Building Resilience of Health Systems in Pacific Island Least-Developed Countries to Climate Change

Introduction:

The Pacific Least Developed Countries (LDCs) - Kiribati, Solomon Islands, Tuvalu and Vanuatu - are among the countries most vulnerable to climate variability and change. These countries have high rates of communicable diseases and non-communicable diseases (NCDs), which are expected to be exacerbated by climate variability and change. National Climate Change and Health Action Plans (NCCHAPs) highlighted the health risks of vector, food- and waterborne diseases, malnutrition, and non-communicable diseases. Threats to water and food security and safety remain a concern, particularly during weather patterns such as El Nino. The region is exposed to natural hazards and rising sea levels that threaten lives and the livelihoods of communities. Disasters relating to climate change disrupt the delivery of health care services and particularly affect the most vulnerable communities, including young children, women of reproductive age, the elderly, and people with disabilities. The majority of populations and health care facilities (such as hospitals and community health centers) are located in close proximity to low-lying coastal areas and are highly vulnerable to cyclones, floods, storm surges, sea level rise, and disturbances in water supply caused by drought or salination of aquifers. Damage to these facilities - buildings and essential supplies/amenities – affects their capacity to provide health services when they are most needed in emergency situations. Due to the lack of capacity and resources in the health sector, the majority of health facilities are not resilient to climate-induced pressures in terms of structural, non-structural, and functional safety. Overall, the ministries of health have limited technical capacity to effectively integrate climate-related risks into policy, planning, and regulatory frames, and into interventions to control the current and project future burden of climate-sensitive health outcomes.

Methods: In consultation with national stakeholders, a project was developed for the Global Environment Facility Least Developed Country Fund to increase the capacity of national health systems and institutions, and sub-level actors, to manage long-term climate-sensitive health risks.

Results:

The most effective measures to reduce vulnerability in the short-term include programs that implement and improve basic public health measures, including the provision of safe water and improved sanitation, securing essential health care including vaccination and child health services, increasing capacity for disaster preparedness and response, and alleviating poverty. Early warning systems for vector- and water-borne diseases are planned for all countries, if possible. In the long-term solution national health systems and institutions need to be modified to explicitly consider climate change risks and resilience in health governance, strengthening of health information management systems, including integrated surveillance to inform early warning systems, and effective and accessible delivery of health services. These solutions would enable the countries to prepare for and respond effectively to climate change impacts on morbidity and mortality, particularly in vulnerable population groups.

The project will have four complementary outcomes to achieve the short- and long-term solutions: (1) strengthening governance of health system and institutional capacities; (2) strengthening capacities of health system institutions and personnel to manage the health risks of climate change; (3) improving the coverage and quality of health services addressing climate-related diseases; and (4) enhancing south-south cooperation. Although the outcomes are similar across countries,each country defined a tailored set of activities to address specific climate-related health risks, within the context of national challenges and barriers.

Common challenges and barriers that will be addressed include: i) insufficient mainstreaming of climate change risks and responses within the health sector and relevant government agencies; ii) limited health system capacity to manage health information and weather and climate early warning systems; iii) limited coverage and quality of health services addressing climate-sensitive health outcomes, and climate-induced disruptions in health care facilities; and iv) under-utilized south-south cooperation to foster knowledge exchange, technical and scientific advice and assistance, and limited integration of health policies and plans into ongoing National Adaptation Plans.

Conclusions:

The project will increase the adaptive capacity of national health systems and institutions, and sub-national level actors, to respond to and manage long-term climate-sensitive health risks in each country. Innovative aspects of the project include i) building on experience in the health sector on managing the risks of climate-sensitive health outcomes; ii) embedding the project in Ministries of Health to support sustainability; iii) encouraging catalytic partnerships across countries, and the regional-level systematization of best practices to develop technical guidelines, manuals and tool-kits, and supporting the scale-up of these across the region; and iv) establishing a network of skilled professionals and practitioners on adaptation and health, and forming a community of practice that can continue to engage and provide support to other countries implementing similar climate change and health projects.