Building heat resilience through district-wide training of frontline health workers in India: a pre-post evaluation of the climate care champions programme in Ananthapuramu district
Cecilia Sorensen, Danielly de P Magalhães, Michelle DePhillips, Nymisha Herrera Nimmagadda, James Sullivan, Vedika Tikmani, Kristie Hadley, Hannah N W Weinstein, Nithya Shree, Umashankar K, Syama B Syam, Margareth O’Donnell, Angela ChaudhuriIntroduction
Extreme heat is a growing public health emergency in India, with rural and low-income communities most at risk. Early symptoms are often overlooked, delaying care and increasing mortality risk. Frontline health workers (FHWs) are critical for prevention and early intervention yet major knowledge and preparedness gaps persist. This study aimed to evaluate a district-wide training programme designed to improve FHWs’ knowledge and confidence in identifying, managing and preventing heat-related illnesses.
Methods
The Climate Care Champions Programme (CCCP) was designed to strengthen the capacity of FHWs to detect, manage and prevent heat-related illnesses. In February 2025, a 2-day Training of Trainers workshop prepared 90 trainers from Ananthapuramu District, Andhra Pradesh, India, who went on to train 2266 FHWs across 76 primary health centres, reaching an estimated 4.5 million residents. A baseline household survey (n=1007, including 241 FHWs) explored knowledge and perception before the training. Longitudinal surveys evaluated confidence and knowledge among trainers and trainees in four heat-vulnerable blocks.
Results
Although 70% of FHWs reported prior climate-health training and most expressed confidence in providing preventive advice, knowledge deficits were identified. During CCCP, a longitudinal evaluation revealed improvements in knowledge: recognition of early symptoms increased from 19% to 70%, severe symptoms from 42% to 95% and infant-specific signs from 32% to 89%. Misconceptions around first-aid priorities were corrected, and confidence rose across all domains. Data from 1453 FHWs confirmed effective knowledge transfer across the cascade training model, particularly in protective actions (+29.5%) and understanding heat-illness aetiologies (+18.6%).
Conclusion
These results demonstrate that localised, evidence-based training can strengthen frontline health worker capacity and close critical knowledge gaps. Scaling such programmes—supported by policy, infrastructure and sustained government commitment—is essential to protect health, reduce inequalities and strengthen community resilience in the face of escalating extreme heat.