Health-National Adaptation Plan (H-NAP) 2025-2030

1.1 ( ON1'EXT •.......••. ...... ..•...... .•.....•.. .....••.. ............. ..••..... .. ... .....••. ...... ......•.. .•...... .. .....••.... ..•........ ..••..... .. ... ..... 1

1.2 H•NAP BACKGROUND ...................................................... .................................................. ........ ........ ........ 2

1.3 H•NAP OEVEtOPMENT PROCESS ,... ...................... ........................................................................................ 2 2 SITUATION ANALYSIS .............................................................................................................................. 4

2.1 THE POLICY ANO LEGAL FRAMEWORK FOR CLIMATE CHANGE IN UGANDA •......... ........ ........... .. ...... ..... ...... ... ..... ... .. 4

2.2 IN5T11'UTIONAl. FRAMEWORK ..... ... ... ........ .. ...... ..... ...... ... ..... .... . ............... ... ........ .•......... ........ ..... ......... ..... .... . 6

2.3 STATE OF CLIMATE CH ANGE VULNERABIUlY ANO ADAPTATI ON IN T HE H EALTH SECTOR .. , ........... ..... ... ... ..... ...... ... .. .... . 7

2.3.1 E)(posure to cllmote•reloted hotords in HCFs.ln Ugondo .... .............. ...................... ................. ......... 7

2.3.2 Climote~change,..related vulnerabilities fn healthcare facilities i'n Uganda. , ... ... ................ ....,.......... 8

2.3.3 Impacts of c/imore change on different HCF components ................................................. ............. 10

2.4 CLIMATE-INOUCEOM0 81LJTY ..................... ...................... ... .................................................................. ... ... 11

2.5 CLIMATE SENSITIVE HEALTH OUTCO!v1ES IN UGANDA ............... .... .. .. ... ... ..... .... .......... ......... ........... ........ ... ..... ... 12 .Z.5.1 lrJury ond mortality from exrreme weother events .......................... .............................................. 12

2.5.2 Water--borne diseases ........~........................... ........~······················••·••·.. ···· ........... ..... ........... ........~ .... 12

2.5.3 Non-communicable diseases .......... ... ... ...... ...................................... ............................... ............... 13

2.5.4 Respiratory il/nesses ................... ................... ..................................................................... ............. 13

2.5.5 Molnu/fftion and food•borne dfseoses............. .............. ................... ...................... .............. .......... 13

2.5.6 Zoonoses ...................... ................... .................................................. .............................................. 13

2.5.7 Vector-borne diseases (Malaria, Schistosomiosis, lymphatic filarias/5) .......... ... ........................~ .... 14

2.5.8 Mental ond psychosocial heolth ..... ................................................................................. ............... 15 ~.6 SWOT ANALYSISFOl! THE H•NAP ..................................................................................... ...................... ... 16

2.7 CUMATI; SERVICES FOR HEALTI< ...... .............. ...................... .............. .................................... ................... ... 16 3 THE STRATEGIC DIRECTION ... ................. ........................... ................... .... .............................................. 18

3.1 VISION . ... .. ........ ...... ................... ......... ............. .............. ....................................................... .............. ... 18

3.2 MISSION ...................................................................................... ................... ........... ............................ 18

3.3 GUIDING PRINCIPLES .... .... ........ ... .. ......... ... ........................ ...... ... ..... .. .... ... ..... ... .. ......... ......................... .. ... 18 3.3.1 ln.stlcurlonallzed onrJ Coordlnoted ResPOn.se ................. ................................................................. 1.8

3.3.2 Adopting to Climate Shacks .... ......................... ... ......................................... ........ ................. ... ....... 18

3.3.3 Building Bridges for Adoptotion ....................... .............. .............................. ............................ ....... 18

3.3.4 Risk-Based Health Prioritizotion ...................................................................................................... 18

3.3.5 Increasing Competitiveness through Health Innovation ..... .............. ........... ...... ................ ... .......... 18

3.3.6 Empowered Participation ...........................,.................. ..................................................,............... 19

3.3.7 C-Ommunity·Based Solutions ............................ .............. ................... ........... ...... ................... .......... 19

3.3.8 Market-driven Solurlons.......... ............................ ........... ................... ........... .............. .............. ....... 19

3.3.9 Capacity Bui/ding and Institutions ................ .................................... ..................................... ......... 19

3.3.10 Innovative Portnerslilps ...... ... ...... .......... ... ... ........ ... ...................... ........... ... ... ... .......... ...... ........ .. 19

3.3.11 Loco/ and lnternotionol Collaboration ........................................................................................ 19 33.12 ensuring Implementation ... .................................... ........ ........... ... ........... ...... .............. ............... 19

3.3.13 Cross-Cutting Issues ............ ............................ ..... ...... ..... ......................... ................................. .. 19

3.4 ALIGNMENT OF H•NAP TD NOP PROGRAMMING ....... ... ... ......... .. ...... ... ........ ..... ... ... ........ .•...... ..... ... ... ... .. ...... 20 ix 3 .5 GOAL ....... .......................................... ... .. ...................... ............................................... ...................... ... 20

3.6 SPeCIFIC 08JECTIV(S OF THE H•NAP ..................... .......................... .. .......................................................... 20 4 BUILDING A CLIMATE RESILIENT HEALTH SYSTEM I N UGANDA ..............................................................21

4.1 THE AOAPTATION Sl'RATEGIB .................... ...... .. ................. .................................... ........ ........... .............. ... 21

4.2 H•NAP STRATEGIC I NTERVtNTIONS AND ACTtONS ... ............................................. ...................... .. ................. 24 5 FINANCING FRAMEWORK AND STRATEGY ............................................................................................31 5.l TME H-NAP flNANONGSTRATEGY .. ............................... ...... ..................... .......................................... ..... ... 3 1

5.2 COSTING PROCISSANDMETHOOOLOGY .................. .............. ....................................................... ................. 31

5.3 SUMMARY Of HIE H ..NAP BUDGU (2025•2030) ........................................................................................ 32

5.4 OUAILED COSTS ACROSS COMPONENTS ANO STRATEGIB . ........ ............ .. .................... ..................... .............. ... 33 5 .5 FUNDINGSOURCES/ R.ESOUP-CE MOBRIZAl.lON STRATEGY ...... .............. ............ ................................................. 34

5.5.1 Internal funding mechanisms and actians ...................................................................................... 34

5.5.2 External Financing Mechanisms and actions .................................................................................. 35 5.5.J AddWonof Innovative Financing Mechanisms .... .............................. .................................... ... ....... 35 6. MONITORING ANO EVALUATION FRAMEWORK ..................... ................... ...... ...................................... 36

6.1 INTRODUCTION ... ......................... ............ ...................... .. ............................................. ........................... 36

6.2 DATA MANAGEM<NT, REPORTING ANO USE . ..................................................................... ........................... 36

6.3 DATA FLOW OIAGRAM ...... ... ........ ........... ............. .............. .............. ...... ...................... .. ....................... .. ... 36

6.4 ROUTINE M ONITORING DATA GENERATION. ANALYSISANO M ANAGEMENT .... .... .......... ........... ......................... ... 37

6.5 DATA QUALfTY ASSURANCE M ECHANISMS ................................. ... ... ........ ....................... ................... ........... 38

6.6 REPORTING ANO UTILIZATION MECHANISMS .......................................................................... ................... ..... 38 6 .7 M&E COORDINATION MECHANISMS .......... .............................................................................. ................... 39

6.7.1 Functionality of the M&E system ............... ...... ................... .................................................. .......... 39

6.8 HUMAN CAPhCJTY FOR M &E ...... ... .................... ................ ........ ... ... ..... .............. ........... ......... ............. ... ... 48

6.9 PARTNERSHIPS TO PLAN. COORDINATE. AND MANAGE THE M&E SYSTEM .. ...... ............. ....................................... 49 6 . 10 NATIONALM ULTI·SECTORAL M&E PLAN ..... ... ................ ...... ......................... ...... ..... ........ ...... ........ ........ ...... 49 6 .11 ANNUAL COSTEOM&E WORK PlAN ................................. .................................. .. ......................... ........ ...... 49 6 .12 AOVOCACY,COMMUNICATIONANO CULTURE FOR M&E .... ... ... ........ .... ............................ ..... ..... ..... .... .... ... ... ... 49 6 .13 ROUTINE PROGRAM MONITORJNG . .. ...................... ...... ... ............. ,.. ... .................... .......... ......... .. ...... ... ........ 4 9

6.14 SURVEYS ANO SURVEILLANCE ....... ... ................................. ... ... ..... ......................... ................. ................ ... ... 49 6 .15 NATIONAtANO SUB-NATIONAL DATABASES ........................ ... ........ .............. ............................ ..... ... ............ .. 49

6.16 SUPPORTIVE SUPERVISION AND DATA ASSESSMENT ...................... ...... ............................................................. 50

6.17 EVALUATION ANORESEARCH ·............... ... .................... ........ ........ ........... ..................... ....... .............. ..... ... ... 50

6.18 DATADISSEMINATIONANO USE ....... .................................... .............. ................... .............. ...... .. ......... ..... ... 50

6.19 LEARNING AND KNOWLEDGE MANAGEMEITT. ........ ........... ..... ........ .................................... ... ... ... ........... ..... ... 50 6.19.l Leaming Mechanisms far H·NAP................................................................... ............................. SO 6.1 9.2 Knowledge Management Proc,:sses ......... ..................................................................... ............. 50

6.20 PERFORMANCE REVIEWS ANO EVAWATIONS ... ... ................ ... ..... .............. .... ....... ............ .. ... ... ........ ........... ... 51

6.20.1 Periodic audits of the M&E processes ........................................................................................51 6.20.Z Annual Performance reviews.... ....................,.................. ,......................, ...................... ... .......... 51

6.20.3 Midterm evaluation of the H·NAP.............................................................................................. 51

6.20.4 Endllne evaluation of the H-NAP ................................................................................... ... .......... 51

6.21 M&E IMPLEMENTATION PLAN ............ .......................... ........................ ... .................... ........ .............. ........ 62 REFERENCES ........... .,....................................... ,................................................................................... ,.......... 69 ANNEX ........................................................................................................................................................... 72 ANNEX 1; SWOT A NALYSIS FOR THE H•NAP ..... ................................................................................................. 72 X LIST OF TABLES Table 1: Climate-related hazards and health facility ownership across health facility levels in Uganda8 Table 2: Proportion of healthcare facilities where the impacts of climate change-related hazards on the different HCF components were observed .................................................................................... 11 Table 3: Strategic Interventions and actions ........................................................................................ 25 Table 4: Summary of the H-NAP Budget (2025-2030) .......................................................................... 32 Table 5: Detailed costs across components and strategies .................................................................. 33 Table 6: Organisational structures with M&E functions ....................................................................... 39 Table 7: M&E Framework matrix·for the H-NAP 2025-2030 ................................................................ 52 Table 8: M&E Implementation plan for the H-NAP .............................................................................. 62 Table 9: SWOT Analysis for the H-NAP ................................................................................................. 71 List of Figures Figure 1: Uganda Climate Response Timeline (Source: UNAS (1)) .......................................................... 6 Figure 2: Total Dengue Cases per Region in Uganda from 2020 to 2023 (MOH Uganda, DHIS2) ........ 14 Figure 3 : Total Malaria incidence per Region in Uganda from 2020to 2023 (MoH Uganda, OH IS2) ... 15 Figure 4: Cl imate and Health Adaptation Components ........................................................................ 22 Figure 5: Data management, reporting and use ................................................................................... 36 Figure 6 : A figure showing data flow .................................................................................................... 37 ======================= xi INTRODUCTION

