National Climate Change Action Plan for Public Health (2020-2024)

1. To promote better governance, coordination, and partnership for climate change adaptation and disaster risk reduction in the health sector.

2. To build institutional capacity and skills of medical personnel and relevant stakeholders to effectively plan and implement climate change adaptation and disaster risk reduction in the health sector.

3. To strengthen research, surveillance, and vulnerability assessment capacity to support decision making for adaptation to climate change impacts and disaster risks.

4. To promote knowledge sharing, awareness, and web-based information management systems related to health vulnerabilities associated with climate change and disaster risks.

5. To build resilience of the existing health service delivery system to respond to and cope with the impacts of climate change and disaster risks.

6. To develop effective financing mechanisms and an M&E framework for climate change adaptation and disaster risk reduction. National Climate Change Action Plan for Public Health page. 9 Addressing Cross-cutting issues Gender Since climate change affects men and women differently coupled with existing gender inequality in communities and societies, the policies and programmes should address the issues in a holistic approach, particularly in the context of climate change and public health. The people with special need of health supports are usually the most vulnerable groups, namely disabled people, pregnant women, elder people, children and migrants, toward the climate risks. For example, women especially pregnant women have a relatively limited access to health centre during flooding and facing malnutrition. The list of activities below is meant to address gender inequality in the context of climate change and public health. ● Provide gender and climate change adaptation focusing on health and domestic violence capacity building for MoH Gender Working Group, PHD Gender Focal points and Gender Focal points of Health Centre and Commune Women and Children Focal points in the target communes. ● Disseminate gender and climate change adaptation on health sector and domestic violence to communities with support from the PHD as well as from the MoH. ● Ensure that disaggregated data is included in the HC report as well as the PHD report. ● Include gender components in surveys or assessments ensuring that different issues and need of males and females are collected. Conduct Focus Group Discussion with women' groups separately for any assessment with female facilitators where possible, study or research to find out issues and needs of women, especially elderly women and pregnant women for the CCA focuses on their health issues. ● Ensure the participation of at least 40% of men in dissemination on gender in CCA and domestic violence in communities. ● Training materials should include more pictures ensuring that participants, especially women and elderly women who may be illiterate understand the message delivery. ● Livelihood activities should be provided for communities, especially for women and girls. ● Establish the coordination between health centre and commune women and children Focal Points for gender in CCA on target diseases including malaria, dengue, diarrhea, etc. and domestic violence awareness raising at communities. ● Provide support to improve the nutritional status of pregnant women, elderly women who taking care of their small children while their parents migrate to other towns looking for work. ● Follow up the gender mainstreaming as well as gender action plans to provide feedback for the improvement of gender mainstreaming activities. Communication Communication is an effective tool to address the impacts of climate change on public health. Three levels of communication—namely health centres, public health practitioners and mass-media, should be considered for communication mechanisms to have timely effect measures on climate change and health. National Climate Change Action Plan for Public Health page. 10

1. For health centres across the country:  Develop a climate change master guide for the public health sector;  Provide series of communication trainings and tools, which will be accompanied by hand book (master guides) to help local health centres develop key messaging and strategies to foster awareness of the health benefits of climate change preparedness and mitigation.

2. Public health practitioners have a unique opportunity to talk to local authorities and policy makers about proactive climate change and health adaptation and preparedness. Activities for consideration include:  Employ a variety of media outreach strategies (radio, TV, social media platform, and newsletter);  Organize climate change and public health forums or dialogues;  Develop climate change and health (CC&H) web portal to share CC&H stories;  Develop success stories of current or past CC&H projects to share with donors and other interested agencies; and  Organize Cambodia showcase at the global climate change and health events.

