Climate Change Health Adaptation Strategy and Action Plan (2023-2030)

Government of Nepal Ministry of Health and Population Ramshahpath, Kathmandu 2023 Health National Adaptation Plan Climate Change Health Adaptation Strategy and Action Plan (2023-2030 AD) Health National Adaptation Plan Climate Change Health Adaptation Strategy and Action Plan (2023-2030 AD) Ref: Government of Nepal 262987 262590 Phone: 4. 262802 262706 262935 262862 Ministry of Health & Population Ramshahpath, Kathmandu Nepal Ministry of Heal th and Population Government of Nepa Ramshahpath, Ka thmandu Date: Foreword Nepal is one of the most affected countries in terms of climate change, and the impact of climate change on human health has become a matter of serious concern for all of us. In this context, the publication of the second phase of Health National Adaptation Plan: Climate Change Health Adaptation Strategy and Action Plan (2080-2087) is a matter of great joy. This adaptation plan has been prepared based on various commitments and policy decisions made by the Government of Nepal at both national and international levels. The main objective of this adaptation plan is to minimize the adverse impacts of climate change on human health. Additionally, this plan will serve as a useful reference document for policymakers, decision-makers, planners, managers, academicians, researchers, and other relevant stakeholders to strengthen the health adaptation mechanism in the country. The impacts of climate change have started to be experiencėd in most parts of Nepal, posing a risk to public health. Nepal's National Climate Change Policy has identified public health as one of the most vulnerable sectors to the negative effects of climate change. In the health sector, the issues of infectious diseases, injuries and mental illness have been increasing due to contaminated water and food, air pollution, drought and lack of nutrition. The increase in temperature has directly and indirectly increased the incidence of communicable diseases such as various vector, food and waterborne diseases. The Dengue and other vector borne diseases become prevalent in all 77 districts in Nepal in recent years. Disasters like flood and landslide caused by heavy rainfall are causing public health emergencies. The temperature is rising in Nepal and it is impossible to deny that it will rise rapidly in the coming years due to population growth, excessive consumption of fossil fuels, an increase in number of vehicles, development activities and changes in the agricultural pattern and various other factors. As a result, the impact of climate change will also increase, and it will have more direct impact on human health. I express my gratitude to all the members of the Technical Working Group under this ministry, stakeholders and experts who provided constructive suggestions during the preparation of this Health National Adaptation Plan. The chief of the Health Coordination Division, Dr. Chuman Lal Das is appreciated for his tireless efforts in the publication of this adaptation plan. I would like to give special thanks to Dr. Samir Kumar Adhikari, Senior Health Administrator of the Ministry of Health and Population and Health Education Officer, Hema Raj Neupane for their coordination at various levels. I am thankful to the World Health Organization Nepal for providing necessary financial and technical support. In addition, Er. Raja Ram Pote Shrestha, National Professional Officer of WHO Country Office for Nepal deserves thanks for his continuous technical support and overall facilitation. I would also like to thank Dr. Manish Baidhya and Mr. Upendra K.C. of WHO Nepal for technical inputs and necessary coordination. I would like to acknowledge the contribution of Dr. Meghnath Dhimal and the entire team of Nepal Health Research Council for providing technical inputs. Last but not the least, I would like to express my gratitude to the entire team for good collaboration in preparing this adaptation plan successfully. Dr. Roshan Pokhrel Secretary I Table of Contents Acronyms III Executive summary V Background 1 Need for National Climate Change Health Adaptation Plan 2 Current climate-sensitive health risks in Nepal 3 Vulnerability and the adaptation assessment of health impacts of climate change in Nepal 4 National Policies, Plans and Strategies to address Climate Sensitive Health Risks in Nepal 6 Vision, Mission and Goal 10 Objectives of Health National Adaptation Plan to Climate Change 10 Implementation Strategies 10 Monitoring and Evaluation 12 Financial aspects 14 Action Plan for Climate Change Health Adaptation Strategy (2023-2030) 15 II III °C Degree Celsius AR6 Sixth Assessment Report AWPB Annual Work Plan and Budget CDC Curriculum Development Centre COP Conference of Parties DHM Department of Hydrology and Meteorology DoHS Department of Health Services DWSSM Department of Water Supply and Sewerage Management EDCD Epidemiology and Diseases Control Division e.g. Example etc. et cetera FBDs Food-Borne Diseases FCDO Foreign, Commonwealth and Development Office GCF Green Climate Fund GEF Global Environment Facility GESI Gender Equality and Social Inclusion GIZ Germany Agency for International Cooperation GoN Government of Nepal H-NAP Health National Adaptation Plan IPCC Inter- governmental Panel on Climate Change LDCs Least Developed Countries MoCIT Ministry of Communication and Information Technology MoEST Ministry of Education Science and Technology MoF Ministry of Finance MoFAGA Ministry of Federal Affairs and General Administration MoFE Ministry of Forests and Environment MoHA Ministry of Home Affairs MoHP Ministry of Health and Population MoWCSW Ministry of Women, Children and Social Welfare MoWS Ministry of Water Supply MToT Master Training of Trainers NAP National Adaptation Plan NAPA National Adaptation Programme of Action NDC Nationally Determined Contribution NDRRMA National Disaster Risk Reduction and Management Authority Acronyms IV NHEICC National Health Education Information and Communication Centre NHRC Nepal Health Research Council NHTC National Health Training Centre no. Number NPC National Planning Commission NPHL National Public Health Laboratory PHTC Provincial Health Training Centre RCP Representative Concentration Pathway SOP Standard Operating Procedure TWG Technical Working Group UNFCCC United Nations Framework Convention on Climate Change USAID United States Agency for International Development USD United States Dollar VAA Vulnerability and Adaptation Assessment VBDRTC Vector Borne Disease Research and Training Centre VBDs Vector-Borne Diseases WASH Water Sanitation and Hygiene WBDs Water-Borne Diseases WHO World Health Organization V Executive Summary Earth’s climate is changing rapidly. The greenhouse gases such as carbon dioxide, methane, nitrous oxide, ozone etc., is increasing in the earth's atmosphere especially due to human activities and resulting in increasing earth’s temperature. The events of heat waves, droughts, fires, floods, cold waves, famines and epidemics have been affecting human health as the average temperature of the atmosphere is increasing globally. According to the internationally renowned Lancet Journal Report 2021, worldwide 5 million deaths are linked with extreme heat and cold temperatures. Health is one of the major and important sectors affected by climate change. In the health sector, the problems of diseases, injuries and mental illness are increasing due to contaminated water and food, air pollution, drought and malnutrition. The increased temperature has been directly and indirectly causing increased cases of communicable diseases such as vector, food and waterborne diseases. Disasters like flood and landslide due to heavy rainfall have been causing public health emergencies. So, it is inevitable to develop a climate-resilient health system through development of appropriate strategies in the health sector in order to mitigate the adverse impacts of climate change. The different commitments made by Nepal at national and international level, Constitution of Nepal 2015, National Health Policy 2019, National Climate Change Policy 2019, Environment Protection Act 2019, Public Health Service Act 2018, Fifteen plan 2019-2024, National Adaptation Plan 2021-2050 and various policy and programs have guided to prepare and implement the national climate change health adaptation strategies and action plan. The main principle of National Climate Change Health Strategy is to protect the health sector from the impacts of climate change through appropriate collaboration in the health sector. Similarly, the strategy helps in effective implementation of National Adaptation Plan (NAP) prepared by the Government of Nepal for the period of 2021-2050. The vision, mission and goal of this strategy are as follows: Vision: Climate Resilient Health System. Mission: Minimize the impacts of climate change on health through coordination and collaboration between federal, provincial and local levels and other stakeholders. Goal: Adopt appropriate adaptation measures to minimize adverse impacts of climate change on Health. National strategic objectives of climate change health adaptation strategies: 1. Raise awareness, advocacy and build capacity on climate change. 2. Manage the identification, prevention, control and treatment system of climate sensitive health risks including development of disease surveillance, preparedness and response system. 3. Develop and promote environment friendly and climate-resilient physical infrastructure and technologies. 4. Mainstream climate change adaptation in health policies, strategies, and plans at federal, provincial, and local levels. 