1.1 Context Uganda is already experiencing the effects of climate change, which is characterized by shorter or longer rains, harsher droughts, and warming up in different parts of the country. For instance, seven droughts occurred between 1991 and 2000 in the arid Karamoja region of northeastern Uganda, with subsequent droughts occurring in 2001, 2002, 2005, 2008, and 2011 {1, 2). These prolonged droughts have resulted in widespread crop failures, drying up of surface water sources, a hunger crisis, and death due to malnutrition and starvat ion in t he Karamoja cattle corridor (3, 4). Furthermore, heavy rainfall and flooding have caused death, internal displacement, and eroding sources of livelihood in parts of Eastern, Western, and South Western Uganda {5). Climate change has also had an impact on the health of the population In various ways. Directly, climate change has resulted in injury or death from extreme weather events and heat illnesses related to temperature Increases, among others. Indirectly, climate change has resulted in mal nutrition, increased spread of vector-borne diseases, and impacts on mental health) {6). Climate change is not only leading to mental healt h challenges and substance abuse as coping mechanisms, but it's also reshaping disease patterns. Conversely, dry ·spells increase respiratory infections as dry air and reduced moisture levels create favourable conditions for airborne viruses. Moreover, the destruction o f crops and livestock, coupled with reduced soil fertility, is causing widespread malnutrition, particularly affect ing vulnerable children with weakened immune systems. The World Health Organization (WHO, 2021) predicts an estimated 250,000 additional deaths an nually between 2030 and 2050, attributing them to malnutrition, malaria, diarrhea, and heat stress d ue to climate change. In flood-prone regions, there's a heightened risk oi malaria due to increased mosquito breeding environments, while drought periods intensify malaria cases with a higher transmission rate. Additionally, climate change is introducing new diseases and pests to previously unaffected areas, such as highland regions experiencing a surge in mosquitoes. Economic hardships resulting from climate change contribute to increased HIV and sexually t ransmitted infection (STI) transmission rates, driven by limited income sources and restricted access to protective services like condoms and prophylactic tr eatments. (Regenerate Africa, 2023). Climate change has also indirectly contributed to a rise in gender-based violence, early marriage, sexual violence, and sex trafficking (Asian-Pacific Resource & Research Centre for Women [ARROW], 2014, 2017b; Le Masson, 2016; Sorensen et al., 2018). According to Women Deliver (2021), vulnerabilit¥ to clj mafe change is determined by factors such as gender, sexuality, age, wealth, indigeneity, and race. Also, climate change-related events strain healthcare workers, interrupt supply chains, and disrupt physical infrast ructure, resulting in complexities in patient treatment and threatening healthcare q uality and safety, as well as hindering access to sexual and reproductive healt h services. Other indirect impacts encompass the consequences oi climate-related shocks on household finances, potentially reducing resources av_ailable for healthcare (J. R. Castro, personal communicatioA, July 26, 2020). The World Bank (2020) estimates a mortality rate of 28.1% attribut ed to exposure to unsafe water, sanitation, and hygiene services per 100,000 population in Uganda by 2019, resulting in approximately 12,435 associated deaths for both males and females. These impacts negatively affect health, productivity, and overall economic growth. The direct damage cost's to health are projected to reach USD 2-4 billion per year by 2030. 1 These ongoing climate change events and related impacts still present unique opportunities for Uganda to define how to respond to its persistent development challenges (1). Uganda has recognized the need to pursue a climate-resilient development pathway (1). The government of Uganda (GOU) has developed several laws, policies, and str-ategies upon recognizing that climate change affects Uganda's development agenda, all sectors, institutions, and communities. Uganda has also committed and is a signatory to various international frameworks and conventions to address climate change and how to minimize, mitlgate, and adapt to its impact. Existing national policy and legal framework is sound enough to t ackle the climate change challenge, but there has been lack of a comprehensive health vulnerability and adaptation assessment to support evidence-based health adaptation planning and strategy development (7).

1.2 H-NAP background Uganda has been pa rt of global and regional efforts to address climate change, including UNFCCC, the Kyoto Protocol, and the Paris Agreement. The country has signed and ratified these agreements, committing to implement policies to mitigate and adapt to climate change impacts. As a member of the East African Community, the country has initiated policies and harmonized them to be consistent with the EAC Climate Change Policy. To address the challenges of climate change, the UNFCCC recommended that countries develop National Adaptation Plans (NAPs) to identlfy and implement strategies that enhance countries' resilience to climate change, foster adaptability wit hin economies, societies, and ecosystems over the medium and longer-term (8). Uganda developed the Nationa I Climate Change Policy (2015) and the National Climate Change Act of 2021 to serve as t he cornerstones of the country's climate action prog~am and measu res. To operationalize the implementation of the NCCP and the Act and actualize the country's commitment under the Paris Agreement, Uganda developed and submitted an updated Nationally Determined Contribution (Updated NDC 2022) to the UNFCCC, which also serves as the National almate Change Action Plan 2020- 2030. The NDC and other strategic documents specify a package of Uganda's key strategic programs, measures, and actions to address climate change and build climate change resilience across drfferent sectors. Wit hin the NCCP 2015, Uganda committed to and prioritized the d evelopment of the H-NAP. In December 2021, the Ugandan Ministry of Health (MoH) committed to the UNFCCC at COP26 in Glasgow, UK, to develop a Healt h National Adaptation Plan (H-NAP). The H-NAP presents a framework for climate change adaptation actions for the health sector. It is intended to enhance Uganda's resilience against the impacts of climate change by Incorporating climate change adaptation into development strategies and planning across various sectors. !t will ultlmately mitigate vulnerabilities, st rengthen the adaptive capacity, and build greater resilience for the healt h sector in Uganda.

1.3 H-NAP Development Process The development process of the H-NAP was coordinated by the Ministry of Health (MOH), and it involved a systematic appr-0ach comprising several key step-s; a) Desk review: This involved an extensive review of literature, including key strategic documents, global frameworks and strategies, national frameworks and strategies, country commitments at various forums, research documents, legal documents, as well as benchmarks 2 of other country NAPs and H-NAPs that already exist. The rationale for this review was to articulate the context from which the H-NAP effo1t is anchored, identify evidence on the nexus between <limate change and health, and guide the articulation of key actions for inclusion in the plan. b) The National Health Climate Change Vulnerability and Adaptation Assessment (VAA). This assessment was commissioned by the Ministry of Health (MOH) and conducted by Makerere University School of Public Health (MakSPH). The rationale for the national VAA assessment was to assess the nature and extent of risk and vulnerabi lity to climate change for the health sector and suggest recommendations for dealing with those risks and vulnerabilities. The VAA findings acted as a key input in informing the development of the H-NAP. c) Stakeholder Engagements and Consultation.s: Stakeholder mapping was conducted and key stakeholder-s were identified and engaged at different levels of t he H·NAP development process. These key stakeholders included the Ministry of Water and Environment (Climate Change Department), Ministry of l oca l Government, Ministry of Finance, Planning and Economic Development, National Planning Authority, Ministry oi Health, Office of the Prime Minister, Ministry of Agriculture, Academia, Civil Society Organizations (CSOs), UN Agencies (UNDP, WHO, UNICEF, etc.) Researchers, and Non-Governmental Organi2ations, Implementing Partners, among others. The key stakeholder engagements largely included workshops, technical reviews, key informant interviews, and expert opinions. The engagements focused on reviewing and validating VAA findings, formulating t he strategic direction of the H-NAP, technical reviews, and validating the plan. d) Approval and launch -The H-NAP was taken through the approval processes of the MOH - including through TWGs, management, senior Management, and HPAC. Following the approval, a launch of the plan was conducted, which also acted as a key step and forum for dissemination of the plan. Key stakeholders across different Institutions graced the launch. 3 2. SITUATION ANALYSIS The situation analysis highlights the policy, legal and Institutional framework for climate change in Uganda and subsequently illustrates the evolution of climate-related national policies and obligations. In addition, it provides an ovetview of the state of climate change vulnerability and adaptation in the health sector, summarising exposure to climate-related hazards and their impacts on the different components of the health system in Uganda. Finally, It provides a summary of the temporal and regional distribution of climate-sensitive health outcomes in Uganda and analyses the strengths, weaknesses, opportunities, and threats for t he H-NAP.