3. Examples of potential media outlets and/or needs for communication on climate change and health adaptation activities include:  Wireless access at local health centre;  Telephone alerts for EWS;  Radio or digital video at local health centre;  Banners posted at the main roads in communities that are vulnerable to climate change; and  Continued technology development. Action Plan Scope of Action Plan The NCCAPPH 2019-2023 follows the government mandate and carries the same title as National Climate Change Action Plan for Public Health, and the strategic objectives of the National Strategic Plan for Climate Change Adaptation and Disaster Risk Reduction in Health Sector. The NCCAPPH 2019-2023 is building on the previous planning documents, up-to-date information and data, research and the vulnerability and adaptation assessment (V&A) [16], and experiences gained from implementation of climate change responses in health sector. The key documents reviewed to generate a long list of actions are the:  National and Provincial Vulnerability and Adaptation Assessment in Cambodia [16];  Public Investment Programme of MOH;  National Climate Change Action Plan for Public Health 2014-2018;  Health Strategic Plan 2016-2020 (HSP-3);  Cambodia’s Nationally Determined Contribution relating to public health;  MOH’s priority actions in the NSDP 2019-2023; and National Climate Change Action Plan for Public Health page. 11  Project documents of the existing climate change and health in MOH. Goal The goals of the NCCAPPH are to reduce morbidity, mortality, injuries and health vulnerability to climate variability and extreme weathers and to contribute to the implementation of strategic objectives in the Climate Change Strategic Plan for Public Health, the Cambodia Climate Change Strategic Plan 2014-2023, and the Health Strategic Plan 2016-2020 (HSP3). The defined actions will continue to build the resilience of health system, reduce the vulnerability of health public to changing climate and climate variabilities—floods, drought, and extreme weather events, and build the adaptative capacity of the medical personnel and MOH as a whole. The actions are grouped into Activity Clusters, in which are categorized to Strategic Objectives, representing: Coordination, Capacity Building, Research, Knowledge Management, Intervention & Infrastructure, and Finance and M&E. Figure 1: Main Activity Clusters and Goal of the NCCAPPH Action Plan Matrix Table 2 lists the Activity clusters and the indicators to address climate change in public health in Cambodia for 2019 - 2023. The priority actions focusing mainly on the adaptation to climate change in public health were based on the consultative processes led by the Department of Preventive Medicine with support from ADB (RETA 8898-REG) and the technical working group on climate change and public health of the MOH. The prioritization methodology was maintained to be consistent with the prioritization processes used in the development of first NCCAPPH, which was guided by the Secretariat of the National Climate Change Committee (later, reformed to the National Climate Change Action Plan for Public Health page. 12 National Council for Sustainable Development) and encompassed the comprehensive consultations with relevant stakeholders under close coordination of the MOH’s climate change working group. Table 2: Actions Matrix Activity Cluster Indicators Output I: Better governance, coordination, and partnership for climate change adaptation and disaster risk reduction in the health sector. 1.1 Mainstreaming climate change adaptation  Number of CBA and evidence-based and disaster risk management in MOH studies conducted to support the sector planning and budgeting. mainstreaming CCA and DRR in planning  Conduct cost-benefit analyses and and budgeting evidence-based studies to generate  Number and types of advocacy materials evidences to advocate for planning and on the relationship between Climate budgeting Change and health developed and utilized  Prepare and disseminate advocacy  Number of health sector policies/ materials (i.e. brochure of CBA, case strategies/ programs that incorporated the studies, policy leaflets) to MOH’s high-level health issues in relation to climate change decision makers, MEF, and other and DRR. stakeholders  Percentage of the national health budget  Work with planning and budgeting for climate change adaptation and DRR department to integrate action on CC and DRR in planning and budgeting, and annual operation plan. 1.2 Improving coordination within MOH, with  Approved the Decision (Sechkei Samrech) MOH’s provincial department of Health on TWG on CC and Health and Healthcare centres/hospital, and with  Number of collaboration mechanism for other key sectors to ensure coherence in CC&H and DRR established with relevant response to climate change related health government agencies and with designated impacts and disaster risks. focal points for specific programme of  Update the Decision (Sechkdei Samrech) action and budget allocated. on TWG on CC and Health, and get  Joint multisectoral risk management approval from minister of health 1 approaches to health risks related to  Establish a joint multisectoral working disasters, water, waste, food and air group for information exchanges and joint pollution (e.g. food safety, diarrhoeal actions to address health impacts of disease control, integrated vector climate change disaster risks management, joined up risk  Establish coordination mechanism communication) undertaken. between health care staff and provincial 1 An Update of TWG on CC and Health has taken place within the framework of GEF Project National Climate Change Action Plan for Public Health page. 13 committee for disaster management to better address climate change related impacts and disaster risks 1.3 Promote public and private partnerships to  Roadmap to engage private sector to support implementation of climate change address climate change risk in public health adaptation and disaster risk reduction.  Number of PPP established to support  Prepare a roadmap to engage private implementation of climate change sector and their contributions in adaptation and disaster risk reduction. addressing CC impacts on health sector  Sensitize and orient the private health care providers and facilities in preparedness and vulnerability reduction measures Output II: Strengthened institutional capacity and skill of medical personnel and relevant stakeholders to effectively plan and implement climate change adaptation and disaster risk reduction in the health sector. 