5. Collaborate and coordinate with multi-stakeholders to minimize health risks through study, research and knowledge promotion on climate change and health. VI 1 Background Climate is the average weather conditions observed in a place over a long period of time. Climate change and associated health risks have now become a major issue globally. The climate has been continuously changing since the formation of the earth. In recent centuries, due to the human activities, the pace and process of climate change has become unnatural, as a result, the greenhouse gases like carbon dioxide, methane and nitrous oxide are increasing in the earth’s atmosphere and the temperature of the earth has been increasing due to these greenhouse gases. The United Nations Framework Convention on Climate Change (UNFCCC) defines the “climate change” as a change of climate which is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods. Climate change is exerting both direct and indirect impacts on human health and different sectors all over the world. The sixth assessment report (AR6) of the Intergovernmental panel on climate change (IPCC) reported that more than 40% of the population globally are at high risk of climate change. Globally, the temperature of the earth's surface has been increasing at an average rate of 0.08 degrees Celsius per decade since 1880. The Paris Agreement of the Conference of Parties (COP) 21 committed to limit the temperature increase up to 1.5 degrees by the year 2100. But according to various study reports, it is estimated that the temperature of the earth's surface will increase by 1.5 to 2.7 degrees by that period. The report clearly states that the changes in the ecological system led to the extinction of different species and impacts on human health and livelihood. Around 3.6 billion people in the world are at high risk of climate change. Along with climate change, infectious diseases continue to spread around the world. Due to the increase in temperature, the most vulnerable people are the elderly and children, the disabled and the chronic patient. Asian, South American and African countries have been facing an epidemic due to delay in the diagnosis of the disease, lack of proper treatment and lack of knowledge to protect from the disease related with spread of other vector borne diseases along with covid. The effects and events of climate change have been seen in all sectors in Nepal. If the temperature continues to rise in this way, it is estimated that the additional risk of climate and disasters will increase, which will directly affect people, economy, environment and development. Despite low greenhouse gas emission of Nepal, Nepal is at high risk of adverse effects of climate change due to its weak geology, topography and diverse ecological system. The high risks in the country are associated with impacts such as flood, landslide, cold wave, depletion of water sources, long droughts, extreme rain, low rainfall, forest fires and increased epidemics of new diseases. The annual average temperature has increased by 0.02 °C/year during 1980-2020 with a significant decrease in annual rainfall in Nepal at a rate of 4.8mm/year. Similarly, the annual maximum temperature has increased by 0.03 °C/year during the same period. The negative effects of climate change, the threat of disasters, including accidents, violence and injuries add three times the burden on Nepal's health sector. In the past 41 years, the effects of climate-induced hazards such as floods, landslides, and fire events have increased in the hills and lowland regions. The disease, injuries and mental illness related problems associated with contaminated water and food, air pollution, droughts and malnutrition have been increasing in the health sector due to climate change. The increase in temperature has, directly and indirectly, increased the epidemic of various vector and water related communicable diseases. The National Climate Change Impact Survey, 2016 carried out by Central Bureau of Statistics mentioned that 89 percent, 99 percent and 40 percent of household reported increase in temperature, drought and human health-related diseases respectively. Climate Change created a favorable environment for carriers of disease transmission, which led to continuous increment in infection resulting in emerging new diseases and reemerging previously eliminated diseases and appearance of diseases in places where there was no disease prevalence causing impact on human health. It is confirmed with the increase in prevalence, occurrence and severity of diseases such as malaria, kala-azar and Japanese encephalitis. According to the Vulnerability and Adaptation Assessment of Climate Sensitive Diseases and Health Risks report 2022, 17 districts of the Terai and Hills: Banke, Bara, Dhading, Dhanusha, Jhapa, Kailali, Kaski, Kathmandu, Mahottari, Makwanpur, Morang, Rautahat, Rupandehi, Saptari, Sarlahi, Sunsari 2 and Taplejung are at high level of climate induced risks. Similarly, according to the same report 15 districts of Terai, Mountain and Hill: Dang, Dhanusha, Kailali, Kanchanpur, Kapilvastu, Mahottari, Saptari, Sarlahi, Siraha, Salyan, Bajhang, Bajura, Humla, Kalikot and Mugu are at high risk of climate-induced diseases such as vector, water/food-borne, respiratory, mental illness and malnutrition. Therefore, it is necessary to analyze the current and future health risks and identify climate adaptation options to prepare sector specific adaptation plans at the national and international levels. The Government of Nepal, with support from development partners, has been implementing various climate change adaptation projects in Nepal. The Ministry of Health and Population made a commitment at COP26 to update the National Health Adaptation Plan. In this context, the Ministry of Health and Population in collaboration with and support from the World Health Organization has updated Vulnerability and Adaptation Assessment of Climate Sensitive Diseases and prepared Health National Adaptation Plan (H-NAP). Need for National Climate Change Health Adaptation Plan Nepal is a party to United Nations Framework Convention on Climate Change (UNFCCC), which was institutionalized nearly three decades ago i. e. in 1992, to address the climate change issues. The article 1 of the convention has considered health sector as one of the adversely affected sectors by climate change whereas the article 4 requires the commitment of member countries for the effective implementation of adaptation measures and Greenhouse gas (GHG) mitigation policies. UNFCCC and Kyoto Protocol adopted in 1997 have provided legal frameworks for climate change related international process and agenda. In response to this, the UNFCCC secretariat organizes annual Conference of Parties (COP) and discusses on implementation of both legal provision and commitments made by the member countries. Parties to the UNFCCC have committed to provide financial support to the developing countries to develop and implement the National Adaptation Plan (NAP). Such adaptation fund provided by the developed countries to the developing ones should be accessible to everyone. The Developing Countries can receive grant through Green Climate Fund (GCF) for the implementation of adaptation and resilient programs. The UNFCCC conference held in 2010 in Cancun has decided to develop and effectively implement National Adaptation Plan. Considering the importance of public health, the National Adaptation Programme of Action to Climate Change (NAPA) prepared in 2010 identified public health as one of most vulnerable sectors to climate change. The meeting of the Southeast Asian member countries of the World Health Organization made a commitment to build a Climate Resilient Health System through the "Male Declaration 2017". Accordingly, Nepal has prepared and implemented the Climate Change Health Adaptation Strategy and Action Plan 2072-2077 under the National Health Adaptation Plan to effectively address the issue of climate change in the health sector. National Adaptation Plan should consider health sector as an important part to achieve the goals related to health sector. The exclusion of the health sector in adaptation plan may miss the important opportunity in protecting human health. So, there is a need of Health National Adaptation Plan (H-NAP) to effectively address the health sector and to achieve the objective of health adaptation. The planning of National Health Adaptation Plan has followed guiding principles prepared by Least Developed Country Expert Group (LEG). The principles are as follows: • The National Adaptation Plan is prepared by the state, and it takes full ownership. • Health Adaptation Plan should be prepared on the basis of best appropriate and available evidence. • The preparation and implementation of climate change health adaptation programs should be incorporated in existing local and national initiatives. • The climate change health adaptation should be integrated in national health planning strategy, process and monitoring systems. 3 • Climate change health adaptation should be flexible and relevant to the subject. The National Health Adaptation Policy should be implemented effectively considering national condition, available information and experience on climate change through institutional arrangement and necessary resource mobilization. • Ensuring that the health adaption plan is coordinated with the overall NAP process. The World Health Organization has stated that the Health National Adaptation Plan (HNAP) should be considered as part of the National Adaptation Plan process when developed by the Ministry of Health of any country. HNAP development is required for: promoting and facilitating coordinated and inclusive climate change and health planning among health stakeholders at different levels of government and across health determining sectors ensuring prioritization of actions to address the health impacts of climate change; enhancing health sector access to the climate funds; linking the health sector to national and international climate change agendas, including an increased emphasis on health co-benefits of mitigation and adaptation actions in other sectors. This HNAP has been prepared by adopting “Quality Criteria for Health National Adaptation Plan” prepared by World Health Organization. The quality criteria outline the actions to build climate-resilient health and climate-resilient health systems. The quality criteria cover the following six areas. 1. Leadership and enabling environment 2. Cross-sectoral coordination and policy coherence 3. Comprehensive coverage of climate-sensitive health risks 4. Comprehensive coverage of adaptation options and actions 5. Resourcing 6. Monitoring, evaluation and reporting Current climate-sensitive health risks in Nepal All sectors started experiencing the impacts of climate change. The National Adaptation Program of Action identified public health as one of the most vulnerable sectors to climate change. The various study reports have suggested that due to the changes in weather pattern, the effects like current health problems, morbidity and mortality have been increasing day by day. Indicators related to Hydrology and Meteorology include temperature rise, flood, landslide, glacier lake outburst, desertification, drying up of water sources, drought, etc., and the risk in the health sector has been increasing due to these reasons. The health of vulnerable communities (women, children, disabled, senior citizens) are at risk due to limited access to health services, lack of awareness about healthy lifestyle and behavior, household and professional workload, lack of financial resources and similar factors. The climate change affected agriculture, energy, water resources, forestry etc. which has resulted direct and indirect adverse impact to the vulnerable communities. In developing country like Nepal with a wide coverage of mountainous region, there are many challenges relating to research activities regarding climate change and its impact on health. The inadequate trained human resources, poor economic condition, lack of data and appropriate research methodology etc. are some of the current challenges. Vector borne diseases (Malaria, Kala-azar, Dengue, Japanese Encephalitis, Scrub Typhus, Zika and Chikanguinya), food and water borne diseases (Cholera and Diarrhea), respiratory and other climate sensitive diseases (Malnutrition and mental illness) are considered as climate sensitive health outcomes. The risk of climate change on health varies based on demographic characteristics, geographical location and occupational group, social, cultural and political aspects. The health sector of Nepal has been practicing measures to address the prevalence of various types of diseases through preventive and curative promotion programme. 