As El Niño Peaks, Accra Is Rewriting Its Rules To Protect Residents From Extreme Heat

Dr. Louisa Ademki Matey, Director of Health Services, Accra Metropolitan Health Directorate

Last month, the World Meteorological Organization (WMO) warned that the current El Niño could be unprecedented in strength, peaking towards the end of the year, with effects lasting well beyond it. Its outlook points to drought in Southern Africa and heavy rain in East Africa, and the prospect of additional extra heat across large parts of the world. For city governments, these warnings demand preparation: how will we protect residents when temperatures rise? 

Accra began preparing for extreme heat well before this warning. We are changing our rules, identifying who is most exposed, and strengthening the systems needed to protect residents. The test is whether this work makes daily life safer for those at greatest risk. 

Heat is a health emergency

Extreme heat is one of the deadliest and most unequal effects of climate change. Heat strains the heart and kidneys, worsens chronic conditions such as heart disease, diabetes and chronic respiratory disease—noncommunicable diseases, or NCDs—and can cause heatstroke, a medical emergency. 

Deaths and hospital admissions can follow within a day, so cities have little time to react once a heatwave arrives. The Lancet Countdown on Health and Climate Change estimates that heat was linked to about 540,800 deaths a year between 2016 and 2023, and to a record 710,000 in 2023—71.5% of them driven by climate change.

Africa’s toll is harder to count, but the direction is clear. The continent is warming faster than the global average. In Ghana, annual heat-related deaths among adults over 65 rose 310% between 1990 –1999. In 2023, people in Ghana experienced an average of nine hours a day when heat posed a moderate or higher risk of heat stress, even during light activity. 

These risks demand more than public advice. They demand changes to the conditions in which people live and work.

A hotter city, and rules built for a cooler one

A review of Accra’s regulations exposed a fundamental gap: heat was not adequately recognized as a public health risk. 

Satellite readings in an assessment by the Accra Metropolitan Assembly (AMA) show the heat of its roads, roofs and open ground rising from an average of 35.5°C in January 1991 to 40.0°C in December 2024. These risks demand more than public advice. They demand changes to the conditions in which people live and work.

But now Accra is responding. Our response is targeting those gaps in our rules, knowledge and coordination, and the mayor is championing it.

Under the leadership of Mayor Michael Kpakpo Allotey, the city has begun addressing those gaps.  In April 2026, the city announced that it would amend its bylaws so that heat counts as a public health risk. 

In August, the Assembly passed the amendment, which is awaiting gazetting before it takes legal effect.  It consolidates an integrated municipal framework to heat-health risks, with the aim of reducing heat-related illness and deaths. Its proposed requirements include tree planting, landscaping, green space and permeable surfaces in new developments, protection of existing trees and significant vegetation, and shade and green infrastructure in public facilities, markets, schools and community spaces.

The reforms announced in April include requirements for shade, ventilation and cooling through building design, and the amendment would define “excessive heat” in law. It would also set safety rules for markets, transport terminals and temporary structures, protect outdoor workers, and protect trees as public health assets. 

These changes matter because protection should be built into everyday surroundings. A shaded market, a better-ventilated building or a protected tree can reduce exposure before someone needs medical care.

Understanding who needs protection

Effective action also depends on knowing where heat is most dangerous, who is most affected, and how it impacts residents. In October 2025, the city trained 30 environmental health staff in Geographic Information System (GIS) mapping, climate data analysis, and urban heat assessment to strengthen capacity for citywide heat-risk assessment.

The findings of the study, however, identified a critical gap in the existing health surveillance system: health facilities did not have a direct mechanism for establishing the relationship between reported illnesses and extreme heat. To address this gap, the AMA Public Health team is sensitizing clinicians and other health professionals to identify, track and report heat-related illnesses and deaths to the Health Directorate, thereby strengthening the city’s capacity to monitor the health impacts of extreme heat.

In July, the city launched a survey of residents in high or extreme heat-risk areas such as Makola, Kaneshie, Old Fadama and Chorkor, to learn how heat affects traders, transport operators, workers, and households differently. The mayor said that the findings would guide public education, greening, and policies to protect vulnerable groups.

The assessment found that the agencies responsible for health, weather, emergencies and planning had no integrated heat strategy and had no standard definition of a heatwave. A draft Heat-Health Action Plan, reviewed last May, would treat extreme heat as a major shock in the city’s resilience framework. In practice, this means planning for heat the way the city plans for floods or fires: as a hazard to prepare for in advance, with a place in its plans and budgets. The plan has since been developed. It provides a colour-coded alert to tell the public how severe the heat is, and measures to help health facilities identify, manage and report heat-related illness.

Together, these give Accra a legal basis to act, a picture of where the risk lies and who bears it, and a plan to coordinate the response and warn residents.

Ahead of the peak

Through the Partnership for Healthy Cities, Accra is making heat protection a part of everyday city government. Our experience offers a practical lesson: recognizing heat as a health risk must lead to changes in the city’s rules, and services that reduce people’s exposure and protect their health.

For Accra, the measure of progress is what changes for those most exposed: traders working in hot markets, outdoor workers and families living in our hottest neighborhoods. As El Niño approaches its peak, our task is to turn the preparations already under way into protection our residents can count on.