2.1 Assessing the capacity need of health staff  Number of technical guideline and (national and sub-national) through implementation practices updated to working with existing academia (i.e. NIPH), include the capacity need of national and relevant government agencies and WHO sub-national health staff to effectively aiming to update the health technical address climate change and DRR. guidelines and implementation practices 2.2 Incorporate climate change related health  Climate change and health is integrated in impact into academic programmes for the university programme for public health public health and medical and to the and medical school curriculum of general education  Climate change and health is integrated in the curriculum of general education National Climate Change Action Plan for Public Health page. 14 2.3 Building capacity of national and sub-  Number of training materials developed national levels for improving programs and  Percentage of health staff with awareness system performance to better cope with of CC impacts in health and the potential climate change and disaster risks. for vulnerability assessments,  Develop training materials and train health interventions, and the use of climate data staff and relevant stakeholders at different for early warning, surveillance and levels on climate change, public health and planning. disaster risks  Percentage of health staff with capacity to detect and respond to climate stress. 2.4 Developing early warning systems and  Functional alert system for early warning preparedness plans on potential health regarding the quality of the ambient air, effects of climate change, upcoming water, extreme events such as, drought, disasters and health related risks. landslides, floods etc, epidemic  Integration of climate data in Dengue Early preparedness to protect health Warning System (advocated by the WHO TDR)  Linking the Early Warning System of MOWRAM to the MOH Early Warning System (CamEWARN) for disaster related health emergencies Output III: Strengthened research, surveillance and vulnerability assessment capacity to guide decision making for adaptation to climate change impacts and disaster risks. 3.1 Conducting research and implementing  Number and types of researches and surveillance plans on key climate related surveillance conducted diseases and health risks at national and  Changes in or scale up of diseases control sub-national levels, especially in the high programmes especially in the high climate climate risk areas. risk areas  Strengthen vector surveillance and control programmes 3.2 Conducting health vulnerability assessment  Number of health vulnerability assessment and developing composite health climate completed at national and sub-national vulnerability indices levels  Epidemiological studies of daily mortality  Plans developed and implemented based and morbidity in relation to weather on the results of assessment variables  Availability and recently update of composite health climate vulnerability indices National Climate Change Action Plan for Public Health page. 15 3.3 Assessing the resilience and adaptive  Number of HCF assessed per province capacity of healthcare facilities to climate  Maps of vulnerable HCF produced risks and maps the vulnerability of healthcare facilities Output IV: Knowledge sharing, awareness, and web-based information management systems related to health vulnerabilities associated with climate change and disaster risks. 4.1 Improving health database systems and 1.4 Availability of updated essential baselines web-based management information for monitoring the health risks of climate systems by incorporating climate change change (e.g. priority climate-related variables, disaggregated gender data and diseases), environment (e.g. Climatic health climate indicators. variables), socioeconomics (e.g. poverty,  Updating Health Database with inclusion of demographics and occupation), and climate change variables and associated current level of interventions and health diseases; systems capacity 4.2 Developing knowledge products relating to  Types and number of knowledge products climate impacts, health implications, to raise awareness of health and climate vulnerability assessment and successful change and response options targeting key responses to CCA and DRR in the health audiences such as health professionals, sector. communities, media and other sectors developed and utilized 4.3 Promoting awareness among communities  Number and types of awareness raising and healthcare personnel on possible materials developed and utilized on health implications, prevention and possible health implications, prevention treatment of climate related diseases. and treatment of climate related diseases.  Percentage of healthcare personnel with information and training to address climate change and health links, appropriate to their role and function  Percentage of community members (men, women, boys, girls and indigenous people) reached through awareness raising activities Output V: Enhanced resilience of the existing health service delivery system to respond to and cope with the impacts of climate change and disaster risks. 5.1 Improving healthcare coverage with  Percentage of HCFs with adequate medical adequate medical staffing, stock of staffing and stock of medicine medicines and treatment guidelines in  Percentage of HCFs following treatment climate health sensitive areas, especially at guidelines in climate health sensitive areas the sub-national levels. National Climate Change Action Plan for Public Health page. 16 5.2 Promoting climate and disaster proofing of  Percentage of healthcare facilities healthcare infrastructure and facilities at incorporating climate Change and DRR in national and sub-national levels. siting, construction, technologies and  Integrating climate change consideration in procedures to ensure provision of basic the design of the HCF construction and services (including energy, water and operation guideline sanitation).  