4 The health risks associated with climate change in Nepal are as follows: • There is an increasing risk of vector-borne, water-borne and food-borne diseases especially in Hilly and mountain region and dengue infection has been seen recently in all 77 districts of Nepal as a proof of this. • There has been a significant rise in non-communicable and respiratory diseases associated with air pollution, smoke especially in urban areas. • Most districts of Terai region are affected by heat waves which may lead to problems such as cardiovascular disease, dizziness, blood pressure, heat stroke and skin diseases, difficulty in working in the outdoor environment. • Due to the cold waves, many people are suffering from respiratory disorders such as common cold and pneumonia and most people died due to cold in the past years. • Eye and skin related problems are increasing as well as mental illness are also increasing day by day due to increasing climate change. • There has been a significant rise in mental illness due to extreme climate events such as drought, flood and landslides. • Risk of malnutrition is increasing due to decreased food production. • There is a decline in the working abilities of people who are vulnerable to climate change. • Due to the climate change, there has been a rise in the rate of illness among women, children and people with disabilities and elderly citizens. Due to climate change, especially poor, developing landlocked and mountainous countries have been affected. As Nepal is affected by climate change, it is necessary to formulate policies and programs to minimize its effects. Managing the impacts of climate change requires concerted efforts, collaboration and cooperation among all levels of government, non-government organizations, educational institutions, health institutions, communities, etc. Vulnerability and adaptation assessment of health impacts of climate change Climate change has affected the social and environmental condition that human need, such as drinking water, clean air, adequate food etc. Human health and climate change are closely inter-related. Along with climate change, the natural disaster such as flood, landslide, irregular rainfall, heat waves, cold waves and the rise in earth’s surface temperatures has led to an increased occurrence of vector and water-borne diseases and other physical and mental health illness. A sound vulnerability analysis is necessary in terms of the risks arising from climate change in order to formulate policies and implement activities related to adaptation. The Ministry of Health and Population has prepared Vulnerability and Adaptation Assessment (VAA) report in 2023 and the report has classified the health impacts of climate change into four categories in terms of risk and adaptation assessment in Nepal: 1) Vector-borne diseases (malaria, kaalazar, Japanese encephalitis, scrub typhus, dengue, Zika and chikungunya) 2) Food-borne and water-borne diseases such as cholera and diarrhea (acute gastroenteritis) 3) Respiratory diseases and 4) Other climate sensitive diseases (malnutrition, mental illness). 5 The key findings obtained from the above-mentioned study are as follows: • Vulnerability has become more complicated due to climate sensitive geographical conditions and inherent poverty. • Changes in the rainfall pattern for longer period of times leading to drought has increased the risk of malnutrition and diarrhea. • Among total population 52%, 87%, 54% and 30% are more sensitive towards vector borne diseases such as Malaria, Lymphatic Filariasis, Japanese Encephalitis and kala-azar respectively. • According to the Malaria Micro-Stratification Report published by the Epidemiology and Diseases Control Division in 2019, out of total 6,743 wards in 77 districts, 2,686 wards were identified as being at risk of malaria infection. • Malaria is increasing in Hill (Dailekh, Gulmi, Lamjung, Nuwakot, Pyuthan, Salyan) and Mountain (Bajura, Dolakha, Humla and Mugu) districts. • The cases of Kala-azar reported from Dolpa district in 2017 were above the national elimination level. Similarly, 53% of total Kala-azar cases reported in 2018 was from those districts which are considered as non-endemic to Kala-azar. • The geographical spread of kala-azar disease in the hilly and mountain districts is becoming terrifying. With the confirmation of kala-azar infection at the local level, the new 6 affected districts were from hilly and mountainous districts. • The rise in cases of cutaneous leishmaniasis and mucocutaneous leishmaniasis has been creating a crisis in its eradication efforts in Nepal. • Nepal is at high-risk zone for Cholera and each year it has been emerged as epidemic due to contaminated water. The Cholera has been more frequent in hill and mountain district and also increasing in Terai as well and recently, Kathmandu, Bhaktapur, Lalitpur, Nuwakot and Dhading has become hotspot for cholera. • In Nepal, Dengue epidemic has been reported in every 2-3 years as a seasonal cycle. In 2022, 54,784 cases of dengue have been reported along with 59 deaths. Dengue has been emerged as a biggest problem in Nepal. Four serotypes of dengue virus have been found in Nepal. • Research have proved that with 1-degree Celsius rise in average temperature, diarrhea among under 5 children will increase by 4.39%. • Many people are suffering from health-related issues such as breathing problem, the common cold and pneumonia which have been attributed due to cold waves and in the last three years, many people have died due to the cold. The data shows that from 1974 to 2014, 822 people died due to cold waves. • Water sources are drying up and due to the lack of water, especially women and children have to invest more time in fetching water. This situation has also led to increased economic fragility and a water crisis. • According to the projection of climate health risk category 2030 in RCP 4.5, the most vulnerable districts are Sunsari, Rautahat, Siraha, Morang, Jhapa, Mahottari and Saptari. • All individuals and communities are impacted by climate change. But not all are equally or equally affected as it depends on factors such as geographical conditions, health system preparedness, health conditions, age, social class and supportive initiatives etc. 6 National Policies, Plans and Strategies to address Climate Sensitive Health Vulnerabilities in Nepal 1. Constitution of Nepal, 2015 The Constitution of Nepal 2015, article 30 defines that it is the fundamental right of every citizen to live in a clean and healthy environment (GON, 2015). Similarly, in article 35 there is a provision of ensuring the right to free basic health services and access to clean drinking water sanitation and hygiene for every citizen. 2. National climate change policy, 2019 Reducing the risk of climate change impacts and providing policy guidance for developing resilient society at various levels and thematic areas is the objective of National Climate Change Policy 2019. Agriculture and food security, forest biodiversity and watershed conservation, water resources and energy, rural and urban habitats, industry transport and physical infrastructure, tourism and natural and cultural heritage, health, drinking water and sanitation, disaster risk reduction and management are the eight thematic areas and four cross cutting areas in this policy. In this context, to encourage health, drinking water and sanitation and climate change related studies, research, technology development and dissemination following topics have been addressed in detail: • Limit the transmission of climate induced vector-borne and communicable diseases epidemics by developing preparedness, forecasting and control mechanism • Enhance access and easy availability of clean drinking water by protecting water sources, collecting and storing rainwater and developing and expanding water efficient technologies • Segregate the households, hotel business and hospitals waste at source for properly managing harmful and hazardous waste and encouraging the use of biodegradable waste for energy production • Conduct regular research and studies on the effects of climate change in various thematic areas and consider their results in decision-making process • Develop technology to minimize carbon mixed pollutants (black carbon) and other greenhouse gases emission from water, land and air pollution. • River, avalanche, wetland and sensitive ecosystems will be regularly monitored for risk with scientific analysis • Alongside pinpointing domestic resources for enacting these policies, enhance equitable access to international financial resources and mobilize in a fair manner • Upon mobilizing climate finance, 80 percent of the funds will be allocated towards implementing programs at the local level 3. Environment Protection Act, 2019 The need of a clean environment for healthy life of all living beings has been comprehensively emphasized in the Environment Protection Act, 2019. Chapter 4 of this Act, specifically includes provisions related to climate change. In order to provide information about the adverse effects and risks to biological diversity, periodic studies should be carried out and the findings should be made public. Similarly, in order to avoid the adverse effects and risks of climate change, the ministry at national level, provincial ministry at provincial level and local authorities at local level can develop and execute an adaptation plan. The Government of Nepal will be able to identify areas that emit green-house gases and determine their national baseline level. The ministry can measure or arrange provisions 7 for the measurement of green house gases emission. In relation to sectoral policies, strategies or action plans for the management of effects and risks caused by climate change and measures to be adopted for mitigation, the government of Nepal may publish notices in gazette and issue necessary orders. In order to determine priority of issues to be implemented in urban and rural areas regarding the adverse effects and risk reduction of climate change, the government of Nepal will determine the necessary criteria and implement them. Similarly, for reduction of carbon emission and storage, this act clearly states that the government of Nepal can engage in carbon trading with foreign governments, organizations, commercial bodies or private sector as established by international treaties. 