2.1 The Policy and legal Framework for Climate Change in Uganda Uganda i-s committed to combat ing climate change. The cou ntry is Involved in and has committed to various frameworks at global and regional levels, including the UN FCCC, the Kyoto Protocol, and the Paris dimat e Agreement (2015). The Agenda 2030 for Sustainable Development, Agenda 2063 the Africa We Want (2015). The count ry has signed and ratified t hese agreements, committing to implement policies to adapt to climate change impacts. As a member of the East African Community, Uganda has Initiated and afigned policies with the EAC Climate Change l egal Fram eworks, including East African Community: Vision 2050 (2016) and EACdimate Change Policy Framework (2011). Uganda developed the National Climate Change Policy (NCCP) of 2015 and the National Climate Change Act of 2021, which serve as the cornerstone of t he country's climate action Programme. To operationalize the implementation of the National Climate Change Policy and the Act 202-1 and to ; trengthen the country's commitment to the Paris Agreement, Uganda developed and submitted an updated Nat ionally Determined Contribution (Updated NDC 2022) to the UNFCCC, which also serves as the National Climate Change Action Plan 2020- 2030. The updated NDC, among other things, provides for building a resilient health system and, to this end, recommends the development of the Nat ional Adaptation Plan for the health sector. In addition, Uganda developed Vision 2040 and the National Development Plan Ill, which are the key strategic plans guiding the count ry's development agenda. Within these strategic plans, the effect of climate change on the country's development process and prospects has been recognized, and t he need to develop and implement climat e action to promote adaptation and resilience has been articulated. To this end, strategies and guidelines have been developed and are being implemented at both national and sectoral levels, including: i) National-Climate-Change-Mainstreaming-Guidelines (2014) with w el~stipulated steps for integrating climate change into sectoral plans and budgets ii) The Uganda Green Growth DevelopmentStrategy-5eeks tooperat ionali ze a green economy, focusrng on promoting, among others, a socially inclusive growth that rmproves food and nutritional security iii) The Strategic Program for Climate Resilience (SPCR) of 2017 iv) The National Adaptation Program of Actions (2007), with a health focus on climate change vectors, pests, and disease control and management, and promotion of early warning v) The National Climate Change Communication Strategy (2017-2021) for Improving climat e change communication at all levels. 4 vi) Guidelines to the Local Government Planning Process (2016) . The focus is to provide a comprehensive framework for local governments in Uganda to develop and implement health sector plans t hat ate responsive to t he specific needs of their communities. vii) Climate Change and the Health Sector Development Plan {2020-2025): The HSDP recognizes the need to mainstream climate change into health sector plans and policies, as wit h any other cross-cutting issue. To this end, the HSDP acknowledges the need to implement the strategies proppsed under the NCCP (2015), includ ing 1) continuous vu lnerability assessment of the healt h .sector to t he impact of climate change; 2] developing plans for bui lding a climate- change resilient health system; 3) asses.sing t he Impact of climate change on human health and wellbei ng; 4) data capture and dissemination; 5) increased disease surveillance and rapid response to control epidemics; 6) strengt hen the public health system by building health facilities and adequately stocking them; 7) addr essing issues of safe water chain and sanitation to limit outbreak of waterborne diseases; and 8) implementing public awareness programs as well as improving healt h workers' awareness about the link between climate change and human health. Other national policies, laws, and guidelines that emphasize climate change include: viii) The National Policy for Disaster Preparedness and Management of 2010 aims to reduce vulnerability to disasters by establishing institutions and mechanisms at national and local government levels. The policy pledges to take proactive actions to reduce climate change causes and negative impacts. It outlines obj ectives for various disaster types, including drought, floods, landslides, epidemics, pandemics, heavy storm·s, pest infestations, earthquakes, and fires. Tile document underscores the escalat ing impact o f disaster -induced loss and damage on impoverished communities, attributing it to a myriad of factors such as shifting demographics, technological and socioeconomic changes, haphazard urbanizat ion, developmental lag, environmental degradation, and climate variability. It underscores the imperative of investing Jn secure and sufficient water resources to cater to the expanding population while acknowledging the potential rise in transport-related incidents with population growth, contributing to human-induced disasters. ix) Additionally, the policy acknowledges the heightened vulnerability of women and children to disasters. Extensive attention is given to health-related considerations across v<1rious contexts. The document delves into t he repercussions of disasters on waterborne diseases, malaria, and epidemics, underscoring the necessity for health interventi•ons during displacement scenarios. The M inistry of Health is assigned the responsibility of fortifying early warning systems wit hin the health sector to implement preventive measures. Fu,thermore, dimate change is adrnowledged as a source of health-related hazards, encompassing factors like radiat ion, intense t ropical winds, and an elevated risk of global warming. x) The National Environment Act 2019. The Act· sets up a Policy Committee on Environment, which provides strategic policy guidance on the environment. The committee is also responsible for climate change and ensures enforcing measures to tackle climate change causes and effects across all sectors. xi) The Health sector aligns with various regional and international frameworks, including the Sustainable Development Goals (SDGs), the Astana Declaration, and the Africa Health Agenda, 5 emphasizing universal healt h coverage, global health security, and primary healthcare. These commitments, integrated into the MoH' s operations, aim to enhance public health through collaborative efforts involving multilateral and public-private partnerships, guiding the development of a National Global Health Strategy to facilitate cohesive policy action. Additionally, the country has established several national pol icies and commitments to strengthen its health system, such as the National Health Policy (2010), whi'ch prioritizes health promotion, disease prevention, and the effective delivery of t he Uganda National Minimum Health Care Package. Furthem1ore, the Ugandan Government's FP2030 Commitments focus on key family planning interventions to improve access to family planning services, aligning with the Second National Family Planning Costed Implementation Plan 2020/ 21-2024/ 25. These Initiatives are supported by the Ministry of Health Strategic Plan 2020/21-2024/ 25, providing a comprehensive roadmap for health sector development in Uganda. ■ ■ • --• -• -• -• -• -• • 0 2024 II II !1IA,Tll !,l,l»IIM M ,111'1Ll'Clllf'UII ,ito..-10,01 Figure 1: Uganda Climate Response Timeline (Source: UNAS (1))

2.2 Institutional Framework The National dimate Change Act of 2021 proposed an institutional framework for climate change action in Uganda. The rationale for this framework was to iacilitate better coordination and alignment of action towards climate change mitigation and adaptation in Uganda across the different sectors. The framework includes the following structures: 1. The Department responsible for climate change (CCD). This is established under the M inistry of Water and Environment (MWE). The Climate Change Act, 2021 gives a mandate to the CCD to broadly: a) ensure that Uganda meets her obligations and realizes her benefits under the Convention, its Protocol, and the Agreement; and (b) coordinate, monitor, and evaluate Government programmes and actions of Government on climate change (Section 14, Part IV of the Act). Thus, the CCD leads in coordinat ing adaptation and mitigation efforts, fosters technology innovation for reducing greenhouse emissions, manages climate change information, enhances stakeholder involvement, supports sectors and districts In act ion planning, supports green growth, mobilizes climate finance, increases public awareness, implements policy decisions, and oversees greenhouse gas inventories. 2. The Policy Committee on Envi ronment, which advises the CCD and lead agencies on implementing the dimate Change Act, and formulates policies for the department's Implementation. 3. National Climate Change Advisory Committee: Composed of experts across various sectors and offers independent advice on climate science, technology, and best practices for adaptation and mitigation, evaluates sectoral impacts, and proposes relevant policies and technological advancements. 4. Lead Agencies: Focus on reducing ecosyst em and community vulnerabilities, undertake VAAs, promote resource diversificatlon, develop alternative livelihoods, enhance adaptive capacities oi communities and ecosystems, enhance the development and dissemination of technology for climate change adaptation, and allocate funds for resilient investments. 5. District Department for d imat e Change: Engages in coordination and liaj son activit ies, promotes awareness and literacy, provides technical support, maintains records and acts as a secretariat, aids in legislative development, monitors and reports compliance, and compiles annual implementation reports. 6. District committee for Climate Change : Integrates climate con.siderations into district planning, coordinates cl imate change activities across various sectors, assists in formulating ordinances and by-laws, disseminates information, and conducts monitoring and evaluation. 7. Low er Local Government Committees : Implement the District Climat e Change Action Plan at various administrative levels, prepare worl< plans for local adaptation and mitigation, run educational campaigns, mobilize community participat ion, monitor and evaluate local climate risks and act ivities, and report on challenges to adaptation and mitigation efforts. 8. National Adaptation Technical Working Group (NATWG) Uganda has put In place a multi-sectoral and disciplinary National Adaptation Technical Working Group (NATWG) to provide information on adaptation, review adaptation assessments, and -guide national climate change resilience-building actions and measures. The Climate Change Department effectively coordinates the NATWG and aims to ensu re synergy and collaboration among stakeholders, including adaptation experts.

2.3 State of climate change vulnerability and adaptation in the health sector A Vulnerability and Adaptability Assessment (VAA) was conducted in 716 selected Health Facilities in Uganda using the WHO-recommended methodological approach (WHO 2013). The selected health facilities were at the level of Health Centre lls (40.9), Health Centre Ills (45.8%), Health Centre IVs (8.7%), and General Hospitals (4.3%). Almost 90.4% of t he facilities assessed were government-owned, 9.2% were PNFPs, and 0.4% were Private for profit. The VAA assessed facilities for the state of vulnerability to several climate change hazards, including floods, storms, drought, landslides, and lightning, as well as climate-r elated extremes like rising water levels, heat waves, and cold waves. For each priority climate change hazard and extr eme, iour dimensions were assessed, Including health workforce; WASH and health care waste, energy, and infrastructure, technology, products, and processes. Additionally, focus group discussions (FGDs) with Village Health Teams and Health Unit management comm ittees (HUMCs) were conducted t o explore the extent of vulnerability and Impact of the specified hazards at the community level.

2.3.1 Exposure to climate-related hazards in HCFs in Uganda The VAA revealed that nearly half (47 .6%) of the HCFs are exposed to drought, 39.7% are exposed to floods, 31.1% are exposed to storms, 12.0% are exposed to wat er level rise, 11.7% are exposed to landslides, 8.9% are exposed to lightning, 2.0% are exposed to heat wave and 0.1% are exposed to 7 cold waves. Regarding the healthcare facilit y level, the VAA found that regional referral hospit als had the least exposure to hazards in comparison to lower-level facilities. Lower-level facilities have higher exposure to storms, high w ater levels, floods, drought, and landslides. This difference could be attributed t o the fact that lower-level facilities are oft en situat ed in more vulnerable areas; thus, they face increased exposure due ro their geographic location. It is, therelore important to consider the vulnerability of HCFs at different levels when planning for climate change adaptation strategies. Table 1: dlmate-related hazards and health facility ownership across health facility levels In Uganda Characteristic General Hospital, Health Centre 11, Health Centre 111, Health Centre IV, RR Hospital, N=31 N =293 N=328 N=62 N= 2 Storms 6 (19%) 90 (31%) 104 (32%) 22 (35%) 1 (50%) Floods 16 (52%) 111 (?.8%) 134 (41%) 21 (34%) 2 (100%) water level rise 3 (9 .7%J 38(13%) 39 (12%) 6 (9.7%) 0(0%) Drought 16 (52%) 140 (48%) 151 (46%) 32 (52%) 1 (50%) Heat Wave 0 (0%) 7 (2.4%) 5 (1.5%) 2 (3-.2%) 0 (0%) Col d Wave 1 (3.2%} 0 (0%) 0 (0%) 0 (0%) 0 (0%) Lightning 4 (13%) 22 (7.5%) 30 (9.1%) 8 {13%) 0 (0%) landslides 0 (0%J 35 (12%) 40 (12%) 8(13%) 1 (50%) Health faoility ownership Gov 20 (65%J 262 [89%) 306 (93%) 57 (92%) 2 (100%) PNFP 11 (35») 30 (11ll s) 20 (6.1%) 5 (8.1%) 0 (0%) PfP 0 {0%) 1.(03%) 2 {0.6%} 0 (0%) 0 (0%)

2.3.2 Climate•change-related vulnerabilities in healthcare facilities in Uganda Vulnerability to climate change-related hazards w as assessed by evaluating various components of HCFs (I.e., health workforce; WASH and health care waste services; energy services; Infrastructure, technologies, products, and processes). From the assessment, a significant proportion of the HCFs exhibited high vulnerability t o climate change- related hazards. Vulnerability was evaluated based on the extent to which the HCFs were prepared to w ithstand and adapt to the likely Impact of clima te change hazards, as elaborated below.

2.3.2.1 Vulnerability of the health workforce to cl/mote chonge-reloted hazards The VAA revealed that HCWs do not participate in the development of drought adaptation plans. (58.1%). There is a notable lack of sun protection and hydration supplies during outdoor work in 60.4% of HCfs exposed to drought and heat w aves (78.6%). Additionally, t here is a lack of training among HCWs on the identification of health conditions exacerbated by drought (56.0%). Furthermore, about half of the HCFs lack provisions for drinking water for their w orkforce during drought (49.3%), with a similar concern for heat waves (50.0%). Over 58.9% of assessed HCFs lack plans for scheduling outdoor work to cooler times of the day to reduce heat-related risks. Across a broader range o f climate hazards, t he VAA revealed significant gaps in emergency planning, staff support, and t raining. Notably, the absence of recovery assistance programs tailored to staff needs post-hazard is alarmingly high across HCFs that are exposed to storms (83.0%), floods (79.3%), landslides (90.2%), and lightning (83.9%), indicating a crit ical gap in post-event staff welfare. Training on public health and climate change hazards is also lacking for over three-quarters of HCFs across all hazards. A recurring theme across all hazards is the lack of participation of staff in Hazard Risk Plans and Responses as well as community disaster planning committees, w ith high percentages Indicating a gap In involving HCWs in contingency planning and emergency response strategies (75.3% for storms, 71.3% for floods, 80.7% for landslides, 8 79.4% for lightn ing and 69.8% for w ater-level rise). The VAA found a lack of programs for supporting staff with regard t o mental health, injuries, m·edical t reatment, and relat ed support measures.