Percentage of HCFs that meet the criteria of climate appropriate and resilient to local current and expected disasters  Percentage of HCFs with access to energy and functional WASH services and practices that enable essential, quality health services for everyone 5.3 Promoting interventions at community to  Number of interventions implemented at reduce health risks associated with the community foodborne, waterborne and vector-borne disease  Awareness campaigns at the local communities on the health risk associated with foodborne, waterborne and vector- borne disease (linking to Action 4.3)  Provision of climate resilient water, sanitation and hygiene infrastructure in HCF in vulnerable setting Output VI: Effective financing mechanisms and a M&E framework for climate change adaptation and disaster risk reduction 6.1 Establishing a viable financial and  Percentage of budget allocated to increase mechanism for implementation of health resilience to climate change and DRR in adaptation /DRR plans. national and/or subnational health investment plans.  Number of Projects / Programmes on building health system resilience submitted to and granted by the main international climate change funds (e.g. the GCF, GEF, Adaptation Fund, bilateral donors). 6.2 Developing M&E framework for tracking  Number of climate sensitive diseases for effectiveness and efficiency of climate which there are monitoring systems that change adaptation and disaster risk are able to forecast and monitor risks reduction in the health sector. and/or to monitor disease risks posed by National Climate Change Action Plan for Public Health page. 17  Develop tools for M&E framework climate change and disaster risks  Operate M&E frame  Indicators on climate change impacts,  Field data collections vulnerability, response capacity and  Produce annual report and MTR emergency preparedness capacity included  Design an M&E framework for assessing in relevant monitoring systems at national the climate sensitive morbidity and level and reported over time. mortalities rate.  Essential baselines for monitoring the implementation of actions in the H-NAP 2019-2023 Management and Financing Mechanisms Analysis of Management Arrangement National Health System and Structure of MOH The MOH is the only government agency with a mandate to lead and manage the entire health sector in the Kingdom of Cambodia delivered by both public and private entities [3]. Since the public health reform in 1995, the RCG adopted three levels of the public health system (Figure 2). Since the NCCAPPH is at the national level, Figure 3 illustrates the institutional arrangement of Figure 2: Three Levels of Public Health System in Cambodia Source: HSP3 the Ministry of Health. National Climate Change Action Plan for Public Health page. 18 Figure 3: Organization Chart of the MoH Source: HSP3 Climate Change and Health Technical Working Group MOH created a Technical Working Group on Climate Change and Health (TWGCCH) on 09 July 2015, with the duties to coordinate, prepare and implement the action plan on climate change and public health with line ministries and relevant national and international organizations [34]. The Technical Working Group will play pivotal roles in coordination and implementation of the actions across the departments and agencies under MOH and the ministries. The TWGCCH is led by the Preventive Medicine Department (PMD) with representatives from the National Centre for Parasitology Entomology and Malaria Control, Department of Health Information and Map, Hospital Service Department, Comunicable Disease Controle Department Department Drugs and Food , National Centre of Maternal and Child Health, CNM, other Ministry such as Ministry of Water and Moteology , Ministry of Forest and Fishermen, Ministry of Environmental, Ministry of Education Youth and Sports, Ministry of Rural Development, and National Committee for Disaster Management. The PMD serving as a de facto secretariat to the TWGCCH has gained substantial capacity on climate change and health, notably since the development of Climate Change and Health Strategic Plan 2014-2018 in 2012/2013. Additionally, the department has experience in managing and implementing climate change projects (mostly with technical support from WHO and financial support from CCCA). Recently, the department has launched the implementation of a four-year project, building the climate-resilience of health systems, funded by GEF. Here are the projects that PMD has implemented:  Strengthening Country Capacity to Deal Effectively with Climate-sensitive Vector- borne and Waterborne Diseases and Reducing the Health Impacts of Disasters;  Vulnerability and Impact Research Targeting Usability and Effectiveness (VIRTUE); National Climate Change Action Plan for Public Health page. 19  Strengthening Resilience to Climate Change in the Health Sector in the Greater Mekong Subregion (ADB, TA-8898); and  Building climate-resilient of health systems (GEF Project). Analysis of Financing Mechanisms National Budget of MOH Ministry of Health is a dominant receiver of the national budget from the Royal Government of Cambodia. The current expenditure of MOH has increased three folds in the last 11 years, from around 500 Million Riel (around USD124 Million2) in 2009 to about 1.5 Billion Riel in 2019 (See Figure 43). The growth of budget of MOH goes along the general trend of increasing public expenditure of the government thanked to the robust economic growth at 7% annually. MOH was among the first ministries that implemented the programme-based budgeting and has four programmes and 22 sub-programmes. Table 34 provides the details of current expenditures for the four programmes for 2016 to 2019. Programme 2, communicable disease prevention and control, containing a subprogramme on malaria and dengue, is the most relevant to climate change. However, the expenditure for the programme is at 1.29% of the total budget of MOH in 2019. The bulk amount of MOH expenditure is for strengthening health system, mainly for providing health service and supporting health system at capital and provinces. 2 The exchange rate is USD1 = 4060 Riel (this is an indicative, not official exchange rate) 3 The data are from the National Budget Law for 2009 to 2019. 4 The data are from https://www.mef.gov.kh/budget-in-brief.html (accessed in July 2019). National Climate Change Action Plan for Public Health page. 20 Figure 4: MOH's Total Current Expenditure Table 3: Expenditure for Programmes of MOH in Million Riel (and in USD) Programme 2016 2017 2018 2019

1. Improving reproductive health, 74,353.20 73,075.60 95,924.80 116,612.80 maternal and new-born care, child ($18.31M ) 5 ($18 M) ($23.63M) ($28.72M) health including immunization, and nutrition

2. Communicable disease prevention 18,156.50 18,288.20 16,493.60 19,869.90 and control ($4.47M) ($4.5M) ($4.06M) ($4.48M)

3. Non-communicable disease 3,329.10 3,014.60 2,527.60 3,256.80 prevention and control, and public ($0.82M) ($0.74M) ($0.62M) ($0.8M) health interventions