4. National Environment Policy, 2019 The national environment policy aims to attain sustainable development by maintaining balance between development and environment conservation, ensuring compliance with environmental laws, regulations and commitments, and fostering coordination and collaboration in environmental management efforts. The aim of this policy is to safeguard citizen’s right to inhabit a clean environment by pollution control, waste management and the promotion of green initiatives. Its objectives encompass preventing, controlling, and reducing various forms of pollution such as water, air, soil, sound, electromagnetic waves, chemical and radioactive contaminants, while also effectively managing waste generated across all sectors, including domestic, industrial and service -related activities. Furthermore, there exists a provision for the establishment of parks and expansion of green spaces in both urban and suburban areas, as well as ensuring environmental justice for those affected by pollution. There are arrangements for research and capacity building for environmental protection and management. It is the responsibility of the nation to ensure the utilization of natural and man-made resources in a way that is fair to the environment and future generations. To address this requirement, the formulation of National Environment Policy has been grounded in the necessity for collaborative coordination among the three tiers of government, civil society, community, private sector and individual public. Within the scope of this policy, the federal, provincial and local levels can implement programs. 5. Environment Protection Regulations, 2020 In paragraph 4 of this regulation, climate change related regulations are mentioned. The Ministry should publish a national report every five years on the status of climate change, its impacts and risks. In Section 26, the Ministry has to prepare and implement a National Adaptation Plan every ten years. Similarly, in section 27, there is a need to take mitigation actions. The Ministry, in collaboration with relevant ministries is responsible for preparing and updating every decade the national baseline levels for greenhouse gas emissions from sectors such as energy, industry, agriculture, forestry and land use and waste management. Furthermore, it is mentioned in article 28 of paragraph 5 that they can participate in carbon trading. 6. National Health Policy, 2019 In a federal structure, developing and expanding a health system that ensures access and utilization of quality health care services for all categories of citizens is the goal of this policy. This is anchored in principles of social justice and good governance. This policy has 6 objectives, one of which is to create an opportunities for all citizens to enjoy their rights related to health provided by the constitution. In 6.11 of the National Health Policy, it is mentioned that integrated preparedness and response measures will be adopted to combat communicable diseases, insect-borne and animal-borne diseases, climate change and other diseases, epidemics control and disasters management. For this, following major strategies have been adopted. 8 a. Programs to reduce adverse effects on health due to climate change will be revised and developed in collaboration and coordination with stakeholders. b. A notification system of classified/listed diseases will be developed and implemented. c. To promptly address disasters and epidemics, mechanisms will be established at all levels, encompassing capacity development, formulation and implementation of preparedness and response plans. Additionally, mobile hospital services will also be organized. 7. The Public Health Service Act, 2018 Chapter-5 of the Public Health Service Act mentions, social, cultural and environmental determinants for the protection, promotion and improvement of public health. In order to control and minimize the adverse effects on public health in relation to noise, air, water and visual pollution, including sanitation and waste management, it is mentioned that the government of Nepal will determine the relevant standards in accordance with the federal law. 8. National Adaptation Programme of Action to Climate Change (NAPA), 2010 National Adaptation Programme of Action to Climate Change (NAPA) has identified public health as high risk area of negative effects from climate change. NAPA has analyzed public health as a distinct area emphasizing its significance and has prioritized the following activities for addressing the challenges related to climate change. • Utilize evidence-based research to guide public health programs aimed at mitigating adverse impacts of climate change on public health in Nepal • Sensitize the public about the negative effects of climate change on public health through education or awareness raising. • Increase investments for disease outbreaks and emergencies • Promote programs related to vector, water and food-borne diseases and disaster management • Strengthening surveillance, forecasting, early warning and preparedness and research systems related to climate change and health 9. Fifteenth Five-Year Plan (2019-2024) The Fifteenth Plan has included climate change as an interconnected thematic area. Its goal is to contribute to building a sustainable society by increasing climate change adaptation capacity and reducing adverse effects. This plan has identified three objectives for addressing climate change and they are: enhance adaptive capacity while mitigating adverse effects of climate change in line with the Paris agreement; Implementation of environment-friendly, clean energy and green development concepts to reduce climate change; Claim international finance and technologies available through the Paris agreement for climate change mitigation and adaptation and equitable distribution of benefits. 10. Second Nationally Determined Contribution (NDC), 2020 The Government of Nepal has prepared and submitted the Second Nationally Contribution (NDC) to address the impacts of climate change by adopting mitigation measures. Under this, various targets related to the health sector have been determined as follows: By the year2030, 1,400 health care facilities will use non-burn technologies to properly manage healthcare waste. By the year 2025, climate-sensitive diseases surveillance systems will be strengthened through the integration of climate and weather information in existing surveillance system. 9 11. Nepal Long Term Zero Carbon Emission Strategy, 2021 This strategy of Nepal aims to achieve net-zero emissions by 2045. In 2019, Nepal's total carbon dioxide emission was 2,30,00,000 metric tons and this figure is expected to reach 3,40,00,000 metric tons in 2030 and 7,90,00,000 metric tons in 2050. According to the statistics of 2019, the consumption of renewable energy in Nepal was only 3 percent, while it has been mentioned that renewable energy will be 15 percent of the total energy consumed by the year 2030. 12. NAP: National Adaptation Plan (2021-2050) The aim of this plan is to by integrate mitigation and adaptation programs to reduce the risk of climate change and include government policies, programs and plans across sectors and at all three levels of government. The plan has been presented in the United Nations Framework Convention on Climate Change (UNFCCC). There are sixty-four priority programs in eight thematic areas and four interdisciplinary areas identified by Nepal’s National Climate Change Policy 2019. The program includes short-term (up to 2025), mid-term (2035) and long term (2050) plans to address the climate crisis. The total budget USD 47.4 billion is expected to be required by 2050 for the implementation of 64 programs prioritized by the National Adaptation Plan. The adaptation plan includes agriculture and food security, forestry, ecosystem and water resource promotion, conservation, energy, climate resilient urban health, drinking water and sanitation, disaster management, research, innovation and development etc. The specific adaptation plan under Health, Drinking Water and Sanitation are as follows: a) Capacity building of health and hygiene sector’s service providers and professionals through the adaptation measures and technologies to improve health outcome and healthcare system b) Development of strategies and raising national level awareness to reform policies, formulate programs c) Managing for sustainable water supply services, promoting healthy envrionment and livelihoods d) Building public awareness, develop health promoting cities, healthy environment and livelihood etc. e) Strengthening climate sensitive disease surveillance system and enhance emergency preparedness and response system 10 Climate Change Health Adaptation Strategy Vision, Mission, Goal and Strategic Objectives Vision: Climate Resilient Health System. Mission: Minimize the impacts of climate change on health through coordination and collaboration between federal, provincial and local level and other stakeholders. Goal: Adopt Appropriate adaptation measures to minimize adverse impacts of climate change on Health. National Strategic Objectives The main objective of preparing the Health National Adaptation Plan is to minimize the negative effects of climate change on human health. The following specific objectives are envisioned to increase the adaptation measures: 1. Raise awareness, advocacy and build capacity on climate change. 2. Manage the identification, prevention, control and treatment system of climate-sensitive health risks including development of disease surveillance, preparedness and response system. 3. Develop and promote environment friendly and climate-resilient physical structures and technologies. 4. Mainstream climate change adaptation in health policies, strategies, and plans at federal, provincial, and local levels. 