2.3.2.2 Vulnerability of the WASH and healthcare waste component A significant proportion oi HCFs lack w ater management and safety plans to address contamination risks. Up to 55.1% of HCFs are exposed to drought, and 58.7% of HCFs are exposed to floods. They lack w ater safety plans and contingency plans for monitoring and reducing cont aminants as w ell as onsite water purification equipment. Additionally, 61% of HCFs do not hav e long-term drought management as w ell as emergency w at er supply plans (59. 7% for floods, 66. 7% for landslides) which highlights .a crit ical gap In ensuring the continuit y of safe water access during and after hazards. The VAA Indicates a widespread lack of infrastructure t o cope with hazard -events, such as stormwater management systems (75.6% for storms) and natural floodwater infiltration systems (68.6% for floods). HCFs are inadequately prepared to manage healthcare wast e, including hazardous w ast e, particularly w ith regards to safe storage (51.6% for storms, 60.1% for floods), safe transport (56.8% for storms, 60.1% for floods), safe disposal systems post-event(56.8% for storms, 53.5% forfloods, 43.9%for landslides). This lack of preparedness raises concerns about environmental contamination in t he aftermath of climat e-induced hazards.

2.3.2.3 Vulnerability of the energy component A significant proportion of HCFs do not perform regular assessments of their energy systems to ensure they can cope with climate change ev ents. The highest neglect is observed in HCFs exposed t o landslides (68.0%), w ater level rise (67.9%), heat w aves (64.3%), lightning (59.4%), and flood s (56.7%). There is a lack of alternative power sources t hat can cover critical service areas and equipment during and after an ev ent across all hazards, peaking In HCFs exposed t o landslides (82.8%), storms (79.7%), heatwaves (78.6%), floods (76.4%), and lightning (73.2%). This gap in energy contingency planning threatens the continuit y o f essential medical services, Including life-saving care, during power outages. The VAA also found a significant lack of emergency plans to ensure t he availability of adequate lighting, communication, refrigeration, and sterilization during ev ent s (67.5% of HCFs exposed to landslides, heatwaves (64.3%), w at er level rise (58.9%) and floods (52.5%). Additionally, there is an absence of secure pla.ces in HCFs t o protect backup energy sources from damage during events; in 73.6% of HCFs exposed to landslides, st orms (70 .2%), w ater lev el rise (68.1%), floods (67.1%), lightning (60.0%) and heat w aves (50.0%).

2.3.2.4 Vulnerability of infrastructure, technologies, products and processes Up to 71.0% of HCFs lack a monitoring and early warning syst em that is integr at ed with other areas to manage risks related to drought impacts on the facility, 72.1% lack a mechanism to filter indoor and ambient air pollutants, 72.7% lack a defined and sustained bud.g et as part of core budgeting for emergency prepar edness and response to drought risks and 53. 7% lack a mechanism t o rapidly supply or restore w ater services. Additionally, there is a lack of consideration of climate risks in annual planning in 67 .1% oi the HCFs, 69.9% lack a contingency plan for personnel evacuation before, during, and follow ing a storm, 53% lack a plan for relocating critical equipment supplies post -storm, and 63.8% lack one for relocating critical equipment after a flood. Over 80.0% of HCFs lack a post-storm recovery plan and 67.1% of HCFs lack a contingency plan for safe and efficient personnel evacuation before, during, and following a flood. The assessment also shows that 81.0% lack.an established post-landslide recovery plan for all infrastructure facilities. 9 l.3.2.5 Vulnerability within communities ond impacts an health and wellbeing The most r ecent country-wide vulnerability and adaptation assessment elucidated that climate change impacts all spheres of life of the population. The long-term change in weather patterns was reported to have severe consequences on the health and well-being of t he population. The Individuals at a heightened risk oi climate-change-related hazards such as hazards and floods included; 1) refugees since they did not have adequate sottrces oi food, 2) pregnant mothers, young children, girls and elderlysince they are deprived t of nutritious foods, and individuals on long-term treatments such as antiretroviral therapy, indigenous peoples as well as people living with disability. The interactions between climate change and; 1) poverty (SDG 1), food security (SDG 2), health and wellbeing (SDG3), and access to quality education (SOG 4), were common, illustrati ng the need for a multi-sectoFal approach to optimize synergies and to reduce trade-offs. Communities reported that an increase in the intensity of rainfall and the longer drought spells negatively impacted food security and nutrition, thus increasing cases of malnutrition. Limited access to adequate food was associated with non-adherence to treatment, especia lly among people living with HIV. Heavy rains and hail stor ms were also reported to increase vector breeding thus leading to an increase in vector-borne diseases includ ing malaria. Climate change-related hazards led to the displacement of the healt hcare workforce and death of those seeking treatment. Climate hazards such as long spells of dr ought and floods led to t he destruction of property and loss of livelihoods, thereby exacerbating the loss of household income (SDG 1). The increase in poverty was associated with school dropouts and violence, which are well-known to hamper the promotion of healthy behaviours (9-11). Cli mate hazards compromised; 1) the ability of households, including t hose of the health workforce, to access safe water sources for drinking and other household chores, and access to decent housing (SDG 11) for both healthcare facility users (community) and the healthcare providers. Some healthcare facilities were also unreachable due to floods, t hus limiting access to healthcare services and the delivery of medical supplies (supply chain) and life-saving reproductive health supplies. In some healthcare facilities, it was difficult to cross from one department to another due to floods. Long dry spells led to the sharing of water sources with animals thus Increasing the risk of zoonotic diseases, while children and women who trekked long distances to water sources were at risk of sexual and physical violence. Droughts and floods w ere also reported to destroy WASH infrastructure at both community and healthcare facility levels thus skyrocketing the risk of diarrheal diseases such as chol era. At healthcare facilities, climate hazards were r eported to compromise infection prevention and control and the quality of healthcare received by the clients/ patients. In some communities, community health workers (CHWs), also known as village health teams (VHTsj, governmental officials such as environmental health staff (environmental health ofiic.ers, health inspectors, and health assistants), community development officers, religious leaders, and non- governmental organisations, played a central role in fostering adaptation to climate change in some communities. In response to climate change-related impacts on water, sanitation, and hygiene, these sensitized communities on the importance of having and using WASH facilities, and food reservoirs. Aside, the community also r elied on vil lage saving schemes t o cope wit h the effects of climate hazards including deprivat ion of food. Although some communities reported the existence of disaster response committees, these were inactive, and efforts of health workers in fostering adaptation to climate change hazards w ere only evident during disease outbreaks.

2.3.3 Impacts of climate change on different HCF components From the VAA assessment, a substantial 76.5% of HCFs that have been hit by drought observed notable impacts on thei r health workforce, 73.6% encountered impacts on WASH, and 32.6% encountered impacts on infrastructure, t echnologies, products, and processes. Flood events showcased widespread effects, with 79.6% of HCFs encountering impacts on the health workforce, 71.1% on WASH and ================== 10 healt hcare wast e, and 68.0% facing impacts in infrastructure. The rise of water levels also.sign ificantly impacted HCfs, affecting the health workforce (75.6%), WASH (73.3%), and infrastructure condit ions {53.5%). Landslides, too, left their mark, with 71.4% encountering impacts on t he health workforce, 75.0% on WASH and healthcare waste, and 70.2% on infrastructure components. Only one HCf reported having experienced a cold wave and thus has not been reported in the summary Table 1 below. Table 2: Proportion of healthcare facilities where the impacts of climate change-related llazards on the different HCF components. were observed , .. • ' Floods Storms Water level Heat Liglltning Landslides rise waves Health 76.5 79.6 71.7 75.6 78.6 46.8 71.4 workforce WASH and healthcare 73.6 71.1 63.7 73 .3 35.7 25.8 75.0 waste Energy 31.1 56.7 63.7 53:.5 0.0 51.6 41.7 services Infrastructure, technologies, 44.3 6.8.0 70.4 75.6 64,3 54.8 70.2 products, and processes The assessment further reveals several impacts including fatalit ies, reduced work capacity, mental healt h effects, interruptions in supply chains and disruptions in service delivery, emphasizing the need for mental health support and emergency plans. Additionally, the assessment show s infrastructure destruction, damage t o vital equipment, water contamination, and disrupt ion of waste management systems in the healthcare facilities. The power failures, loss of essential supplies, and damage to alternative energy sources highlight the crit ical importance of energy resilience for healthcare facilities during extreme weather events. Thus, proactive measures and adaptive strategies are imperative to enhance t he climate resilience of HCFs and safeguard public health in t he face of a changing climate.

2.4 Climate-induced mobility In Uga nda, human mobility manifest s in two pr imary forms: internal and external (12, 13). External mobility involves people crossi ng into Uganda from neighboring countries, seeking permanent or temporary settlement (12). Internally, mobility is driven by climate-related stresses, with rising temperatures, unpred ictable rainfall, declining soil product ivity, and livestock losses prompting people to move {12-14). For example, t he Karamoj ong from northeastern Uganda migrate seasonaffy to neigh bor ing regions in search of water and pastures for their livestock (12). The Karamoja region faces prolonged droughts and erratic rainfall, severely Impacting agriculture and livestock and leading to food and w ater scarcity (14), which drives them to migrate seasonally as a coping mechanism. In addition, climat e-related events have in the last three decades increased internal displacement of people in Uganda, with over 47,467 people displaced in 2023 alone (15), The most severely affected areas are t he Teso and Mt. Elgon sub-regions, including the districts of Sorot i, Amuria, Katakwi, Bukedea, Kumi, and Sironko in the East ern region o f Uganda (13, 16-18). ================== 11 Climate-induced migration in Uganda slgnificant ly impacts public health, affecting both the migrants and the host communities (12-14). Infectious diseases are a major concern, as overcrowded and unsanitary living conditions in relief camps and urban slums facilitate the spread of diseases such as cholera and tuberculosis (19-22). Migrants often lack access to adequate healthcare, exacerbating these health risks (19-22) Mental health issues are also prevalent among climate migrants, with the stress of displacement, loss of livelihoods, and challenges of adapting to new environments leading to anx1ety, depression, and post-traumatic stress disorder (PTSD) (19-22). Nutritional deficiencies arise as displacement disrupts food supply chains, leading to malnutrition and food insecurity. Migrants, particularly children and pregnant women, are especially vulnerable to nutrit ional deficiencies, which can have long-term health consequenc,es. Access to healthcare is another critical issue, as migrants often iace barriers such as lack of Informat ion, financial constraints, and discrimination (19-22). A notable example In Uganda is t he recent increase in flood impacts in Kasese, which has led t o large- scal e displacement and resulted in overcrowding of camps (22). This situat ion has further led to lim ited access to healt hcare services, gender inequalities, increased drug and alcohol abuse, and a rise in gender-based violence (22). Su0h condit ions highlight the complex interplay between climate-induced migration and publ ic health, and highlight the need for interventions to address both the lmmediate and long-term health needs of affected populations. The Ugandan government has developed various policies and strategies to address climate-related human mobility. However, t here is no policy or legal framework specifically targeting climate-induced mobility and health, with existing frameworks predominantly focusing on refugees managed bythe Office of the Prime M inister. Uganda is expected to face increased exposure to the adverse Impacts of climate variability. Thus, there is an urgent need for actions to avert, minimize, and address human mobility in the context of climate change.