4. Strengthening health system 1,014,952.50 1,107,476.20 1,279,028.00 1,405,785.50 ($249.99M) ($272.78M) ($315.03) ($346.25M) Climate Financing in Public Health The Climate Change Public Expenditure Reviews indicate that MOH has received fluctuating amount from 3.3% (16.9 Billion Riel) in 2012 to 3.4% (29 Billion Riel) in 2016 of the total climate financial for Cambodia from the national budget and donors [35]. The social sector (health, education and gender) shares smaller percentage in climate change expenditure compared to urban and rural infrastructures, irrigation, agriculture, fisheries and forestry. In 2017, MAFF, MOWRAM, MPWT, MRD received more than 80% of total climate change expenditure at 10.5%, 39.6%, 20.8% and 10.3% respectively, while MOH got 3.4%. 5 The exchange rate is USD1 = 4060 Riel (this is an indicative, not official exchange rate) National Climate Change Action Plan for Public Health page. 21 The financing gap for 2016 implementation of the MOH’s climate action (NCCAPPH 2014- 2018) was at 99.1% according to the study of General Secretariat of National Council for Sustainable Development with support from GIZ [36]. Table 4: Climate Change Expenditure in MOH 2012 2013 2014 2015 2016 2017 MOH’s climate change 16.9 32.7 28.5 46.2 29.7 29 6 expenditure in billion Riel ($4.16M ) ($8.05M) ($7.02M) ($11.38M) ($7.32M) ($7.14M) MOH’s climate change 3.3% 4.7% 3.2% 5.3% 4.3% 3.4% expenditure in percentage of total Total climate change 134.6 189.2 248.1 244.4 192.6 228.0 expenditure in million USD Potential Sources of Finance for NCCAPPH National budget continues to play a more important role in the implementation of NCCAPPH 2019-2023. As the national budget is projected to increase annually, the budget allocations to MOH and for climate change actions are expected to increase in the same trend (possibly at 7% growth rate). Aligning with national budget, the health pooled fund is equally important to fund the NCCAPPH. Thus, it is important to ensure that actions in the NCCAPPH are mainstreamed in the planning and budgeting of strategic plans, health pooled fund and programmes/projects under the Health Strategic Plan 3. Multilateral climate funds are the major financial sources for the climate change interventions in Cambodia. The funds presented here are the funds that have financed many adaptation projects in Cambodia and continued to play important role in financing adaptions. The financial mechanisms under the UNFCCC are Green Climate Fund (GCF), Adaption Fund (AF), Least Developed Country fund (LCDF), Special Climate Change Fund (SCCF) and Global Environment Facility (GEF). These funds focus mainly on the adaptation and particularly in the vulnerable countries like Cambodia. In addition, other sources of multilateral climate funds are from the Wold Bank through its Climate Investment Fund (CIF) and the Asian Development Bank (ADB). Bilateral funding is another potential source of financing the NCCAPPH. As at the time of writing, key bilateral development partners assisting Cambodia on climate change are USAID, UKAID, SIDA, and EU. Yet, China Aid is starting to play a more dominant role in funding infrastructures, for example the construction of China-Cambodia Friendship Preah Kossamak Hospital in Phnom Penh. Furthermore, the alignment of actions in NCCAPPH with the works of DPs and NGOs working on health is another potential to support the full implementation of NCCAPPH 2019-2023. 6 The exchange rate is USD1 = 4060 Riel (this is an indicative, not official exchange rate) National Climate Change Action Plan for Public Health page. 22 Entry points for climate change mainstreaming in management and financing mechanisms The current NCCAPPH 2019-2023 requires an estimation of budget around USD 16.6 million for implementation. The estimated of USD 16.6 million does not include the costs of two actions, namely action 5.1 and 5.2 on improving healthcare coverage and promoting climate and disaster proofing of HCF and infrastructures, respectively. The details of the costing are in the Annex. The Preventive Medicine Department leading the Climate Change and Health Technical Working Group of the MOH will manage and coordinate the NCCAPPH implementation building on their experiences and capacity from implementation of previous climate change responses by the MOH. A strong coordination with the relevant departments/programmes is critical to ensuring the integration and alignment of climate change actions in the budget plans and programmes/sub- programmes of MOH. Regular meeting of the TWGCCH led by the PMD are intended to build ownership of the climate change actions by relevant agencies and to ensure the integration of NCCAPPH into the annual planning and budgeting process and the programme-based budgeting of MOH. The integration of climate change actions in the budget programme may require Cost- Benefit Analysis (CBA) of the interventions to generate evidence for the budget negotiation with the MEF. The short-fall fund for implementation will be discussed with the development partners (DP) in regular meetings between Health-TWG and DP, and Climate Change-TWG and DP. Bilateral partners and UN Agencies are important to assist the MOH in mobilizing resources. The MOH will seek the support from the National Implementing Entities (NIE) and the Multilateral Implementing Entity under GCF to develop projects or programmes to implement the unfunded actions. As of now, there are two government agencies—NCDDS and GSSD, applying to be NIE under GCF. Monitoring and Evaluation Indicator Framework The M&E framework of the NCCAPPH follows the Monitoring and Evaluation Framework for Health Adaptation in Cambodia [37], aligned with the national climate change M&E framework [38] developed by the Department of Climate Change (of NCSD) with technical support from the IIED, UK. The Monitoring and Evaluation Framework for Health Adaptation in Cambodia was updated by MOH in collaboration with WHO under a research project called “Vulnerability and Impact Research Targeting Usability and Effectiveness (VIRTUE)” carried out in 2017 with funding from Cambodia Climate Change Alliance [37]. The updated indicator framework focuses on the ownership, sustainability and capacity building of the MOH to continuously tracking long-term trends related to the impacts of climate change on health. Since the health risks of climate change are not new, the indicators are based on data that are or could be collected. This framework outlines