5. Collaborate and coordinate with multi-stakeholders to minimize health risks through study, research and knowledge promotion on climate change and health. Implementation Strategy The collaboration and coordination are necessary among federal, provincial and local governments, development partners, concerned agencies, civil society and other relevant sectors for the effective implementation of the National Health Adaptation Plan. The Ministry of Health and Population (MoHP) will play a leading role in both planning and implementing this adaptation plan. In addition, necessary coordination will be carried out with central, provincial and local governments. A 9-member steering committee, chaired by the Secretary of the Ministry of Health and Population, will provide guidance and policy instructions to implement the HNAP. Similarly, a 15-member technical working group, led by the Chief of the Health Coordination Division under the Ministry of Health Population, will implement the HNAP and coordinate with various stakeholders. The Ministry of Health and Population, along with its Department of Health Services and Divisions under Department of Health Services (DoHS) such as the Epidemiology and Disease Control Division (EDCD), Management Division (MD), National Health Education, Information and Communication Center (NHEICC), National Health Training Center (NHTC), Vector Borne Disease Research and Training Center (VBDRTC), Nepal Health Research Council (NHRC) bears significant responsibility for implementation of this plan. Additionally, other government agencies, such as the Ministry of Forests and Environment (MoFE), Ministry of Water Supply (MoWS), Ministry of Education, Science and Technology (MoEST), Ministry of Communication and Information Technology (MoCIT), Ministry of Women, Children and Senior Citizens (MoWCSC), and related agencies such as Department of Environment (DoE), Department of Water Supply and Sewerage Management (DWSSM), Department of Hydrology and Meteorology (DHM) and National Disaster Risk Reduction and Management Authority (NDRRMA) etc. will conduct various programs with the support and coordination of government agencies. In addition, technical and financial support from 11 the World Health Organization and other development partners will play a crucial role in the successful implementation of this plan. The provincial governments will allocate sufficient resources at the provincial level for the implementation of this adaptation plan, implement the plan and ensure necessary coordination with relevant agencies and stakeholders. Similarly, since the local-level plays a major role in the adaptation and mitigation, the HNAP will be implemented under the leadership of rural/municipality chief with the participation of multi-stakeholder agencies, community-based organizations, educational institutions, media, civil society organizations, and various organizations. The major implementation strategies are described as below: 1. Conduct advocacy, awareness and capacity building programs as needed in coordination and collaboration with the concerned agencies for mitigation and resilient based on the impacts of climate change at the federal, provincial and local levels. 2. Include climate change-related topics in the curriculum and broadcast information on climate change and health through various media and social networks. 3. Conduct studies, research and mapping of health risks that may occur due to climate change in addition to surveillance and survey of the main environmental health risks. 4. Strengthen of rapid early warning and rescue system by developing and expanding climate-informed surveillance system through federal government coordination and provincial government initiation and local government involvement. 5. Enhance the capacity of service provider health institutions, laboratories, human resources by coordinating with other stakeholders to control climate sensitive diseases and health risks. 6. Produce skilled manpower and develop the modern technology and systems through regulatory agency for the construction of environment friendly physical infrastructure. 7. Implement climate change resilient health services, water supply systems and sanitation services with a focus on social inclusion (including children, youth, women). 8. Conduct programs and managing financial resources in coordination with multi-stakeholder agencies through a one-door system on climate change and health. 9. Include the climate adaptation topic in all health-related policies. 10. Provide basic information related to climate change and health through continuous study and research. Integrate the innovative efforts related to climate change and health at the national and international levels and make policy arrangements in the three levels of government to mainstream them as needed. 12 Monitoring and Evaluation It is necessary to monitor on regular basis and evaluate from time to time for the effective implementation of the HNAP activities. Therefore, the Ministry of Health and Population is responsible for the overall moni- toring and evaluation of this plan. The steering committee under the coordination of the Ministry of Health and Population will conduct the necessary monitoring and evaluation for the effective implementation of the proposed activities in the climate adaptation plan of health sector and will also provide policy guid- ance. The Technical Working Group within the Health Coordination Division will coordinate and collaborate on technical works related to environmental health activities and programme. In addition, the TWG will regularly monitor and conduct the mid-term and the final evaluation on the basis of the indicators of this plan for the implementation of HNAP in accordance with the National Adaptation Plan (NAP). The MoHP will prepare and implement the indicators related to monitoring and evaluation. In this order, the agencies under the MoHP are responsible for work progress as well as modifying and resolving the implementation aspects. In order to facilitate the monitoring and evaluation of this national plan, the following strategic indicators have been determined to achieve each objective. Objectives Strategic Indicators (Indicators) Objective 1. Raise awareness, advocacy and build capacity on climate change. • Number of climate change and health related advocacy package • Number of advocacy meeting • Annual plan and budget for climate change and health risks in the Annual Work Plan and Budget (AWPB) • Number of National level conference • Number of information, education and communication materials • Number of messages broadcasted through mass media • Community involvement in climate change adaptation / Number of operational programs conducted / Number of beneficiaries • Number of risk communication for prevention and mitigation of epidemics and pandemic caused by climate change • Number of participants who received MToT • Number of trained health service providers, policy makers and managers at federal, provincial and local levels • Number of training received on climate change. • Number of curricula covering topics related to climate change and health • Number of necessary communication related to climate sensitive disease surveillance system Objective 2. Manage the identification, prevention, control and treatment system of climate sensitive health risks including development of disease surveillance, preparedness and response system. • List of institutions, mapping and roster of experts • Number of researchers receiving funds to conduct research study on health risks of climate change • Updated data on climate sensitive diseases of federal and provincial hospitals and public health laboratories • Additional services for diagnosis of climate sensitive diseases in federal and provincial hospitals and laboratories • Number of hospitals and laboratories with necessary infrastructure for diagnosis and treatment of climate sensitive diseases • Development of climate informed climate sensitive disease surveillance and forecasting systems • Training provided to sentinel sites, laboratories, other health institutions or stakeholders 13 Objectives Strategic Indicators (Indicators) • Potential epidemics and outbreaks are predicted by developing surveillance system • Integrated digital information system developed and updated • Climate-sensitive health emergency management teams at various levels have been expanded and practical drill conducted Objective 3. Develop and promote environment friendly and climate- resilient physical structures and technologies. • Implementation of programs related to climate resilient and low carbon solutions • Environment friendly and climate resilient physical structure construction guidelines prepared • Review if health infrastructures are environment friendly and climate resilient • Assessment and Evaluation of climate resilience of health institutions • Use of environment friendly and climate resilient physical structure construction guidelines for new health institutions • Make health institutions environmentally friendly • Number of health facilities with clean water and total sanitation • Number of Environment, Gender, Child and Disability (GESI) Friendly toilets • Number of health facilities with environment friendly, health care waste management • Number of health facilities with collection and use of rainwater Objective 4. Mainstream climate change adaptation in health policies, strategies, and plans at federal, provincial, and local levels. • Conducted integrated climate resilient health programs • Climate adaptation strategies are identified and prioritized • Climate change and health related issues included in policies at different levels • Partnership with various agencies to develop plan • Communication and technology friendly climate sensitive disease surveillance system • SoP and protocols prepared at various levels • Capacity building for climate sensitivity at various levels • Integrated programs related for emergency management teams at various levels • Number of policies, strategies incorporating climate adaptation • Number of climate adaptation programs • Status of inclusion of climate adaptation in review and revision • Number of innovative programs related to climate change and health Objective 5.Collaborate and coordinate with multi-stakeholders to minimize health risks through study, research and knowledge promotion on climate change and health. • Roster and mapping of institutions and experts and updated annually • Coordination and collaboration with multi-stakeholder agencies • Conducted multi sectoral collaborative study and research • Study and research funds allocation in the Annual Work Plan and Budget (AWPB). • Multilateral and bilateral fund creation and resources mobilized 14 Financial aspects A total of 20 major programs and 62 activities have been proposed to achieve the 5 objectives mentioned in this plan. The estimated cost for these activities is Rs. 96,85,00,000/- (ninety-six crore eighty-five lakh), equivalent to 7.3 million US dollars in 2023 prices. The activities of this plan will be implemented as short- term (2023-2024) and long-term (2025-2030) and the corresponding estimated costs are presented in the table below. Table 1: The estimated cost for the implementation of Health National Adaptation Plan Objectives Short term (2023-2024) Long term (2025-2030) Total Budget (in 1000) 1. Raise awareness, advocacy and build capacity on climate change. 23,600 51,800 75,400 2. Manage the identification, prevention, control and treatment system of climate-sensitive health risks including development of disease surveillance, preparedness and response system. 44,000 174,100 218,100 3. Develop and promote environment friendly and climate-resilient physical structures and technologies. 