2.5 Climate sensitive health outcomes in Uganda

2.5.1 Injury and mortality from extreme weather events Extreme weather events like floods on the banks of river Manafwa and landslides at the foot of Mt. Elgen have in the past decade caused 1,000 deaths and displacement o f over 5,000 individuals (23, 24). More than 400 deaths resu lt ing from landslides occurred rn Bududa district in 2010, while over 150 injuries and 45 fatalities from landslides and floods w ere reported in Eastern and Western Uganda in 2019 (25). l andslides induced by heavy precipitation, in 2022, also led to 46 fatalities in Kasese and M bale (17). The proportion of injuries arising from floods is; 31.7% for bruises or abrasions, 21.8% for broken bones or fractures, and 11.9% for sprains or strains. The proportion of injuries arising from landslides is; 44.4% for broken bones and fract ures, 27.8% for bruises and abrasions, and 11.1% for internal organ inju ries (26).

2.5.2 Water-borne diseases Climate haza rds such as flooding and surface runoff compromise water quality, accelerat e the breeding of disease vectors such as flies, and enhan ce pat hogen transmission. An increase in temperature also contributes to the proliferation of pathogens in food and wat er sources, further amplifying disease transmission (27-30). Thus, water borne diseases, such as typhoid fever and cholera, remain on the increase, largely affecting children. The incidence of diarrheal diseases rose from 3.3 per 10,000 in 2020 to 3.7 per 10,000 in 2023, with the Kampala region reporting the highest incidence at 12.2 per 10,000, followed by Bugisu at .6.4 per 10,000 and Tooro at 5.7 per 10,000. The impacts of climate change on the incidence of diarrhoeal diseases are likely to aggravate the ================= 12 occurr ence of cholera and typhoid outbreaks. Cholera outbreaks have been reported almost annual ly over t he past two decades (31, 32), while typhoid remains endemic, with over 56;000 cases reported per year (33).

2.5.3 Non-communicable diseases Cl imate change indirectly Influences the prevalence and severity of non-communicable diseases (NCDs•) in Uganda. Rising t emperatures and changes in precipitation patterns can affect agricultural productivity and food security, leading to shifts in dietary paiterns and nutritional deficiencies. Extreme weather events and natural disasters also disrupt healthcare systems, limiting access to essential medicat ions and healthcare services for individuals living with chronic illnesses (34). Failure to build health syst em resilience will increase t he already high burden, where 36% of deaths were attributed to NCDs in 2019 (35). Additionally, the age-standardized mortality rate for major NCDs is as high as 709 per 100,000 in males and 506 per 100,000 in females in 2021 (35).

2.5.4 Respiratory illnesses Climate change leads to changes in allergen concentrations, prolonged allergen seasons, declining air quality, increased pre.sence of microbes and particulate matter, and air pollution, which increase the risk of respiratory illnesses (36-39). Heightened heat and sunlight In congested areas can result in increased ozone exposur e among the urban population. The impact of extensive exposure to smoke and pollution from wildfires is exacerbated by corrcurrent heat and drought conditions. Furthermore, intense precipitation events and flooding contribute to increased exposure to indoor humidity and mold. Maids add burden to individuals with asthma and allergies (40). These increase bronchoconstriction and cough among individuals with asthma as they struggle to breathe in hot and humid air conditions (41).

2.5.5 Malnut rition and food-borne diseases Utilization of fossil fuels, deforestation, encroachment on wetlands, and unsustai nable agricultural practices diminish the accessibility of nourishing food and clean water thus contributing to dehydration, food insecurity, food-borne diseases, and malnutrition (42, 43). In Eastern and Northern Uganda, droughts have dried crops in the fields leading to diminished food production, thereby subjecting many to .starvation and malnutrit ion (44). Uganda exhibits increased rates of undernutrition, with approximately 29% and 3.5% of children under the age of 5 experiencing stunted growth and body wasting respectively (45). Toro region records the highest pr evalence of stunting among children under five, while, the Arua region registers t he highest levels of wasting, all partly attributed to climate change (45). In a certai n year, floods and hailstones led to c.rop losses and some farmers struggled to harvest even a single bag (l OOkgs) of maize (46).

2.5.6 Zoonoses According to t he Uganda One Health Strategic Plan 2018 - 2022, cli mate change is exacerbating zoonotic disease outbreaks (47). Extreme weather events, including intense rainfall and flooding, in Uganda have led to an upsurge in epidemics caused by zoonotic diseases. For instance, in March 2016, Uganda experienced its flfst-ever out bfeak of Rift Valley fever (RVF) in Kabale, following a period of heavy rainfall and extensive flooding. Additionally, the country has seen more serious outbreaks such as Ebola, Marburg, yellow fever, Crimean-Congo hemorrhagic fever (CCHF), plague, COVID-19, and avian influenza (47-49). These incidents indicate t he interaction between climate change and t he ================== 13 emergence of zoonotic diseases (47). Several zoonotic diseases are endemic in Uganda includ ing Anthrax, Rabies, Brucellosis, and Trypanosomiasis (47, 50).

2.5.7 Vector-borne diseases (Malaria, Schistosomiasis, lymphatic filariasis) Extreme w eather, heat waves, floods, and rising temperatures, mosquitoes, which are known vectors of a range of infectious diseases like dengue, malaria, chikungunya, yellow fever, RVFs, W est Nile fever, Japanese encephalitis and Zika (51). Figure 2 shows dengue cases per region. .,. ..... .,. .,. ... .... ..-.... RIG'llflll •· .,. ....,. .... ·-~- -·- - :11• ,, ,.... ! t) .... .,.... -·- .... - -_ ,_ .,. - s-c.... •· - - ,_ ... ,._ .,. ... .,, , ,.;,. ·- .,..... ••.~-.,.- :c. )w. Figure 2: Total Dengue Cases per Region in Uganda from 2020 to 2023 {MOH Uganda, DHIS2}

2.5.7.1 Malaria Cl imate change threatens progress made towards malaria elimination (52). Uganda holds t he unfortunate distinction of having the world's highest malaria incidence rate, with 478 cases per 1,000 population annually (53). The disease is endemic in 95% of the country, with even higher incidence (63%) ln the mid-northern region. An estimated 60 million fever cases are treated annually across healthcare faci lities (54). A study examining the consequences of variations in climatic iactor s such as temperature and rainfall on t he malaria incidence among the Ugandan population revealed that (SS). An increase in maximum temperature (hotter days) over t hree consecutive mo nths led to an 8.1% decrease in monthly malaria cases in the long t enm. Conversely, a three-month rise in minimum temperature (warmer nights) was associated with a 16.7% increase In mont hly mala ria Incidence over time. Rainfall also play ed a role: a sustained increase in rainfall over three months resulted in a 14% reduction in long-term monthly malaria cases (55). Figure 3 shows total malaria incidence per region. ================== 14 Tcrtiil M ~ incidence per Region ,,.. ... •· - - - - - - - ------ -· - - ,_ -·-·-- . .... ..... ------- -- -..._ -_ .....,. - - - - --- .;,, ,.,. ,... .... ... ... -,-----:--- - m, ,i,,_ ~------ -- Figure 3: Total Malaria incidence per Region in Uganda from 2020 to 2023 (MoH Uganda, DHIS2)

2.5.7.2 Schistosomiasis The effects of climate change, particularly change in temperature, rainfall, flooding, and drought, have significant impacts on the transmission dynamics of schistosomiasis, primarilythrough their effects on the intermediate snail hosts and the Schistosoma parasites themselves Uganda (56, 57), These climatic factors Influence the lifecycle, distribution, and population density of t he snai l hosts,thereby affecting the tr ansmission rates of schistosomiasis (56, 58). Flooding events can significantly impact schistosomiasis transmission by expanding snail habitat s and dispersing snails and parasites into new areas. Also, increased rainfall can lead to expanded snail habitat s and higher snail populations, thereby increasi ng the risk of schistosomiasis transmission (56, 58). Schist osomiasis threatens millions in Uganda, with its prevalence ranging from 11-91% (54). An estimated 5.7 million people living near lakes, rivers, and irrigated areas across 63 districts are at risk of infection (54). 2.5.7.3 lymphatic filariasis (elephantiasis, hydrocele) In Uganda, an estimated 14.5 million people are at risk of infection in 54 districts (east, north, Bundibugyo), and are susceptible to a mosquito-borne disease called lymphatic filariasis(elephantiasis and hydrocele). The risk is highest in the eastern, northern, and Bundibugyo districts, where infect ion rates can reach over 40% in northeastern Uganda, compared to Just 0.5% in western Uganda (54),

2.5.8 Mental and psychosocial health Environmental experts in Uganda suggest a link between the country' s changing climate and a rise in mental health issues among it s citizens (59). Climate change exacerbates various social and environmental factors that undermine mental healt h and psychosocial well-being. This escalation can manifest as emot ional distress, the emergence of new mental health disorders, and the det erioration of existing conditions (60). The spectrum of mental health impacts attributable to climate change spans from mild stress and disromiort to severe cl inical disorders, including anxiety, sleep lssues, depression, post-traumatic stress d isorder (PTSD), and suicidal ideation (60). Moreover, climate change affects individuals and communities by altering daily lives, perceptions, and experiences, =================== 15 compelling them to adapt, comprehend, and effectively address its consequences. Exposure to news about climate change further contributes to feelings of uncertainty, stress, and depression, leading to a pervasive sense of helplessness (60).

2.6 SWOT Analysis for the H-NAP A detailed analysis of the Strength Weaknesses Opportunities and Threat es (SWOTj was a foundational component for this H-NAP. It was conducted based on the WHO component framework, examing Leadership and Governance, Health workforce, Vulnerability, Capacity, and Adaptation Assessment, Emergency Preparedness and Management, Integrated Risk Monitoring and Early Warning, Health and aimate Research, Climate-Resilient and Sustainable Technologies and Infrastructure, Cl imate and Health Financing, Management oi Environmental Determinants oi Health, and Climate-Informed Health Programmes. The detailed SWOT analysis is available in Annex 1. However, here, we present an overall summa,y of the key emerging issues from the SWOT analysis as a basisfor H-NAP Strategy.