four indicator categories:  Health vulnerability and exposure  Burden of climate sensitive health outcomes  Health adaptation and resilience National Climate Change Action Plan for Public Health page. 23 Impact Indicators Table below presents the impact indicators. Indicator Definition Data Source Health vulnerability Percentage of communes’ Vulnerability index score Vulnerability index and exposure health that are vulnerable to calculated yearly for health risks of climate change climate change Health adaptation Percentage of budget in Total climate changeClimate Public and resilience health sector responding to expenditure by MOH (from Expenditure climate change donors and national budget) inReview conducted percentage of total national by MEF and GSSD climate change expenditure Burden of climate Incidence of dengue fever Incidence of dengue fever per MOH; sensitive health 100,000 population per NDCP/CNM; outcomes month, stratified by province DPHI; MOWRAM Incidence of malaria Incidence of malaria fever per MOH; 100,000 population per NDCP/CNM; month, stratified by province DPHI; MOWRAM Association of diarrhoea with Changes in slope of MoH, CDC weather data (modelled) association of diarrhoeal CamEWARN; (time-series analysis) disease and mean DPHI precipitation and MoWRAM temperature per 1000 population per month Result Indicators The result indicators are listed in the Table 2: Action Matrix. Law and Regulation to Support the Implementation In Cambodia, several key policies, legislations and regulations have been developed and amended to govern the public health and professional health practitioners, serving as a backbone to support the implementation of this action plan. In addition, to effective implementation of actions, there is a need to amend the Decision (Sechkdei Samrech) on the establishment of technical working group on climate change and health on 09 July 2015 [34]. The amendment has to cover the purpose, composition, duties and modus operandi of the TWGCCH. The Department of Preventive Medicine shall draft the amendment in 2019 and get the approval from the Minister ohf Health before 2020. National Climate Change Action Plan for Public Health page. 24 Box: Proposed amendment to the Decision (Sechkdei Samrech) on the establishment of technical working group on climate change and health dated on 09 July 2015 Article 1: Purpose of the technical working group on climate change and health to facilitate and coordinate the health sectoral responses to climate change and provide advisory support on the climate change and health to the policy makers in the MOH. Article 2: Composition of the TWGCCH shall lead by the Department of Preventive Medicine, and have representatives from 1) Department of Planning and Health Information, 2) Department of Communicable Disease Control, 3) Department of Hospital Services, 4) Department of Drug, Food and Medical Equipment, 5) National Centre for Parasitology Entomology and Malaria Control, and 6) Other relevant national centres and programmes under MOH. Article 3: Key duties shall include: 1) Lead the coordination to support the implementation of and report on CCHNAP, 2) Prepare relevant policy documents on climate change and health, 3) Mainstream climate change into the planning and budgeting process of MOH, 4) Provide technical and advisory support to MOH on climate change and health 5) Facilitate and coordinate the health sectoral responses to climate change; 6) Advocate the climate-health related challenges in the higher national policy agenda; and 7) Promote information, knowledge and data sharing inter- and intra-MOH to support the implementation, monitoring and reporting on the CC-H interventions. Article 4: TWGCCH shall have at least two meetings per year. Article 1: Purpose of the technical working group on climate change and health to facilitate and Conclusion This action plan consists of the continuous long-term planning and builds on the exiting efforts to address the climate change and health impacts in Cambodia. The selected actions are primarily built on actions prioritized in the previous national climate change action plan for public health and the National Action Plan for Climate Change Adaptation and Disaster Risk Reduction (not yet approved at time of writing this document). The actions also align with the existing projects on climate change and health being implemented by MOH. In addition, this document is contributing to the implementation of Health Strategic Plan 3, Cambodia Climate Change Strategic Plan 2014- 2023, and National Strategic Plan for Climate Change Adaptation and Disaster Risk Reduction in Health Sector (update to the National Climate Change Strategic Plan for Public Health). This action plan is in line with the vision of WHO Western Pacific Region toward the heathiest and safest region, in particular addressing the climate change and health challenges and specifically for monitoring the health impacts of climate and environmental change on health, ensuring the resilience of health sector, and addressing the identified gaps for further advocating the health impacts of climate change to higher policy level. National Climate Change Action Plan for Public Health page. 25 The full implementation of the action plan will level-up the capacity of the MOH to address climate change issues for the public health of Cambodia. The institutional capacity will be improved in coordination, monitoring and resource mobilization for implementation of the actions. In turn, the success of action plan relies on an effective coordination of the TWGCCH in building staff capacity, research, knowledge management, and implementation of intervention. The role of TWGCCH is critical not only during the development, but also more importantly during the implementation of the action plan. MOH believes that relevant government agencies, development partners and NGOs will support the measures identified in this document and together implement the actions in a timely and effective response, contributing to the reduction of the morbidity, mortality, injuries, and other health vulnerabilities related to climate change impacts and disaster risks in Cambodia. National Climate Change Action Plan for Public Health page. 26 References