34,000 408,000 442,000 4. Mainstream climate change adaptation in health policies, strategies, and plans at federal, provincial, and local levels. 19,300 71,200 90,500 5. Collaborate and coordinate with multi-stakeholders to minimize health risks through study, research and knowledge promotion on climate change and health. 30,500 112,000 142,500 Total 151,400 817,100 968,500 In addition, domestic, international and multilateral financial resources will be mobilized for the successful implementation of this plan with the following provisions. • The main source of the budget will be allocated from the funds received from the national sources of the Government of Nepal and regular budget of the sectoral ministries, provincial government, local governments and departments for the implementation this HNAP. • The Government of Nepal will manage financial aid and other sources through UNFCCC mechanisms and international bilateral and multilateral organizations. Multilateral development partners such as World Bank Group, Asian Development Bank, FCDO, USAID, GIZ, World Health Organization etc. can be important funding sources for implementing this adaptation plan. • The National Climate Change Policy 2076 states that the national resources will be identified for the implementation of climate change related policies and all resources will be mobilized in a just manner by increasing access to international financial resources. Therefore, the Ministry of Health and Population will secure the budget for this adaptation plan by submitting proposals to the Climate Fund such as the Global Environment Facility (GEF), Green Climate Fund (GCF), Adaptation Fund, the Least Developed Countries Fund (LCDF), the Special Climate Change Fund etc. • For implementing this adaptation plan, other national and international organizations can be encouraged to mobilize financial support and coordinate with the National Adaptation Plan (NAP). 15 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 1. 1. A dv oc ac y on cl im at e ch an ge an d its im pa ct s on he al th 1. 1. 1. E nc ou ra ge to in te gr at e cl im at e ch an ge re la te d is su es in h ea lth p ro gr am m es th ro ug h de ve lo pm en t of a dv oc ac y m at er ia ls an d po lic y br ie f o n cl im at e ch an ge a nd he al th ri sk s C on tin ue fro m 2 02 3 • M in is try o f H ea lth an d P op ul at io n (M oH P ) • N at io na l H ea lth E du ca tio n In fo rm at io n an d C om m un ic at io n C en tre (N H E IC C ) • N at io na l H ea lth Tr ai ni ng C en te r (N H TC ) • W or ld H ea lth O rg an iz at io n (W H O ) • A n in te gr at ed ad vo ca cy p ac ka ge is de ve lo pe d by pr ep ar in g se pa ra te m at er ia ls a t t hr ee le ve ls (F ed er al , P ro vi nc ia l a nd M un ic ip al ity ) • P la n an d bu dg et fo r i nf or m at io n an d co m m un ic at io n on cl im at e ch an ge a nd he al th ri sk s a re in cl ud ed in a nn ua l w or k pl an a nd bu dg et (A W P B ) 80 00 20 00 60 00 1. 1. 2. A dv oc ac y w ith st ak eh ol de rs o n cl im at e ch an ge a nd he al th a t t he fe de ra l, pr ov in ci al a nd lo ca l le ve ls R eg ul ar • N H E IC C • M oH P • P ro vi nc ia l a nd lo ca l le ve l h ea lth s ec tio n • N o. o f … . m ee tin gs pe r y ea r w ith di ffe re nt m in is tri es an d st ak eh ol de rs a t fe de ra l l ev el • N o. o f … ..… . m ee tin gs p er ye ar w ith d iff er en t m in is tri es a nd st ak eh ol de rs a t t he pr ov in ci al le ve l ( in al l 7 p ro vi nc es ) • N o. o f … … m ee tin gs w ith st ak eh ol de rs a t t he lo ca l l ev el 50 00 25 00 25 00 1. R ai se a w ar en es s, a dv oc ac y an d bu ild c ap ac ity o n cl im at e ch an ge . A ct io n Pl an fo r C lim at e C ha ng e H ea lth A da pt at io n St ra te gy (2 02 3- 20 30 ) 16 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 1. 1. 3. O rg an iz e a na tio na l c on fe re nc e on c lim at e ch an ge a nd he al th 20 24 & 2 03 0 • M oH P • W H O • M in is try o f F or es ts an d E nv iro nm en t (M oF E ) • Tw o na tio na l co nf er en ce s ar e or ga ni ze d by 2 03 0 30 00 15 00 15 00 1. 2. R ai se p ub lic aw ar en es s on cl im at e ch an ge an d its im pa ct s on he al th 1. 2. 1. D ev el op In fo rm at io n, E du ca tio n an d C om m un ic at io n m at er ia ls o n th e ef fe ct s of c lim at e ch an ge a nd p ot en tia l pr ot ec tiv e m ea su re s an d di ss em in at e an d br oa dc as t t hr ou gh va rio us m ed ia . R eg ul ar • N H E IC C • M in is try o f C om m un ic at io n an d In fo rm at io n Te ch no lo gy (M oC IT ) • P la n an d bu dg et fo r d is se m in at in g an d br oa dc as tin g in fo rm at io n an d m es sa ge o n cl im at e ch an ge a nd h ea lth ris ks a re in cl ud ed in th e A nn ua l W or k P la n an d B ud ge t (A W P B ). • W eb si te s, a pp s, so ci al n et w or ks , ot he r d ig ita l m ed ia , P S A an d ot he r m ed ia a re u se d 24 00 60 0 18 00 1. 2. 2. D is se m in at e in fo rm at io n an d m es sa ge s re la te d to cl im at e ch an ge a nd he al th ri sk s th ro ug h m as s m ed ia (R ad io N ep al , N ep al T V a nd ot he r T V, n ew sp ap er s an d FM ra di o) , m ob ile et c. R eg ul ar • N H E IC C • M in is try o f C om m un ic at io n an d In fo rm at io n Te ch no lo gy • … N o. o f in fo rm at io n an d m es sa ge o n cl im at e ch an ge a nd he al th ri sk s ar e br oa dc as te d pe r ye ar 80 0 20 0 60 0 17 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 1. 2. 3. C on du ct aw ar en es s ca m pa ig ns on c lim at e ch an ge a nd he al th a t t he s ch oo l le ve l R eg ul ar • N H E IC C • M in is try o f E du ca tio n, S ci en ce an d Te ch no lo gy • 10 a w ar en es s ca m pa ig ns a re co nd uc te d pe r y ea r 40 00 10 00 30 00 1. 2. 4. C on du ct p ub lic aw ar en es s pr og ra m s fo cu si ng o n th e he al th o f w om en , el de rly a nd c hi ld re n, di ffe re nt ly a bl ed gr ou ps a nd v ul ne ra bl e co m m un iti es R eg ul ar • N H E IC C • M in is try o f W om en , C hi ld re n an d S oc ia l W el fa re • … … N o. o f p ub lic aw ar en es s pr og ra m m es a re im pl em en te d pe r y ea r i n al l 7 pr ov in ce s 35 00 50 0 30 00 1. 3. E nh an ce th e ca pa ci ty o f t he M in is try o f H ea lth an d P op ul at io n an d re la te d he al th se rv ic e pr ov id er s 1. 3. 1. D ev el op a nd up da te th e va rio us tra in in g m at er ia ls re la te d to c lim at e in du ce d he al th ris ks , a nd d ev el op an d up da te ro as te r of tr ai ne rs th ro ug h or ga ni za tio n of M TO T/ TO T 20 23 -2 02 4 • N H TC • P ro vi nc ia l H ea lth Tr ai ni ng C en te r • W H O • 5 tra in in g m at er ia ls on c lim at e in du ce d he al th ri sk s ar e de ve lo pe d an d up da te d • Tr ai ni ng s ar e pr ov id ed to 1 00 tra in in g pr ov id er s an d tra in er s pe r ye ar • R oa st er o f tra in in g pr ov id er s an d tra in er s is de ve lo pe d an d up da te d 30 00 30 00 0 18 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 1. 3. 2. P ro vi de tr ai ni ng on c lim at e an d he al th ris ks to h ea lth s er vi ce pr ov id er s, p ol ic y m ak er s, m an ag er s an d ot he r h ea lth pr of es si on al s at fe de ra l, pr ov in ci al a nd lo ca l l ev el R eg ul ar • N H TC • P H TC • W H O • Tr ai ni ng is p ro vi de d to 5 00 h ea lth se rv ic e pr ov id er s, po lic y m ak er s, m an ag er s an d ot he r he al th w or ke rs p er ye ar 40 00 0 10 00 0 30 00 0 1. 3. 3. A dv oc ac y to in cl ud e an d up da te cl im at e ch an ge a nd he al th re la te d su bj ec ts in c ur ric ul um o f di ffe re nt le ve ls 20 25 • M oH P • M in is try o f E du ca tio n, S ci en ce an d Te ch no lo gy • C ur ric ul um D ev el op m en t C en te r o f S ch oo l an d U ni ve rs ity • C lim at e ch an ge an d he al th re la te d is su es a re i nc lu de d in th e cu rr ic ul um o f 8, 9 a nd 1 0 cl as se s an d un iv er si ty 50 0 50 0 0 1. 3. 4. R ev is e an d up da te th e cu rr ic ul um of c lim at e ch an ge an d he al th re la te d su bj ec ts fo r g en er al ad m in is tra tiv e tra in in g an d se rv ic e en try , a nd in -s er vi ce tr ai ni ng R eg ul ar • N H TC • N ep al A dm in is tra tiv e S ta ff C ol le ge • M in is try o f E du ca tio n, S ci en ce an d Te ch no lo gy , C ur ric ul um D ev el op m en t C en tre (C D C ) • C lim at e ch an ge an d he al th s ub je ct s ar e in cl ud ed in th e cu rr ic ul um of g en er al ad m in is tra tiv e, se rv ic e en try , a nd in -s er vi ce tr ai ni ng 80 0 20 0 60 0 19 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 1. 3. 5. C ap ac ity bu ild in g of hy dr om et eo ro lo gy , dr in ki ng w at er a nd ot he r s ta ke ho ld er s on th e id en tifi ca tio n an d m an ag em en t o f cl im at e- re la te d he al th ris ks R eg ul ar • M oH P • D oH S • E pi de m io lo gy a nd D is ea se C on tro l D iv is io n (E D C D ) • Fe de ra l a nd P ro vi nc ia l H ea lth M in is try a nd lo ca l le ve l • N H TC • N at io na l D is as te r R is k R ed uc tio n an d M an ag em en t A ut ho rit y (N D R R M A ) • D H M • D W S S M • Tr ai ni ng a re pr ov id ed to 1 60 pe op le 16 00 40 0 12 00 1. 4. S tre ng th en th e in fo rm at io n an d co m m un ic at io n m ec ha ni sm re la te d to c lim at e se ns iti ve d is ea se su rv ei lla nc e an d E ar ly W ar ni ng S ys te m 1. 4. 1. In cl ud e su gg es tio n an d re co m m en da tio n re la te d w ith w ea th er - ba se d he al th ri sk s in th e w ee kl y E W A R S bu lle tin R eg ul ar fr om 20 24 • E D C D • Fe de ra l a nd P ro vi nc ia l H ea lth M in is try a nd lo ca l le ve l • D oH S • D H M • W H O • E ar ly w ar ni ng s of cl im at e se ns iti vi ty ar e in cl ud ed in w ee kl y E W A R S bu lle tin 80 0 20 0 60 0 1. 4. 2. C om m un ic at e m es sa ge s on cl im at e se ns iti ve di se as es s ur ve ill an ce , fo re ca st in g an d ea rly w ar ni ng s th ro ug h bu lle tin s, v ar io us w eb si te s, a pp s an d so ci al n et w or ks o n re gu la r b as is R eg ul ar fr om 20 25 • M oH P • D oH S • E D C D • N H E IC C • D H M • W H O 20 00 10 00 10 00 To ta l 75 40 0 23 60 0 51 80 0 20 2. M an ag e th e id en tifi ca tio n, p re ve nt io n, c on tr ol a nd tr ea tm en t s ys te m o f c lim at e se ns iti ve h ea lth ri sk s in cl ud in g de ve lo pm en t o f d is ea se s ur ve ill an ce , pr ep ar ed ne ss a nd re sp on se s ys te m . A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 1. D oc um en t an d up da te cl im at e se ns iti ve he al th ri sk s 2. 1. 1. U pd at e th e na tio na l V ul ne ra bi lit y an d A da pt at io n A ss es sm en t R ep or t on c lim at e ch an ge an d he al th U pd at e in 20 28 • M oH P • W H O • Vu ln er ab ili ty an d A da pt at io n A ss es sm en t r ep or t is u pd at ed . 25 00 0 25 00 2. 1. 2. P re pa re P ro vi nc ia l l ev el Vu ln er ab ili ty an d A da pt at io n A ss es sm en t R ep or t on c lim at e ch an ge an d he al th P re pa re d in 2 02 8 an d up da te in e ve ry 5 ye ar s • P ro vi nc ia l l ev el he al th re la te d m in is try • M oH P • Vu ln er ab ili ty an d A da pt at io n A ss es sm en t r ep or t is p re pa re d at pr ov in ci al le ve l 10 50 0 0 10 50 0 2. 