2.7 Climate Services for Health Climate seivices for health represent a crucial component in addressing climate change issues in Uganda (61) . These services involve the provision of climate data, tools, and information tailored t o the health sector's needs, enabling health professionals to better anticipate, prepare for, and respond to climate-related health risks. Climate services for healt h encompass a range of activit ies, including the forecasting of climate variables that impact health (such as temperature, precipitation, and extreme weather events), monitoring and predicting the spread of climate-sensitive diseases (like malaria and cholera), and issui ng early warnings for heatwaves and air pollution episodes. By integrating these services into health planning and operations, Uganda <an enhance its public health resilience against the impacts of climate change. According to the World Meteorological Organization (WMO), climate services for health are defined as "the entire iterative process of collaboration between relevant mult i and trans-disciplinary partners to identify, generate, and build capacity to access, develop, deliver, and use relevant and reliable climate knowledge to enhance health decisions." (61). These services ar e iundamenta l in understanding and monitoring how climaie change affects population health and health systems. They provide decision-makers with the foresight needed to inform policies and practices that protect public health over mont hs, seasons, and yea rs. dimate services for healt h are indispensable for several key activities, including risk assessment, emergency prepared ness, early warning syst ems, and programmatic interventions. They play a vital role in disaster risk reduction by enhancing health early warning systems, disease prevent ion and control efforts, heatwave and air quality management, climate change adaptation, and health ed ucation. By empowering individuals and building cllmate- res!lient health systems, climate services contribute significantly to the creat ion o( healthy communities. Examples of successful implementation of climate s.ervices ior healt h can be seen globally. In Kenya, humanitarian organizations use Improved forecasting and drought monitoring to better prepare for drought-related health impacts. A 2022 survey by the Kenya Red Cross indicat ed that all rehabilitated water facilit ies remained functional throughout t he drought period, providing clean and affordable water despite increased dependence. In Europe, a mobile app has been developed to provide real- time information on heatwave risks in urban environments, improving the health of thousands of users. In Fiji, enhanced integrated ris~ monitoring and climate-informed early warning systems have ================== 16 sign ificantly reduced morbidity and mortality from climate-sensitive diseases. By adopting and integrating climate services for healt h, Uganda can proactively address its climate-sensitive health challenges, ensuring t he well-being of its population amidst a changi ng climate. This integration requires collaboration between meteorological agencies, health authorities, and other stakeholders, along w ith capacity bui lding, data sharing, and the development of tailored cli mate-health tools. The meterological data generation by UNMA should be integrated wit h health data from the DHIS2 for early warning and eariy action. With these efforts, Uganda can build a more resilient healt h system capable of protecting its population from the adverse health effects of climate change (61). ===================· 17 3. THE STRATEGIC DIRECTION An adaptive and resiiient health system towards climate change is a cornerstone for ensuring the uninterrupted provision of essent ial healthcare services to the Ugandan population. Disruptions in health service delivery will undermine the country's efforts towards ensuring a productive population t o achieve socioeconomic transformation. We know that cl imate change resulting into climate- induced hazards has major effects o n t he healt h system and ultimately population healt h in Uganda. Essential health service delivery needs to be cushioned against climate-induced health system effects. 3 .1 Vision A responsive, adaptive, and resilient healthy system that protects and promotes t he health and w ellbeing of the people of Uganda.

3.2 Mission Establish a responsive health system that promotes inclusive Climate Change Adaptation measures

3.3 Guiding Principles

3.3.1 Institutionalized and Coordinated Response The H-NAP prioritizes Institutionalized and coordinated responses because fragmented effo rts can not effectively combat the complexities of climate change. The H-NAP will be effect ively implemented through strong collaboration across government ministries, health agencies, civil society or ganizations, and the private sector to leverage synergies.

3.3.2 Adapting to Climate Shocks The H-NAP will harness technology to directly adapt to climate challen ges. Instead of solely focusing on mitigation efforts, investments will target solar-powered facilities ensuring uninterrupted service during power outages, climate-resi lient infrastructure wit hstanding extreme weather events, and early warni ng systems predicting and preparing for healt h risks associated with changing w eather patterns. This adaptation-focused approach equips the healt h sector not j ust to reduce its footprint, but to thrive in a changing climate and continue serving communities effectively.

3.3.3 Building Bridges for Adaptation Beyond simply acquiring technology, the H-NAP focuses on devoting adequate attention to climate- resilient technology needs, develo pment, and t ransfer. This means not j ust importing solutions but nurturing loca l Innovation and expertise. Capacity building for local engineers, researchers, and entrepreneurs will be crucial to ensure access to and sustainability of relevant technologies.

3.3.4 Risk-Based Health Prioritization Employ a risk-based approach to priorit ize healt h adaptation actions, focusing on t he most urgent and severe healt h risks associated with climate change, utilizi ng participatory methods to incorporate local expertise and priorities. 3. 3.5 Increasing Competitiveness t hrough Health Innovation Encourage innovation in health adaptation strategies to improve t he quality and delivery of healthcare services, making Uganda a leader In climate-resilient health sol utions that can be shared regionally and global ly. 18

3.3.6 Empowered Participation The H-NAP understands that effective adaptation requires communicating effectively and promoting participatory approaches. This means translatrng complex climate information into accessible language for communities, engaging healt hcare professionals in decision-maki ng processes, and empowering citizens to be active participants in buildi ng climate resilience.

3.3.7 Community-Based Solutions The H-NAP recognizes that top-down approaches often fail to capture the nuanced r ealit ies or local communit ies. Therefore, lt prior itizes promoting community-b ased approaches to climate change adaptat ion. This involves working alongside communities to identify their specific vulnerabilities, co- creat ing solut ions, and building ownership for long-term sustainability.

3.3.8 Market-driven Solutions HNAP acknow ledges the pivotal role of fostering an environment conducive to market-driven solut ions and, consequently, engaging the privat e sector to realize ifs objectives. Facilitating access to cllmate-resitient and eco-friendly essential products and services hinges on t he effectiveness of market mechanisms. Addressing challenges hindering optimal market functionality will entail identifying ~ey actions, prioritizing efforts to fortify regulatory and policy frameworks, bolst ering private sector capabilities, and expanding access to financing, thus amplifying the reach of impactful solutions. 3.3.9 capacity Building and Institutions The H-NAP em phasizes devot ing adequate attention to capacity development and institutional set- ups. This encompasses traini ng healthcare professionals on climate-sensitive practices, strengthening public health surveillance systems, and equipping Institutions with the knowledge and resources needed to adapt effect ively.

3.3.10 Innovative Partnerships Building more strat egic and effective partnerships, exploring the Interests and priorities of each partner and st akeholder, and identifying shared strategic approaches and shared risks, as well as ensuring t ransparency, mutual accountability, and value money.

3.3.11 Lota! and International Collaboration No count ry is an island. The H-NAP recognizes the Importance of promoting both local and international cooperat ion and relations. This means fostering knowledge exchange with r egional and global partners, participating_in International policy dialogues, and learning from best practices implemented across the world.

3.3.12 Ensuring Implementation The H-NAP is not Just a document; it's a plan for action. Therefore, it prioritizes providing a credible delivery structure. This involves establishing clea r roles and responsibilities, setting measurable targets, and Implementing robust monitoring and evaluation systems to ensure that the plan translates into tangible outcomes.

3.3.13 Cross-Cutting Issues Climate change doesn't exist in isolat ion. The H-NAP understands the need to address cross-cutting issues like gender equality, population dynamics, social justice, and environmental protection. By integrating these con.siderations into all aspects of the plan, we can ensure that climate adaptation efforts .are inclusive, equitable, and sustainable in t he long term. ================== 19 3 .4 Alignment of H-NAP to NOP Programming This H-NAP aligns with several programmes in Uganda's National Development Plans (NDPs), including but not limited to Climate Change, Natural Resources, Environment programme; S'ustainable Urbanisation and Housing programme; Human Capital Development; and Community Mobilization and Mindset Change programme.

3.5 Goal To strengthen the adaptive capacity of the health system to climate change and relat ed hazards

3.6 Specific Objectives of the H-NAP To achieve the Goal of the H-NAP, the following specific objectives shall be pursued; 1. Establish a national coordination framework for climate and health adaptation; 2. Mainstream and integrate climate and health in MDAs and non-state actors In their respective programs; 3. Prioritize actions to address the impacts of climate change on health; 4. Advocate for resource mobiiization and allocation for the implementation of context-specific climate and healt h adaptation measures; 5. Promote the generation and use of evidence in climate and health decision-making ================= 20 4. BUILDING A CLIMATE RESILIENT HEALTH SYSYTEM IN UGANDA

4.1 The adaptation Strategies The adaptation strategies and actions are identified based on the WHO operational framework for Building Climate Resi lient Health Systems (62).The framework's goal is to increase the climate resilience of health systems to protect and improve the health of communities in an unstable and changing climate, while optimizing the use of resources. The framework aims to contribute to t he design of transformative health systems that can provide safe and quality care in a <:hanging climate. Specifically, the framework aims to: I. guide health sector professionals, including through t heir collaborations with officials in healt h det ermining sectors to understand and effectively prepare for the additional health risks posed by climate change, through climate resilient; ii. present t he main health system functions that need to be strengthened to bui ld climate resilience, and use these as the basis for developing comprehensive and practical strategies (e.g. national climate change and health strategy) and plans (e.g. health component of National Adaptation Plan (H-NAP); iii. support the development of specific interventions that can be implemented by health systems that address both the increased risks posed by climate change and progressive reduction of carbon emissions, and the synergies among these actions; and support health decision-makers to identify roles and responsibi lities to develop and implement action plans for resilience, engagrng actors within and outside the health sector. The Framework proposed 10 components that would enable health organizations, authorities, and programmes to be better able to anticipate, prevent, prepare for, and manage climate-related health risks and therefore decrease the burden of associated climate-sensitive health outcomes. The components are used to outline a range of short-term, medium to long-term adaptation strategies tailored specifically for Uganda. Each of t he components are initially described as follows: 21 COMPONENT I Cfimoi.•tran1formotiw klodor,hlp ond fO..,.monco cnmate adaptation Strategy Pillar Components :® ~ @ A V ~ lnu.Rl"£1Utdrilb COMPONENT4 =~n1,andearly COMPONENT 6 COMPONENTS Cr,moto. rl'Silitt!t ln(ra'1NCNrti, Hoafttt Ond blchnol~ ond $Upply chain CWT'Klot RU001d'I Figure 4: Climate and Health Adaptation Components Component 1: Climate-t ransformative leadership and governance This component emphasizes the critical role of leadership and governance in fostering climate resilience, and environmental sustainability within health systems. Its implementation involves: Establishing specific governance structures for cl imate and health issues; Integrating cUmate considerations into health policies and programs; Ensuring health is a component In broader climate policies and plans; and encouraging cross-sectoral collaboration to protect health against climate impacts. Component 2: Climate-smart health workforce A health system's capacity to respond to climate change is heavily dependent on t he availability and competency of its workforce. This includes not only health and care workers but also administrative st aff, managers, decision-makers, and community-based organizations. Their skills need to encompass understanding and utilizing climate information for health interventions, engaging in cross-sectoral action, conducting research and assessments, and managing climate change risks effectively. Component 3: Vulnerability, capacity and adaptation assessment This component includes a range of assessm ents that can be used to generate policy-relevant evidence o n the scale and nature of climate-related risks to hea lth and health syst ems, and the impact of health systems operations This component emphasizes the cllmate change and health VAA as an essential tool ior healt h policy and programmatic planning. VAA can help identify which populations and geographical areas are most vulnerable to the different health Impacts from climate hazards; establish baseline conditions and assess potential health impacts from future climate change; support assessing changes in disease risks; define the protective measures required; and the capacity of health systems to manage risks. ================== 22 Component 4: Integrated risks monitoring, and ear ly warning This component focuses on enhancing integrated disease surveillance and climate-informed early warning systems (EWS) in health, alongside monitoring and communication strategies for timely action against climate change-related health risks. These risks Include increased incidences of vector- ' water-, and food-borne diseases, sexually transmitted diseases, and non-communicable diseases (NCOs) such as cardiovascular and respiratory Illnesses. The approach includes understanding how climate affects health outcomes, anticipat ing health risks, and ensuring timely preparedness and response. Integr ated risk monitoring involves diverse tools to gather real-time gender disaggregated dat'a on healt h, climate, and environmental conditions. Component 5: Healt h and Climate Research This component addresses the Importance of providing evidence base towards policy-r elevant norms and Innovative solutions for climate change and heal th. It includes identifying strategic prio rities for fostering research agenda development and implementation; strengthening research capacity; and integrating research Into policy. Component 6: Climate resilient infrastructures, technologies, and supply chain This component addresses the need for, and importance of, strengthening the adaptation of current infrastructures, technologies, and supply chains; and promoting environmental sustainability of health operations. Component 7: M anagement of environmental determinants of health This component aims to step up efforts to respond to environmental risks to health by strengthening monitoring and management oi environmental determinants of health; developing and implement ing regulatory instruments and mechanisms; and promoting coordinated lntersectoral management and collaboration among climate and health actors. Component 8: Climate-informed health programme This component aims to use the informat ion gathered In the components related to health information systems (i.e. assessments, research and monitoring) to inform the way specific climate sensitive health programming taking into consideration equity and social inclusion. Component 9: Climate-related emergency preparedness and management This component aims to build preparedness, response capacity and health security in health systems and communities by: implementing climate related risks management for emergencies and disasters, through climate-smart polici12s and protocols; establishing climate-informed health -emergency and disaster risk management; and supporting community empowerment, especially among the most vulnerab le populations t hat include women, girls, youth, people living with disabilities, low-income, reiugees, elderly, Indigenous peoples, among others. Component 10: Sustainable climate and healt h financing The objective of this component Is to support the country in identifying and accessing sustainable fi nancing to support climate change and health interventions and proposes ensuring access to healt h- specific funding and financing mechanisms, including climat e change funding str eams and funding allocated for healt h-determining sectors. ================= 23