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National Climate Change Action Plan for Public Health page. 29 ANNEX: Detail of Actions Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) Output I: Better governance, coordination, and partnership for climate change adaptation and disaster risk reduction in the health sector. 1.1 Mainstreaming climate change  Number of CBA and evidence-based TWGCCH, And ADB, WB, x x x x x 1000 adaptation and disaster risk studies conducted to support the relevant WHO, UNDP, management in MOH sector planning mainstreaming CCA and DRR in stakeholders, GIZ, etc. PMD, DPHI and budgeting. planning and budgeting MEF  Conduct cost-benefit analyses and  Number and types of advocacy NCSD (MOE) evidence-based studies to generate materials on the relationship evidences to advocate for planning between Climate Change and health and budgeting developed and utilized  Prepare and disseminate advocacy  Number of health sector policies/ materials (i.e. brochure of CBA, case strategies/ programs that studies, policy leaflets) to MOH’s incorporated the health issues in high-level decision makers, MEF, and relation to climate change and DRR. other stakeholders  Percentage of the national health  Work with planning and budgeting budget for climate change adaptation department to integrate action on CC and DRR and DRR in planning and budgeting, and annual operation plan. 1.5 Improving coordination within MOH,  Approved the Decision (Sechkei TWGCCH WHO-UNDP: x x x x x 1000 with MOH’s provincial department of Samrech) on TWG on CC and Health GEF project, Health and Healthcare  Number of collaboration mechanism etc. centres/hospital, and with other key for CC&H and DRR established with ADB, WB, GCF sectors to ensure coherence in relevant government agencies and response to climate change related with designated focal points for NCSD health impacts and disaster risks. specific programme of action and  Update the Decision (Sechkdei budget allocated. National Climate Change Action Plan for Public Health pg. 30 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) Samrech) on TWG on CC and Health,  Joint multisectoral risk management and get approval from minister of approaches to health risks related to health7 disasters, water, waste, food and air  Establish a joint multisectoral pollution (e.g. food safety, diarrhoeal working group for information disease control, integrated vector exchanges and joint actions to management, joined up risk address health impacts of climate communication) undertaken. change disaster risks  Establish coordination mechanism between health care staff and provincial committee for disaster management to better address climate change related impacts and disaster risks 1.6 Promote public and private  Roadmap to engage private sector to Department UNDP, GIZ, x x x 100 partnerships to support address climate change risk in public of WB, ADB, implementation of climate change health international WHO, etc. cooperation adaptation and disaster risk  Number of PPP established to and ASEAN reduction. support implementation of climate  Prepare a roadmap to engage private change adaptation and disaster risk TWGCCH sector and their contributions in reduction. addressing CC impacts on health sector  Sensitize and orient the private health care providers and facilities in preparedness and vulnerability reduction measures 7 An Update of TWG on CC and Health has taken place within the framework of GEF Project National Climate Change Action Plan for Public Health pg. 31 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) Output II: Strengthened institutional capacity and skills of medical personnel and relevant stakeholders to effectively plan and implement climate change adaptation and disaster risk reduction in the health sector 2.1 Assessing the capacity need of health  Number of technical guideline and TWGCCH WHO, ADB, X X X X 200 staff (national and sub-national) implementation practices updated to etc. through working with existing include the capacity need of national academia (i.e. NIPH), relevant and sub-national health staff to government agencies and WHO effectively address climate change aiming to update the health technical and DRR. guidelines and implementation practices 2.2 Incorporate climate change related  Climate change and health is TWGCCH WHO-UNDP: x x x x 500 health impact into academic integrated in the university GEF project, programmes for public health and programme for public health and etc. medical and to the curriculum of medical school MOEYS general education  Climate change and health is RUPP integrated in the curriculum of UHS general education NIPH 2.3 Building capacity of national and sub-  Number of training materials TWGCCH WHO, 2000 national levels for improving developed programs and system performance to  Percentage of health staff with better cope with climate change and awareness of CC impacts in health disaster risks. and the potential for vulnerability  Develop training materials and train assessments, interventions, and the health staff and relevant stakeholders use of climate data for early warning, at different levels on climate change, surveillance and planning. public health and disaster risks  Percentage of health staff with capacity to detect and respond to climate stress. National Climate Change Action Plan for Public Health pg. 32 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) 2.4 Developing early warning systems and  Functional alert system for early TWGCCH WHO-UNDP: X X X X X 1000 preparedness plans on potential warning regarding the quality of the GEF project, health effects of climate change, ambient air, water, extreme events DPHI, etc. CNM, upcoming disasters and health such as, drought, landslides, floods CDC UNDP related risks. etc, epidemic preparedness to  Integration of climate data in Dengue protect health MOWRAM Early Warning System (advocated by NCDM the WHO TDR)  Linking the Early Warning System of MOWRAM to the MOH Early Warning System (CamEWARN) for disaster related health emergencies  Output III: Strengthened research, surveillance and vulnerability assessment capacity to guide decision making for adaptation to climate change impacts and disaster risks. 3.1 Conducting research and  Number and types of researches and TWGCCH WHO-UNDP: x x x x 2000 implementing surveillance plans on surveillance conducted GEF project, key climate related diseases and  Changes in or scale up of diseases NIPH etc. UHS health risks at national and sub- control programmes especially in the ADB, GCF, national levels, especially in the high high climate risk areas HCF WB, GIZ, Etc climate risk areas.  