1. 3. F ac ili ta te th e pr ep ar at io n of lo ca l le ve l V ul ne ra bi lit y an d A da pt at io n A ss es sm en t R ep or t ba se d on th e cl im at e se ns iti ve h ea lth ri sk s an d ne ed s R eg ul ar • M un ic ip al ity / R ur al m un ic ip al ity • M oH P • P ro vi nc ia l l ev el he al th re la te d m in is try • Vu ln er ab ili ty an d A da pt at io n A ss es sm en t r ep or t is p re pa re d at lo ca l l ev el 10 50 0 0 10 50 0 21 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 2. D ev el op ac tio n pl an an d im pl em en t fo r m in im iz in g po te nt ia l c lim at e se ns iti ve h ea lth ris ks a fte r t he ir m ap pi ng 2. 2. 1. Id en tif y an d m ap th e po te nt ia l ris ks a t t he p ro vi nc ia l he al th s ys te m R eg ul ar fro m 2 02 4 • P ro vi nc ia l l ev el he al th re la te d m in is try • M oH P • N at io na l D is as te r R is k R ed uc tio n an d M an ag em en t A ut ho rit y (N D R R M A ) • M ap pi ng a nd li st in g of p ot en tia l r is ks to th e he al th s ys te m 35 00 50 0 30 00 2. 2. 2. Im pl em en t r is k re du ct io n pr og ra m s by fo rm ul at in g an ac tio n pl an w ith co nfi rm ed fi na nc ia l re so ur ce s R eg ul ar fro m 2 02 4 • D is as te r a nd h ea lth re la te d m in is try / of fic es a t f ed er al , pr ov in ce a nd lo ca l le ve l • D ev el op m en t pa rtn er s • … N os o f im pl em en te d ris ks re du ct io n pr og ra m s pe r y ea r a s pe r ac tio n pl an 35 00 50 0 30 00 2. 3. S tre ng th en th e di ag no si s an d cu ra tiv e sy st em o f cl im at e se ns iti ve di se as es a t pr ov in ci al le ve l 2. 3. 1 S tre ng th en th e di ag no st ic c ap ac ity of c lim at e se ns iti ve di se as es in fe de ra l an d pr ov in ci al ho sp ita ls a nd p ub lic he al th la bo ra to rie s R eg ul ar fro m 2 02 4 • M oH P • P ro vi nc ia l H ea lth M in is tri es • P ro vi nc ia l a nd fe de ra l h os pi ta ls • N at io na l P ub lic H ea lth L ab or at or y (N P H L) • P ro vi nc ia l P ub lic H ea lth La bo ra to rie s • E pi de m io lo gy a nd D is ea se C on tro l D iv is io n (E D C D ) • R ur al M un ic ip al ity / M un ic ip al ity • D ia gn os tic c ap ac ity of c lim at e se ns iti ve di se as es is st re ng th en ed in a t le as t 1 la bo ra to ry in e ac h pr ov in ce • D at a on c lim at e- se ns iti ve d is ea se s ar e up da te d in fe de ra l a nd pr ov in ci al h os pi ta ls an d pu bl ic h ea lth la bo ra to rie s • N um be r o f ho sp ita ls a nd la bo ra to rie s w ith n ec es sa ry in fra st ru ct ur e fo r th e di ag no si s an d cu re o f c lim at e- se ns iti ve d is ea se s • N um be r o f t ra in ed em pl oy ee s in th e pr ov in ci al la bo ra to rie s 14 00 0 0 14 00 0 22 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 3. 2. E nh an ce th e cu ra tiv e an d m an ag em en t c ap ac ity (d at a, h um an re so ur ce , p hy si ca l in fra st ru ct ur e, c ur at iv e se rv ic e, b ud ge t) of cl im at e se ns iti ve di se as es in th e fe de ra l a nd p ro vi nc ia l ho sp ita ls 70 00 0 70 00 2. 3. 3. In cr ea se th e ca pa ci ty o f la bo ra to rie s fo r th e ra pi d sa m pl e co lle ct io n, d ia gn os is / da ta re co rd in g an d re po rti ng o f c lim at e se ns iti ve d is ea se s 50 00 20 00 30 00 2. 4. S tre ng th en th e ex is tin g su rv ei lla nc e sy st em a s a cl im at e se ns iti ve di se as e su rv ei lla nc e, fo re ca st in g an d ra pi d re sp on se sy st em th ro ug h th e us e of ap pr op ria te te ch no lo gy 2. 4. 1. E xp an d an d up gr ad e th e cl im at e- in fo rm ed c lim at e- se ns iti ve d is ea se su rv ei lla nc e an d fo re ca st in g sy st em by in co rp or at in g w ea th er in fo rm at io n in to th e cu rr en tly ru nn in g he al th ra pi d su rv ei lla nc e sy st em R eg ul ar • E D C D • D oH S • D H M • P ro vi nc ia l H ea lth M in is try • P ro vi nc ia l H ea lth D ire ct or at e • Lo ca l l ev el • W H O • C lim at e in fo rm ed cl im at e se ns iti ve di se as e su rv ei lla nc e an d fo re ca st in g sy st em is u pg ra de d • D ev el op ed in ex is tin g 11 8 se nt in el s ite s 23 60 0 60 00 17 60 0 23 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 4. 2. S tre ng th en th e da ta c ol le ct io n, m an ag em en t a nd re po rti ng c ap ac ity of h ea lth in st itu tio ns (e .g . s en tin el s ite s, la bo ra to rie s) a nd st ak eh ol de rs (e .g . D H M a nd D W S S M ) on c lim at e se ns iti ve di se as e su rv ei lla nc e an d fo re ca st in g sy st em s. R eg ul ar fro m 2 02 3 • E D C D • W H O • Tr ai ni ng a re pr ov id ed in … .. no . of s en tin el s ite s pe r ye ar • Tr ai ni ng a re pr ov id ed in … .. no . of la bo ra to rie s pe r ye ar • Tr ai ni ng a re pr ov id ed in … .. no . o f o th er h ea lth in st itu tio ns a nd st ak eh ol de rs 80 00 20 00 60 00 2. 4. 3. S tre ng th en cl im at e se ns iti ve di se as e su rv ei lla nc e an d fo re ca st in g sy st em in a n in te gr at ed m an ne r b y co lle ct in g, m an ag in g an d an al yz in g th e ne ce ss ar y da ta fr om he al th in st itu tio ns op er at ed b y th e go ve rn m en t a nd o th er ag en ci es R eg ul ar fro m 2 02 3 • E D C D • M oH P • D H M • W H O • D at a- ba se d cl im at e se ns iti ve d is ea se su rv ei lla nc e an d fo re ca st in g bu lle tin is p re pa re d 40 00 10 00 30 00 24 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 4. 4. E st ab lis h ne ce ss ar y di gi ta l in fra st ru ct ur e (in te rn et , c om pu te r, so ftw ar e et c. ) i n he al th in st itu tio ns fo r i nf or m at io n, co m m un ic at io n an d te ch no lo gy fr ie nd ly cl im at e se ns iti ve di se as e su rv ei lla nc e sy st em R eg ul ar • E D C D • M oH P • W H O • N ec es sa ry d ig ita l in fra st ru ct ur e is d ev el op ed in he al th in st itu tio ns fo r c lim at e se ns iti ve d is ea se su rv ei lla nc e 16 00 0 40 00 12 00 0 2. 4. 5. P re pa re S O P s, pr ot oc ol s re la te d to c lim at e se ns iti ve di se as es e ar ly w ar ni ng a nd re sp on se sy st em s A s pe r n ee d fro m 2 02 4 • E D C D • M oH P • N D R R M A • W H O • S O P s / p ro to co ls re la te d to c lim at e se ns iti ve d is ea se w ar ni ng , r es po ns e sy st em is p re pa re d an d up da te d 10 00 10 00 0 2. 4. 6. F or ec as t cl im at e- se ns iti ve di se as es a nd po te nt ia l h ea lth ri sk , ou tb re ak s/ ep id em ic s th ro ug h m od el in g of e xt re m e cl im at e ev en ts R eg ul ar fro m 2 02 6 • E D C D • M oH P • N D R R M A • D H M • W H O • P ot en tia l e pi de m ic , di sa st er is pr ed ic te d 50 00 50 00 0 25 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 4. 7. D ev el op an d st re ng th en th e su rv ei lla nc e sy st em of w at er , a ir, fo od a nd ve ct or b or ne d is ea se s R eg ul ar fro m 2 02 4 • E D C D • M oH P • M oF E • D W S S M • Ve ct or B or ne D is ea se a nd R es ea rc h Tr ai ni ng C en tre (V B D R TC ) • D ep ar tm en t o f E nv iro nm en t • D ep ar tm en t o f Fo od T ec hn ol og y an d Q ua lit y C on tro l • W H O • S ur ve ill an ce sy st em is de ve lo pe d 80 00 20 00 60 00 2. 4. 8. In te gr at e re po rti ng fr om a ll su rv ei lla nc e sy st em s in to a n in te gr at ed di gi ta l i nf or m at io n sy st em R eg ul ar fro m 2 02 6 • D oH S (I H IM S ) • Fe de ra l a nd pr ov in ci al h ea lth an d ho m e m in is try a nd lo ca l le ve l ( re le va nt or ga ni za tio n an d ot he r g ov er nm en t ag en ci es ) • In fo rm at io n of al l s ur ve ill an ce sy st em s is in co rp or at ed i n in te gr at ed s ys te m • In te gr at ed d ig ita l in fo rm at io n sy st em is u pd at ed 40 00 0 40 00 '2 .5 . E m er ge nc y m an ag em en t, id en tifi ca tio n of m ed ic al te am s an d th ei r c ap ac ity en ha nc em en t 2. 5. 1. E nh an ce ca pa ci ty fo r r es po ns e at lo ca l l ev el R eg ul ar fro m 2 02 4 • E D C D • Fe de ra l a nd pr ov in ci al h ea lth an d ho m e m in is try a nd lo ca l le ve l ( re le va nt or ga ni za tio n an d ot he r g ov er nm en t ag en ci es ) • M oH P • Fe de ra l a nd pr ov in ci al h ea lth an d ho m e m in is try a nd lo ca l le ve l ( re le va nt or ga ni za tio n an d ot he r g ov er nm en t ag en ci es ) • D is tri ct A dm in is tra tio n O ffi ce • N um be r o f t ra in ed ra pi d re sp on se te am s (R R T) • Li st o f r es ou rc e de ta ils 80 00 0 20 00 0 60 00 0 26 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 2. 5. 2. M ob ili ze he al th s er vi ce pr ov id er s an d R ap id R es po ns e Te am s (R R Ts ) w ith n ee ds - ba se d m od ifi ca tio n fo r c lim at e se ns iti ve he al th e m er ge nc y m an ag em en t R eg ul ar fro m 2 02 5 • H ea lth O ffi ce • E D C D • M oH P • Fe de ra l a nd pr ov in ci al h ea lth an d ho m e m in is try an d lo ca l l ev el (n ec es sa ry or ga ni za tio n, ot he r g ov er nm en t ag en ci es ) • H ea lth D ire ct or at e • N D R R M A • C lim at e se ns iti ve he al th e m er ge nc y m an ag em en t t ea m is p re pa re d in ev er y pr ov in ce 60 00 0 60 00 2. 5. 3. C on du ct re gu la r e xe rc is es an d pr ac tic al d ril l f or re du ct io n of p ot en tia l cl im at e in du ce d he al th ri sk s en su rin g re ad in es s of h ea lth se rv ic e pr ov id er s an d R ap id R es po ns e Te am s (R R Ts ) R eg ul ar fro m 2 02 5 • ... ... ... . n o. o f pr ac tic al e xe rc is es co nd uc te d at e ve ry le ve l p er y ea r 60 00 0 60 00 To ta l 21 81 00 44 00 0 17 41 00 27 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 3. 1. P ro m ot e co nc ep t o f cl im at e re si lie nt an d lo w c ar bo n su st ai na bl e he al th sy st em s an d fa ci lit ie s 3. 1. 1. D ev el op a nd ex pa nd c lim at e re si lie nt a nd lo w - ca rb on s ol ut io ns in he al th s er vi ce c en te rs R eg ul ar fro m 2 02 6 • D oH S (M an ag em en t D iv is io n) • M oF E • M oH P • W H O • D ev el op m en t pa rtn er s • … … n os . o f h ea lth in st itu tio ns w ith de ve lo pe d an d ex pa nd ed c lim at e re si lie nt a nd lo w ca rb on s ol ut io ns 14 00 00 0 14 00 00 3. 2. P re pa re gu id el in es fo r th e co ns tru ct io n of e nv iro nm en t- fri en dl y an d cl im at e- re si lie nt ph ys ic al in fra st ru ct ur es 3. 2. 1. R ev ie w th e ex is tin g in fra st ru ct ur e by p re pa rin g gu id el in es o n bu ild in g en vi ro nm en t fri en dl y an d cl im at e re si lie nt p hy si ca l in fra st ru ct ur es 20 25 • D oH S (M an ag em en t D iv is io n) • W H O • E nv iro nm en t fri en dl y an d cl im at e re si lie nt p hy si ca l in fra st ru ct ur e co ns tru ct io n gu id el in es is pr ep ar ed • R ev ie w ed e xi st in g ph ys ic al h ea lth st ru ct ur e fo r en vi ro nm en t fri en dl y an d cl im at e re si lie nt 20 00 20 00 0 3. 3. C on ve rt th e bu ild in gs o f h ea lth se rv ic e pr ov id in g in st itu tio ns in to en vi ro nm en t fri en dl y 3. 3. 