4.2 H- NAP Strategic Interventions and Actions This section will provide a brief description of strategic interventions and actions under the H-NAP over the next five (5) years aligned to the recommended WHO component framework. This framework proposes ten (10) components that need to be focused on to build an adaptive and resilient health system against t he adverse effects of climate change on health. The interventions and actions identified are also aligned with the H-NAP SWOT analysis conducted w ith all stakeholders. The obiectives, components, strategic interventions and proposed actions are outlined in Table 3 below: ================== 24 Table 3: Strategic Interventions and actions Objective Component Strategic intervention Proposed actions 1. Establish a Clim;ite- 1.'.I, Improve coord rnation for Estal:)lish and functronali2e a Clfrnclte and Health coordfnatron national transformatfve Climate Chan ge and Healtl.i m echanism within the MOH Environm ental Health Departm ent. coordination Ieadersl:lfp ,1n,d Action Develop guidelin es for rnarnstreamfng climat e and health in the framework for governance health sector. climate and t:,ealth Est,1blish rnter-mrnist erial committee on he.:1lth and clfmate adaptation change '(including C50s and th e private sector); Establish the Climat e Chan ge and Health Technfcal workin g Group (TWGs) 2. M ainstream and 2.1 M afnstream clfmate and Develop gutdelinesfor mainstreamfng climate and health in integrate climate health in plann ing at all levels other MDAs, local gov ernment. and th e private sector. and health in MDAs Advocat e for climate and health·ac:ross st;ikehold ers at all and non-state actors lev els. in their respective D'isseminatron of the H•NAP across stakehold ers at all levels - programs; National, regronal, and sub-national level 2 .2 Advocacy & lobby[ng for Trarn leaders at various national and sub -natronal levels. rnclusion of clfrnare change and in clu q in g publfc and privat e health issues fn plan s and Tr.ain media practition ers in climate and health messaging pudgets Support community-level women and youth inclusive advocacy campaigns on climate change and health. Integrate health and climate messaging rnto the Minfstry of H eaIth Commun i catf on s Strategy and re vise th e Uganda Nati on al Cirmate Change Commu nf cations Strategy (U NCCS) 3. Prioritize actions Climate-smart health 3 .1 Burl d capacity for the Train health workers in climate and health. to address the workforce health workforce in climate Integrate clfmate and health in currfcu la for th e health health impacts of change and heal t h issues w·o rl<force. ~limate change Provid e IEC mat erial s on climate and health to the health w·o rl<force. Conducted supervision and mentorship visits at the regional .:1nd district levels. =========================25

3.2 Appointment and Support districts to assign climate and health focal persons fadlltation of health worRforce for climate and health action Vulnerapilfty. 3.3 Promote evid'ence-lnformed Develop gend er-responsive guidelin es and standardized capaclty, and decision making aP.proaches for VAA and risk asses~m eht s at nation al and sub• ;id_apt ation n<'ltl on al levels. assessl'i, ent Support distrl cj s to conduct per[odic climate ano he.alth VAA M ap-out Inst itution s Involved in clfmate and health Develop a. on e-stop data repository for climate and health. Integrated r,isl\ 3.4 lntegrcited dlse.ise Develop a platform under DHIS2 that Integrates climate and monitoring and early survefll ance and early warnings health data for early warnin g. warning Upcfate the survell lance syst em ·to mon it or clim at e-sensitive diseases. sy17chroni2E! and enhancta the interoperabilityofOPM • Disaster database, MOH (DHIS2), and M\f\/E· CCD climate forecast.

3.5 M onitoring a11d progr-ess Develop a dashboard at the national and sub-17ational level tracking

3.6 Enhance climate change risk M OH periodlcally communicat es.climate and health updates and corn mu ni·cati on early warnings t o subnational stakeholders In coll aboration with UNMA Integrate Indigenous knowledge in risl<analysis and communi cat, on. Cl imat~ resfl iel'lt 3.7 Promote climate-resll ieht Revise current health infrastructure standards for climate• inf rastr1:1ctures, ihfrastructures, technologies., proofin g techno1oi i.es, anc:J and supply chain M onitor compliance with the revised Health Infrastructure 1 supply chain standards for climate-proofing Train l<ey st.il<eholders (h ealth.care m anagers and contractors) on climate-proofi11g for health infrastru cture. Advocat e for i,nstall in g cl<!!an energy and climate-smart techn ologies such as solar ~quipment and solar system s at health facillti es. Conduct support superyisfon for the digitalfzation of records at ,_ ·th e healthcare facility level. ======================= 26 ======================= Management @f 3.8 Monitoring of Conduct joint multf-settoral risk management to proattiv~ly envir@nmentill envi°ronment;il dei ermf nants of manage health ri sl<s related to water, san ftati on, food, sexual determinants of health and reproductive health, nutrition, and air quality, emphasizing health the most vulnerable populations, fncludfng women, girls, youtl1, di-sabled, lo.w:inc:ome, refugees, elderly, and li1digenou s. Conduct public awareness to increase household r<tsiJi ence to the rmpacts of cltmate change on WASH, food securitY, nutrition, and air quality.

3.9 Strengthen the reciulat ory Advocate for revfsing the Envrronmental lmpatt Assessment Framework and Audit ~egulatfonsto strengthen the fnvol.vement of health experts in th e EIA and audft process. Support MDAs and LG In ensuring compliance wfth laws and regulations on erwironmental pollution. Support districts to review community ~rograms/projects (such as th e Parish Development Mooel) for climate arid health mai.nstr-eami.ng Document entities wfth fund sto Implement climate chari ge and health-related programs/activitfes

3.10 Coordinated cro~s-sEit1ori:II Revf se the roles arid responsibilities of partners under the management, partnership and multi• sector.al management of environmental determinants of coll aborcitf on health Foster mul tf sectoral col laQorati on with other government ministries, NGOs, and aGademic institutions to promote fntegration of health, g_ender, youth, sexual and reproductive health, and elf mate change Promote PPPs to foster rnnovatr on to build clfrnclt e resil iente in the health settor Cl irnate•rl21 ated 3.11 Strengthen health set1or Update national disaster reduttion strategies to incorporate emergency capa~iW and prepare t>Ians and elfmate-related emergency t>reparedness and manage/nent preparedness and procedures for weather and data. m;i11;igement clfmat e-relared qisasrer Improve multi-sectoral collaboratfon in responding to preparedn ess, response, and emergencies at region al ano di stri et levels. recovery 27

3.12 Community empowerment Conduct public awareness to increase household resrlience to and resilience ehhancement the Impacts of clrmate change, maihly t11rgeting vuln erabl e populations that ipclude women, girls, youth, disabled, low• Income, re'fugees, elderly, and Indigenous, among others. Integrate climate-related health emergency preparedness and response In the School Health Programme/ _ colleg_e and university curriculum. Empower local communities by involving the most vulnerable in the pi annl ng and implementation of climate and health initiatives. 4. Advocate for sustafn ilbl e climatt\ 4.1 Strengthen capacity and Training stal<eholders in resource mobilii ation a,,d gra,,t writing resource ant'i health flnancil'lg coordihation to aoces$ at natl orial and sub-nation al level s mobilization and resources Increase fundi t1g for project management opercltion sfor allocation for the climate change projects and programs In the Ministry of implementation of Finance·, Planning, and Economic Development, considering context-specific national adminf strative arrangements. climate and health Increase national budgets for. health and climate change adaptation polfcies anq actions. measures; Strengthen International and National Ml.llti-Settoral partnershipsfor resource mobiJ.izatfon with international organizations, such as WHO, UNDP, UNFPA, FAO, Adapt,iti°on Fund, GCF, and Global Environment Facility (GEF), to access technlcal and fln;incial support.

4.2 Advocacy for prioritizing Condu·ct adlioc(!lcytrainings to increase negotiation skill s for health issues in climate funding health and climate change financing to.advocate for adequate al Iocati on of resources for health system resilience to climate variability and change in line with acti.ons proposed under the. 1-t·NAP Hold ehg<1gement meetings with private sec~ors and development partners to mobilize resources to address health a,,d climate change through green, health impact bonds, and climate funds to finance climate-resilient health infrast~ucture, programs, preve11t[ve health measures, and climate adaptation project s. ========================= 28 ========================= Develop a comprehenstve resource mobillzati on plan that identiffes funding m echanisms for health, sectors inflt1encing health and climate change, specific proposal options, timelin es, ,;1nd respon sibilities.; 5. PromotEithe Mealth and clim11~e 5.i Knowledge generation an d Cor,dut t training to en har,ce research capacities. generation and use research m anagem ent Conduct periodic r esearch to gen erate evidence that draws·the of evidence in int er connection betweer, h ealth (including sexual and climate and health reproductive health, RMNCAM and, mental h ealth, gender, decision-making ·nutrition, and climate change) t o inform innovation, policy, and oractice. Develop a data platform, e.g., a repo•sitory for all stakeholders. Report on the he,3lth ar\d climate prof)ress against the overarching national clilnate plans ahd comm itments and other frameworks, e.&., the NDCs, overall NAP, and NOP programmin g,

5.3 Knowledge tran slation and Build capacity for knowledge translo;ltion, data analytfcs. and use evidence use. Develop a gender and yo.uth-inclusive platform for sharing health and climate change- r elated research and information to inform policies, plans, and strat egfes. 'Clirnat e, fnformed 5.4 Promote health Integrating information on curren t and projected (future) health pro:gramme programming climatic condition s into strategic planning of h ealth programs for climate-sensitive diseases Mainstream climate change into' the national health-policy arid its implem entation strategies and guideline.s; Support the integr-ation otclimate-related health risks into regional ,1nd district Pl,ins; Develop system s th .a t fntegrate climate change data into the natronal health database for mon itoring and informing health programming. Support climate arid health-capacity building within the h ealth System, civil society, and the community.