Strengthen vector surveillance and control programmes  3.2 Conducting health vulnerability  Number of health vulnerability TWGCCH WHO, ADB, x x x x 500 assessment and developing assessment completed at national Etc. composite health climate and sub-national levels vulnerability indices Epidemiological  Plans developed and implemented studies of daily mortality and based on the results of assessment National Climate Change Action Plan for Public Health pg. 33 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) morbidity in relation to weather  Availability and recently update of variables composite health climate vulnerability indices 3.3 Assessing the resilience and adaptive  Number of HCF assessed per province PMD, NCSD, ADB, x x x x x 1000 capacity of healthcare facilities to  Maps of vulnerable HCF produced HSD WHO-UNDP: climate risks and maps the GEF project, vulnerability of healthcare facilities etc. Output IV: Knowledge sharing, awareness, and web-based information management systems related to health vulnerabilities associated with climate change and disaster risks 4.1 Improving health database systems  Availability of updated essential TWGCCH WHO, ADB X X X X X 200 and web-based management baselines for monitoring the health information systems by incorporating risks of climate change (e.g. priority WHO-UNDP: GEF project, climate change variables, climate-related diseases), etc. disaggregated gender data and environment (e.g. Climatic variables), health climate indicators. socioeconomics (e.g. poverty,  Updating Health Database with demographics and occupation), and inclusion of climate change variables current level of interventions and and associated diseases; health systems capacity 4.2 Developing knowledge products  Types and number of knowledge TWGCCH WHO, ADB, X X X X X 500 relating to climate impacts, health products to raise awareness of health implications, vulnerability assessment and climate change and response NCDM WHO-UNDP: GEF project, and successful responses to CCA and options targeting key audiences such etc. DRR in the health sector. as health professionals, communities, media and other sectors developed and utilized 4.3 Promoting awareness among  Number and types of awareness TWGCCH WHO-UNDP: X X X X 1000 communities and healthcare raising materials developed and GEF project, National Climate Change Action Plan for Public Health pg. 34 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) personnel on possible health utilized on possible health GCF, WB, ADB implications, prevention and implications, prevention and etc. treatment of climate related treatment of climate related diseases. diseases. HCF:  Percentage of healthcare personnel Healthcare with information and training to facilities address climate change and health links, appropriate to their role and PHD function  Percentage of community members MRD, MOWA, (men, women, boys, girls and NCDM indigenous people) reached through awareness raising activities Output V: Enhanced resilience of the existing health service delivery system to respond to and cope with the impacts of climate change and disaster risks. 5.1 Improving healthcare coverage with  Percentage of HCFs with adequate TWGCCH WHO, ADB, x x x x x (tbc) adequate medical staffing, stock of medical staffing and stock of WB, GIZ, etc. medicines and treatment guidelines medicine MEF in climate health sensitive areas,  Percentage of HCFs following China Aid especially at the sub-national levels. treatment guidelines in climate health sensitive areas 5.2 Promoting climate and disaster  Percentage of healthcare facilities TWGCCH WHO, ADB, x x x x (tbc) proofing of healthcare infrastructure incorporating climate Change and WB, GIZ, GCF and facilities at national and sub- DRR in siting, construction, Unicef, etc. national levels. technologies and procedures to WHO-UNDP:  Integrating climate change ensure provision of basic services GEF project, consideration in the design of the (including energy, water and etc. HCF construction and operation sanitation). guideline  Percentage of HCFs that meet the MEF, MRD criteria of climate appropriate and China Aid National Climate Change Action Plan for Public Health pg. 35 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) resilient to local current and expected disasters  Percentage of HCFs with access to energy and functional WASH services and practices that enable essential, quality health services for everyone 5.3 Promoting interventions at  Number of interventions TWGCCH WHO, Unicef, x x x x 5000 community to reduce health risks implemented at the community ADB, WB, GIZ, associated with foodborne, etc. waterborne and vector-borne disease  Awareness campaigns at the local MRD communities on the health risk associated with foodborne, waterborne and vector-borne disease (linking to Action 4.3)  Provision of climate resilient water, sanitation and hygiene infrastructure in HCF in vulnerable setting Output VI: Effective financing mechanisms and a M&E framework for climate change adaptation and disaster risk reduction 6.3 Establishing a viable financial and  Percentage of budget allocated to TWGCCH WHO, UNDP, x x x x 200 mechanism for implementation of increase resilience to climate change UNFPA, ADB, health adaptation /DRR plans. and DRR in national and/or GEF, etc. subnational health investment plans. NCSD-CCCA  Number of Projects / Programmes on building health system resilience submitted to and granted by the main international climate change funds (e.g. the GCF, GEF, Adaptation Fund, bilateral donors). National Climate Change Action Plan for Public Health pg. 36 Year Total Cost Activity Cluster Indicator Responsibility Partners 2019 2020 2021 2022 2023 (USD 000) 6.4 Developing M&E framework for  Number of climate sensitive diseases TWGCCH WHO, x x x x 400 tracking effectiveness and efficiency for which there are monitoring of climate change adaptation and systems that are able to forecast and WHO-UNDP: GEF project, disaster risk reduction in the health monitor risks and/or to monitor etc. sector. disease risks posed by climate change  Develop tools for M&E framework and disaster risks  Operate M&E frame  Indicators on climate change impacts,  Field data collections vulnerability, response capacity and  Produce annual report and MTR emergency preparedness capacity  Design an M&E framework for included in relevant monitoring assessing the climate sensitive systems at national level and morbidity and mortalities rate. reported over time.  Essential baselines for monitoring the implementation of actions in the H- NAP 2019-2023 National Climate Change Action Plan for Public Health pg. 37