1. E va lu at e th e cl im at e re si lie nc e an d en vi ro nm en ta l fri en dl in es s of e xi st in g he al th p hy si ca l in fra st ru ct ur es b as ed on th e gu id el in es Fr om 2 02 6 to 2 02 8 • D oH S (M an ag em en t D iv is io n) • M in is try o f U rb an D ev el op m en t (M oU D ) • D ep ar tm en t of U rb an D ev el op m en t an d B ui ld in g C on st ru ct io n (D U D B C ) • W H O • 12 00 h ea lth in st itu tio ns a re ev al ua te d 12 00 0 0 12 00 0 3. D ev el op a nd p ro m ot e en vi ro nm en t f rie nd ly a nd c lim at e- re si lie nt p hy si ca l i nf ra st ru ct ur e an d te ch no lo gi es . 28 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 3. 3. 2. A pp ly m an ag em en t m ea su re s to re du ce cl im at e ris ks in he al th ca re fa ci lit ie s ba se d on th e gu id el in es R eg ul ar fro m 2 02 7 • D oH S (M an ag em en t D iv is io n) • W H O • D ev el op m en t pa rtn er s • … … . n o. o f ex is tin g he al th fa ci lit ie s ar e im pr ov ed 50 00 0 0 50 00 0 3. 4. C on ve rt he al th ca re fa ci lit ie s en vi ro nm en t fri en dl y (p ol lu tio n, dr in ki ng w at er an d w as te m an ag em en t) 3. 4. 1. C on du ct te st in g of w at er q ua lit y on re gu la r b as is b y en su rin g ad eq ua te an d sa fe d rin ki ng w at er in h ea lth ca re fa ci lit ie s Fr om 2 02 4 to 2 03 0 • H ea lth ca re fa ci lit ie s an d re le va nt a ge nc ie s • M in is try o f W at er S up pl y (M oW S ) • M oF E • M oU D • M in is try o f E ne rg y, W at er R es ou rc es an d Irr ig at io n • D oH S (M an ag em en t D iv is io n) • Lo ca l l ev el • … … … n o. o f en vi ro nm en t fri en dl y he al th ca re fa ci lit ie s 40 00 0 10 00 0 30 00 0 3. 4. 2. C on st ru ct ad eq ua te n os . o f en vi ro nm en t f rie nd ly, ge nd er a nd d is ab le d fri en dl y to ile ts in he al th ca re fa ci lit ie s 40 00 0 10 00 0 30 00 0 3. 4. 3. M an ag e pl an ta tio n ar ou nd th e he al th ca re fa ci lit ie s, gr ee n be au tifi ca tio n an d ad eq ua te o pe n sp ac e 80 00 20 00 60 00 29 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 3. 4. 4. M an ag e co lle ct io n, u se an d ha rv es tin g of ra in w at er 30 00 0 10 00 0 20 00 0 3. 4. 5. P ro m ot e re ne w ab le e ne rg y in he al th ca re fa ci lit ie s to ge th er w ith a do pt in g ne ce ss ar y m ea su re s to m iti ga te a ir po llu tio n 60 00 0 0 60 00 0 3. 4. 6. M an ag e ch em ic al s af et y, w as te w at er a nd he al th ca re w as te in he al th ca re fa ci lit ie s in a pr op er w ay 60 00 0 0 60 00 0 3. 4. 7. F ac ili ta te th e pr om ot io n of en vi ro nm en t f rie nd ly an d he al th y ci tie s 80 00 20 00 60 00 To ta l 44 20 00 34 00 0 40 80 00 30 4. M ai ns tr ea m c lim at e ch an ge a da pt at io n in h ea lth p ol ic ie s, s tr at eg ie s, a nd p la ns a t f ed er al , p ro vi nc ia l, an d lo ca l l ev el s. A ct io ns A ct iv iti es / M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 4. 1. M od ify he al th p ol ic ie s, st ra te gi es , p la ns an d re la te d ac tiv iti es a t fe de ra l, pr ov in ci al , an d lo ca l l ev el s cl im at e fri en dl y 4. 1. 1. In te gr at e an d de ve lo p cl im at e re si lie nt is su es in he al th p ol ic ie s an d pr og ra m s R eg ul ar fro m 2 02 4 • M oH P • C on ce rn ed m in is tri es • W H O • … … . n o. o f h ea lth po lic ie s an d pr og ra m s w ith co ns id er at io n of cl im at e re si lie nt is su es 50 00 15 00 35 00 4. 2. In iti at e th e in cl us io n of cl im at e ch an ge is su es in o th er se ct or al p ol ic ie s, st ra te gi es a nd pl an s 4. 2. 1. In te gr at e cl im at e ch an ge an d he al th re la te d is su es in th e fe de ra l, pr ov in ci al a nd lo ca l le ve l p ol ic ie s R eg ul ar fro m 2 02 4 • 3 tie rs o f go ve rn m en t • M oH P • D ev el op m en t pa rtn er s • … .. no . o f p ol ic ie s at d iff er en t l ev el s w ith c on si de ra tio n of c lim at e ch an ge an d he al th is su es 50 00 15 00 35 00 4. 2. 2. D ev el op c lim at e re si lie nt h ea lth s ys te m in p ar tn er sh ip w ith ci vi l s oc ie ty , p riv at e se ct or a nd d on or ag en ci es R eg ul ar fro m 2 02 4 • M oH P • P ol ic y R es ea rc h In st itu te (P R I) • W H O • D ev el op m en t pa rtn er s • C iv il so ci et y an d pr iv at e se ct or • … .. no . o f a ge nc ie s w ith p ar tn er sh ip 20 00 30 0 17 00 4. 3. F ac ili ta te th e fo rm ul at io n of a H ea lth A da pt at io n P la n (H A P ) a t t he pr ov in ci al a nd lo ca l l ev el s as p er th e re qu ire m en t 4. 3. 1. D ev el op p la n fo r h ig h he al th - r is k ar ea s ba se d on th e as se ss m en t Fr om 2 02 5 to 2 03 0 • P ro vi nc ia l a nd lo ca l le ve l • M oH P (H ea lth C oo rd in at io n D iv is io n) • M in is try o f F ed er al A ffa irs a nd G en er al A dm in is tra tio n (M oF A G A ) • W H O • … .. no . o f de ve lo pe d pl an s 30 00 0 30 00 4. 3. 2. E nc ou ra ge pa rti ci pa tio n of h ea lth w or ke rs a nd o th er st ak eh ol de rs in de ve lo pi ng c lim at e re si lie nt p la n 20 00 50 0 15 00 31 A ct io ns A ct iv iti es / M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 4. 4. D ev el op st ra te gi es fo r ea rly w ar ni ng a nd re sp on se s ys te m s fo r c lim at e se ns iti ve d is ea se s 4. 4. 1. D ev el op c lim at e se ns iti ve d is ea se su rv ei lla nc e sy st em at fe de ra l, pr ov in ci al an d lo ca l l ev el in fo rm at io n, co m m un ic at io n an d te ch no lo gy fr ie nd ly R eg ul ar • M oH P • P ro vi nc ia l a nd lo ca l le ve l h ea lth a ge nc y • Fe de ra l, pr ov in ci al an d lo ca l le ve l ( re le va nt or ga ni za tio n, ot he r g ov er nm en t ag en cy ) • H ea lth D ire ct or at e • N D R R M A • C lim at e se ns iti ve di se as e su rv ei lla nc e sy st em is in fo rm at io n, co m m un ic at io n an d te ch no lo gy fri en dl y 40 00 0 10 00 0 30 00 0 4. 4. 2. P re pa re S O P an d pr ot oc ol s fo r t he de ve lo pm en t o f d at a m an ag em en t s ys te m s at fe de ra l, pr ov in ci al an d lo ca l l ev el fo r cl im at e se ns iti vi ty R eg ul ar fro m 2 02 4 • … . n o. o f S oP an d pr ot oc ol s ar e de ve lo pe d at di ffe re nt le ve ls 35 00 50 0 30 00 4. 4. 3. D ev el op p la ns an d pr og ra m s on ca pa ci ty b ui ld in g of cl im at e se ns iti vi ty am on g he al th s er vi ce pr ov id er s at th e fe de ra l, pr ov in ci al a nd lo ca l l ev el R eg ul ar fro m 2 02 5 • … .. no . o f h ea lth se rv ic e pr ov id er s ar e ca pa ci ta te d at di ffe re nt le ve ls 30 00 0 50 00 25 00 0 To ta l 90 50 0 19 30 0 71 20 0 32 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 5. 1. P re pa re lis t a nd m ap in st itu tio ns , un iv er si tie s, ex pe rts a nd st ak eh ol de rs w or ki ng o n cl im at e ch an ge a nd h ea lth re se ar ch 5. 1. 1. P re pa re li st o f in st itu tio ns , m ap a nd de ve lo p a ro st er o f ex pe rts U pd at e re gu la rly fro m 2 02 5 • N ep al H ea lth R es ea rc h C ou nc il (N H R C ) • M oH P • N H TC • W H O • In st itu tio ns a nd ex pe rts a re m ap pe d • A ro st er o f in st itu tio ns a nd ex pe rts p re pa re d an d up da te d 15 00 50 0 10 00 5. 1. 2. C ol la bo ra te an d co or di na te w ith re se ar ch er s, in st itu tio ns a nd m ul ti- st ak eh ol de r a ge nc ie s fo r s tu di es , r es ea rc h an d kn ow le dg e pr om ot io n on c lim at e an d he al th R eg ul ar • M oH P (H ea lth C oo rd in at io n D iv is io n) • M oF A G A • N H R C • W H O • … . n o. o f m ul ti- st ak eh ol de r ag en ci es w ith co lla bo ra tio n an d co or di na tio n 30 00 10 00 20 00 5. 2. C on du ct s tu dy an d re se ar ch o n cl im at e ch an ge an d he al th s ec to r 5. 2. 1. M an ag e re so ur ce s fo r re se ar ch er s to co nd uc t s tu dy a nd re se ar ch o n th e he al th ri sk s of c lim at e ch an ge R eg ul ar • M oH P • N H R C • M ed ic al E du ca tio n C ou nc il • W H O • D ev el op m en t pa rtn er s • Fu nd is a llo ca te d fo r s tu dy a nd re se ar ch in A W P B • … no . o f i ns tit ut io ns th at a llo ca te d fu nd fo r s tu dy a nd re se ar ch 60 00 15 00 45 00 5. C ol la bo ra te a nd c oo rd in at e w ith m ul ti- st ak eh ol de rs to m in im iz e he al th ri sk s th ro ug h st ud y, re se ar ch a nd k no w le dg e pr om ot io n on c lim at e ch an ge an d he al th 33 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 5. 2. 2. C on du ct s tu dy an d re se ar ch o n th e in te rr el at io ns hi p of c lim at e an d di se as e se ns iti vi ty , tre nd s, fo re ca st in g, ea rly w ar ni ng , pr ep ar ed ne ss , re sp on se a nd im pa ct m iti ga tio n et c. b y us in g cl im at e se ns iti ve d is ea se su rv ei lla nc e sy st em R eg ul ar • M oH P • E D C D • N H R C • D H M • W H O • … . n o. o f s tu dy an d re se ar ch es p er ye ar 10 00 0 20 00 80 00 5. 2. 3. C on du ct s tu dy an d re se ar ch o n th e ef fe ct s of c lim at e in du ce d ex tre m e w ea th er e ve nt s su ch as h ea t w av es , c ol d w av es , d ro ug ht s, flo od s, e tc . o n hu m an he al th R eg ul ar • M oH P • E D C D • N H R C • M in is try o f H om e A ffa irs (M oH A ) • D H M • W H O 45 00 15 00 30 00 5. 2. 4. U pd at e w or ki ng ar ea s an d to pi cs re la te d to c lim at e ch an ge re la te d di se as e an d re se ar ch U pd at e re gu la r f ro m 20 26 • N H R C • M oH P • E D C D • D H M • W H O • O nc e in tw o ye ar s 15 00 0 15 00 34 A ct io ns A ct iv iti es /M ea su re s Ti m e fr am e R es po ns ib le a ge nc y C ol la bo ra tin g ag en cy In di ca to r B ud ge t (in 1 00 0) Ti m e fr am e of b ud ge t (A D ) Sh or t t er m (2 02 3- 20 24 ) Lo ng te rm (2 02 5- 20 30 ) 5. 2. 5. C on du ct s tu dy an d re se ar ch o n cl im at e ch an ge a nd no n- co m m un ic ab le di se as es (N C D ), m en ta l h ea lth , s ex ua l re pr od uc tiv e he al th , di sa bi lit y, m al nu tri tio n, ge nd er e qu al ity , eq ui ty e tc . R eg ul ar fro m 2 02 5 • M oH P • N H R C • E D C D • W H O • D ev el op m en t pa rtn er s • … . s tu dy a nd re se ar ch a re co nd uc te d 60 00 10 00 50 00 5. 3. M an ag e na tio na l c lim at e fin an ce a nd ex pa nd a cc es s to in te rn at io na l a nd bi la te ra l fi na nc es 5. 3. 1. D ev el op a nd ex pa nd a cc es s to m ul til at er al a nd bi la te ra l c lim at e fin an ce R eg ul ar fro m 2 02 3 • M oH P (H ea lth C oo rd in at io n D iv is io n) • M oF • M oF E • N P C • D ev el op m en t pa rtn er s • W H O • R s … .. cl im at e- fin an ce m ob ili ze d 20 00 0 20 00 18 00 0 5. 3. 2. M ob ili ze fin an ci al re so ur ce s in c oo rd in at io n w ith m ul ti- st ak eh ol de rs , e. g. , a gr ic ul tu re , en er gy , e du ca tio n, w at er s up pl y, fo re st ry , pa rtn er o rg an iz at io n et c. • M oF E • C on ce rn ed li ne m in is tri es • D ev el op m en t pa rtn er s 10 00 0 10 00 90 00 5. 3. 3. M ob ili ze re gu la r he al th b ud ge ts to m in im iz e cl im at e in du ce d he al th ri sk s R eg ul ar fro m 2 02 5 • M oH P • M oF • R s… … h ea lth bu dg et m ob ili ze d 80 00 0 20 00 0 60 00 0 To ta l 14 25 00 30 50 0 11 20 00