation for a single project through a simpler and faster process. The pilot ran from 2023 – 2026.

Most of GCF’s approved project/programmes are through International Entities. About half of Direct Access Entities don’t have a GCF project proposal in the pipeline. That is, accreditation is only the first step [7].

Key points

At the Alliance for Transformative Action on Climate and Health (ATACH) global meeting “Transforming Health Systems in the face of Climate Change” held on 4^th & 5^th March 2024, a representative from the GCF presented on the key points to remember when considering applying to GCF for funds that are still relevant.

Design health applications around climate trends.

‘It is important to highlight that our mandate restricts us to climate finance. GCF is not a standard health fund or a development fund, GCF is a climate fund. So, when you design a health intervention, the critical criteria to start with is your climate context. You need to demonstrate robust and clear understanding of your climate context over the decades and therefore what will be the impacts on human health’.

Paradigm shifting work, not a one-off health project.

‘Another key issue is the need to be paradigm shifting, that is, the potential of an intervention to catalyse change beyond a one off project or program. GCF are intentional in the interventions to invest in, GCF want to see that the intervention can be replicated, can be scaled, and are sustainable’.

Country ownership and grassroots impact.

‘A key consideration is that the work must be country owned. GCF work with countries with an existing climate strategy and seek coherence between existing national policies and what you want to do. GCF also care about demonstrating impact at the last mile. Capacity to respond to climate change within communities is important and this should be built into your intervention’.

Reality Bites

On the face of it, applying to the GCF looks time consuming and complicated.

But what is the reality of trying to get accreditation, and thereafter, applying for money.

Accreditation is complicated and lengthy, and over 2 years is a common timeframe. Help and advice is given by the GCF Secretariat and GCF Accreditation Panel. To get a sense of the resources required, a full time staff teams of 3-4 people, may be needed. Moreover, the accreditation process will require time and documentation from staff in the wider organisation including senior buy-in. Applicants have stated that organisations policies had to be changed in order to be consistent with GCF requirements [8].

GCF provides money for Direct Access Entities to help pay some of these costs to get accredited, through the GCF Readiness Programme. This funding is available only after initial steps have been taken and there are restrictions on how funding for internal staff time as well as constraints to changing funding purposes once proposals are approved [5].

But the work doesn’t stop there.

After becoming approved, the newly Accredited Entity must formalise the agreement through an Accreditation Master Agreement and comply with conditions in that agreement to evidence that the Accredited Entity is complying with GCF standards (e.g. send committee meeting minutes to show that work is focused on sustainability).

Next the Accredited Entity creates an entity work programme. This is a work programme that is submitted to the GCF which is aligned with

a) the Accredited Entity scope of accreditation;

b) the country strategy at the National Designated Authority;

c) GCF scope e.g. consistent with GCF focus on transformation.

The Accredited Entity work programme will state what the Accredited Entity will work on in the short to medium term. The work programme outlines a manageable number of possible ideas that will be developed into project proposals. Once agreed by the GCF Secretariat, the Accredited Entity can now start to develop project concept notes and apply for project/programme funding.

After funds are approved, the Accredited Entity can invite Executing Entities, if needed, to help implement the project/programme.

Progress is reported as required by GCF monitoring & evaluation processes.

GCF provides money to Direct Access Entities to help pay for project development, through the GCF Project Preparation Facility.

An Alternative Path to GCF

Accreditation is a resource heavy process but there are other ways to access GCF funds apart from becoming accredited.

Organizations could apply to become a Delivery Partner or an Executing Entity in partnership with an existing Accredited Entity.

Delivery Partners relate to the GCF Readiness Program. Either the National Designated Authority, or an Accredited Entity, or a Readiness Delivery Partner can implement activities under the GCF Readiness Program. To become a Delivery Partner, the organisation must complete a Financial Management Capacity Assessment questionnaire and submit supporting documentation to GCF for review. This is a much lighter process than seeking accreditation. World Health Organization is a Readiness Delivery Partner.

While an Accredited Entity can carry out all or some of approved project/programme activities, it can also channel funds and activities through Executing Entities. Executing Entities look a lot like sub-contractors. An Executing Entity must still go through an approval process to demonstrate that it has the required policies and procedures on Gender, Environmental and Social Safeguards, has capacity to manage and oversee implementation as well as having the necessary checks and balances in place.

Is it Worth It?

Direct Access Entities have reported that financial returns from becoming GCF accredited and implementing projects are initially “minimal” but do have multiplier effects once institutional capacity exists, and a pipeline of projects is ongoing [7].

What are these effects?

GCF accreditation is really about the strategic direction of the organisation. Some or many of the requested policies for GCF may not be needed during everyday organisational activities and therefore can seem onerous or even inappropriate.

But… if this area is where your organisation wants to grow in the future, then the GCF accreditation is like a future-proofing process for working in climate mitigation/adaption for the next decade and beyond.

Direct Access Entities in South Africa noted that when it was known that their institution had evolved their policy frameworks in-line with GCF standards, other development finance institutions invited them to participate in similar projects. Accreditation can be, then, an opportunity to integrate or strengthen activity in this new field of climate mitigation and adaptation [7].

Another reported effect has been generating new partnerships with existing Accredited Entities or different organizations who wish to partner with the newly Accredited Entity.

Not least, accreditation, is a way to ‘grow your own’ capacity where climate finance skills are scarce and thereby strategically build local institutional capacity in this area (partly supported by GCF’s Project Preparation Facility and/or the Accredited Entity Fees).

Establishing a collaborative relationship with the National Designated Authority as early as possible and starting small while growing through track record has been the advised by Accredited Entities in South Africa [7].

And so…

Should you, as a health-related organisation, seek accreditation and funding at the GCF? Or not?

Yes, if your long term organisational goal includes climate mitigation, increasing biodiversity and adaption within and for health systems;
Yes, if your organisation is willing to go through the pain of changing now in order to be a stronger player in that future space. The obvious starting point would be connecting with an existing Accredited Entity and become a Readiness Delivery Partner or an approved project/programme Executing Entity;
No, if you just want some one-off project funding. There are other sources and types of money are easier to access than GCF.

References

[1] GCF (2022) Health and Wellbeing Sectoral Guide. Sectoral Guide Series. Yeonsu: Green Climate Fund.

[2] United Nations Climate Action https://www.un.org/en/climatechange/all-about-ndcs

[3] 2020 Climate Funds Monitor: The Green Climate Fund: An Appetite for Risk? DOI:10.13140/RG.2.2.11469.77281 Report number: 3 Affiliation: Frankfurt School of Finance & Management

[4] UCSF Institute for Global Health Sciences & Open Consultants (2023). Improving investments in climate change and global health: Barriers to and opportunities for synergistic funding. San Francisco: University of California, USA

[5] World Resources Institute https://www.wri.org/technical-perspectives/insider-three-ways-improve-direct-access-green-climate-fund

[6] Hammersley et al (2023) Revitalising the Green Climate Fund Lowy Institute, Sydney.

[7] The Southern Africa Climate Finance Partnership (2020) Knowledge for Climate Finance Mobilization: Routes to Accessing GCF Resources, South Africa

[8] CMIA & Camco 2022 What Is it Like to Become a Delivery Partner at the Green Climate Fund? https://www.youtube.com/watch?v=xJe81W7YaJo