5.5 Delivery of in terventions Revise standard operating procedures to integrate climate change con siderations concerning re·silience in delivering public health programs/ int,efl(entions. ======================= 29 Develop test and seal e up projects and innovations that lnteg.rate climate change, gender, FP/SRM, an d nutrition in health programs at different Ievels; Upq ate rnedlum and Iong-terrn plans with at-J;ions to prevent climate and health·o.utcomes. 30 ========================= 5. FINANCING FRAMEWORK AND STRATEGY

5.1 The H-NAP financing strategy This section presents the financing framework oi the plan. It provides t he overal l and disaggregated costs of the plan and the strategies ior mobilizing the required financing. The H-NAP financing framework and strategy are critical to identifying feasible long-term and sust ainable financing mechanisms forclimaie change and health while using existing ones to attract critical funding to build healt h system resilience. The H-NAP financing framework and strategy, thus, requires: a) Developing a comprehensive package of interventions and actions to address health and climate change risks and vulnerabilities b) Estimating the package of resources that are required to feasibly and sustainably implement the ident ified a.ctions c) Developing a comprehensive resource mobilization plan that specifically d etails the key and possible funding streams, funding mechanisms, and mechanisms for accessing and attracting funds d) Adopting the whole-of-government approach to mainst ream and integrate climate change and health, including into budgets at all levels of government e) Preparing bankable proposals that .attract funding from existing as well as future climate change funding portfolios, particularly from multi-lateral, bilateral, and philanthropic arrangements.

5.2 Costing process and methodology The cost estimates were generated using.two generic approaches, i.e., the ingredients approach and the Activity-based-cost approach. The approaches primari ly involved two key phases: 1) 1. Stakeholder engagement through workshops is needed to identify key actions for the H-NAP, the activities Involved in each action, the package of inputs required to conduct the act ivity, and the monetary value of those inputs. Participation was drawn from different government MDAs, Local governments, Ovit Society Organizations, private sectors, development partners, researchers and academia; 2. Identifying the monetary values of inputs based on prevailing market prices, expert opinion, as well as review of documents. The cost estimates provide a fair picture of the resources required for the plan period. 31 ================= 5,3 Summary of the H-NAP Budget (2025-2030) The estimated resource requirements for implementing the H-NAP over the five-year plan period (2025-2030 is 239,792,418,160. The summary is in Table 4 below. Table 4 : Summary of the H-NAP Budget (2025-2030) Amounts per y,Nt COMPONENTS VHtl YNl"l Year3 Yeer A veers tfotal CQ1nponen1 l: Cl~n't3lt'*t.nn$-fQrM8lN'e- l~ade-n»h.:p &t1d ll()VCO\lln« ll,713,790,000 12,607.870,000 12,907,870,00() 12,607,$70,000 11,607,870.000 63.14$,UO,OOO Component 2: Cli'mr..e-smart health woridorce 'J,513,990,000 2,499,440 coo 1,191125'2.720 2,630 0S2,710 1,.1.9.4,251,720 9 031,9!~8.160 Com·ponent 3; Vulner3bility. c:cp;acity and adaptation assewnent 7S,230,000 2·. 276,990,000 9,120,000 U60,6S0,000 9,t20,COO 4,631,110.000 Compone.nt -l: tntcerat1!'d 1h:Cs mooltorine, .rrld early w.amln& 3,848,100,000 3.871.SS0,COO J..n4.60o,ooo 19,043.480,000 J..n4.ooo.ooo 3,n4.600.ooo compontf'lt S: Hitalth and cll~te 1'tie:111ch 857,580,000 n2·.120,ooo n2. 120,ooo na. 120,000 ,n.120.000 3,946,060.000 Component S-: CILmaie resltlent. lnfranructurf#S. tec.hnologies., 31'\d 1upply c~in 14;458 200,000 14.539;790 000 hl,4,5$."200000 '4,539,790.000 111,458,700.000 72AS4.180,000 Component 7,. Management of emlironmem:al determinants ofheal; h 6,980,270.000 6,998,250,000 6,998,250,000 6,998,250,000 6,998,250,000 14,973.270,000 Componer1t 8: Clfmate-informed health pr'ogramm~ 4,708;520,000 4.4·23.250,000 4,704,SOO,0OO 4,-123.250;000 4,423,250,COO 22,68:t.770,000 CQmPQnt:1it 9• Clrf'l'll't,,..rc.l11t ed emih<gencv p1tp;11'e d0ie.5s ~nd Mill'l<lfetme,u 1/ (46,650,000 1,724,<;30,COO ~724,630,000 '724,630,000 ~n•.030,000 S.645-, l 70,000 Q.i.rnponf!'tlt 10. $t.ts1atn11bf~ d lmrtte .ind he,1llh Jinanclfl& l36,670,000 481,440,000 17~670,000 173;670,000 t 73,670,00<> 1,239, L20,<)00 41139,000000 50 195 360,000 46417 212.720 ;19,904 an.no 46 135 962i720 239,19" 41.8 i60 32 g§ § !§ § i i § § § § § s ~ Iii ~ § § § § ~ § t §~ !,; ~.s ! .g ~ !f [ € I s~ !! 6 3a ~ ~ ! I r ; . : ! . .~ ~ ~ ""i· ~ . .,- ~ :l ::, ~ ~ ~ ~ "~ ,.; ls ;;; j ~ ~ 1, ~ ~ :! 1 ~ ~ § ~ !~ §~ ;~ § § § § § !t I I § § § i i § § I ~ i ~ j! ~ § . .5 ,.~ '" C 0 0 -~ ~ j :: ~ ~ ~ fi ; ;:; ~ • j ! :; ~ • • § • l § g •s l !! ~ ij I ~ ~ I ~ a~ I I: ~~ iji ij ~ ! ! ! 8 ~ !'" ' !" -< sN ... -~ -~ ~ C ~ 8 ;:; ~ ~ ~ 31=• ?j : ~ ~ !! ~ ~ s ~ 5 ~ ~ ::'. ij g ~ I l §_ ~ ! §~ 2 § ~ •" ii ii ~ ~ • I §_ "~ ~ § ~ § ~ ~ ,. ~~ •§ "a §_ !g ::f s § 1l ~ i~ g~ -~ 2 li l ;; ~ . il • ~ ~ a • ~ ~ i, § ;i ; • :~ ,i : ~ ;:: ' ; Ii t !,§ ~ ~ ~ I"t i C ;;, § !i., ;:I § ~ ~ ! ! II2 I ij ~ l I ~ !11 g§ ; • ~ I § § §_ ;; ~ ;; 5sf " ~ ~: ~ M ~ ;i ~ ~ ,; ,; ! • 5 i ~ I• ..i ; § s s ~ l ~ ~ § ~ § I "' I5 I i I i .a .,i I I~. ~~ I ~ § § ~ < ~ ~ ~ i § ~ §_ if , -~ "' QI ! f l'c ~ ~ :g • " ll; ~ , ~ ;:: ~ ~ "ti"D "04 .... QI .... ......."' QI ! ......."' "' i "' "0 C £ ;f a f ...."'"' "0 C "' l lt §, } tl C C QI C ..l !" ~ i I QI C 0 0. 0 0. E j l) it ...I ] " !.., '"i !! E 0 I 1 l i.. fj u u 0 "'0"' ... '~ 1 ! ] 1l • 1! i• <§ -II !• f ..."'u0"' "'u l ; ~ f ,. ~ & { ~ ki ! i t f s r. ! 'i ·t i. " !:; ~ i l }I i t I i l i• f ~ -I ..."'"' tl"'0 _f .. 1 f :; ,§ 1 1'f t f!· t 1J~ t· ~ I t 1t i I i t "'u0 u fi ~ ~ ~ ~ It i• Ji ' l ,r l i "0 ~ !: 5 ~ ~ i t I j i ! ~ •• "0 QI "iii .... ! I l . • I t' ...."' 0 QI 0 QI 1/1 2 1 I • t i " ! I i i I li t -i ,.J 'I~· :it l - I j. .. "lI1 i f: tI fI t ) t I i 1 I f ~ 1 :i-- 1 ~ i: i,. l ~ ~ l ..l ,i " .¥ R ~ ,.ji " "li " "" "' " • ,t. ~ :; i ~ QI i• it i ',. a ":' ~ " r- • I ~ ! f~ J Ii f i " t J , f ,; ii ,,.t <t J:i "' I i. I • "" t i f' . ! ~ - tt. ~ "i e- ~ '} ~ - • I ~ !, ~ "' I- J ~ ~- ~ 1.s-- ,

5.5 Funding sources/ resource mobilization strategy Several mechanisms for climate change financing exi;t in Uganda. However, these mechanisms are not yet focused on adaptation actions required for the health sector. The H-NAP will take advantage of already existing funding sources and mechanisms. However, additional feasible and alternative funding sou rces will be leveraged.

5.5.1 Internal funding mechanisms and actions a) Mainstream climate change financing and including it in national budgets and plans, and ultimately, local governments, given that 90% oi local government financing comes from the central level. b} Financing support from Development/implementing partners: both on-budget and off-budget .support. For example, the government has been undertaking numerous 'Climate-Smart' initiatives in collaboration with FAO, UNDP, FCDO, WB, EU, UNFPA, WHP, ATACH, and USAID. c) Prioritization and integration of climate change agenda into the national plan: The climate change agenda and fi'nancing have been integrat ed into the National Development Plans (NDPs), and the MOFPED has been designated as t he national GCF Focal Point. In 2022, M oFPED took a significant step by establishing the Climate Finance Unit (CFU) in collaboration with the British High Commission, the Commonwealth and Development Office, and the Global Green Growth Institute (GGGI). The CFU operates as a department responsible for managing and overseeing climate change financing and national implementation matters. The unit is designed to benefit Uganda's climate preparedness efforts. The CFU aligns with Uganda's nationally determined contribution (NDC) commitment, renewed in September 2022, which pledges a mitigation target of a 24. 7% reduction below the Business-as-Usua l Scenario by 2030. This key institutional framework will be leveraged to support the mobilization for funding and the implementation of the H-NAP. d) The Uganda Development Bank (UDB) Climate Finance Facility. This initiative aims to bol.ster the green economy while mobilizing funds to assist smallholder farmers and rural communities mitigate financial shocks from environmental changes. Additionally, a partnership between the Financfal Sector Deepening (FSD) Uganda and BIDHA SASA, a Kenyan finance company, has attracted financing to specifically extend credit to women and fam ilies to faciiitate access to and acquisition of climate-friendly technologies like energy-efficient cookstoves and innovative agricultural tools. These initiatives will help a great deal to influence t he adoption of tools and technologies that address the root causes of climate change while contributing to positive health outcomes. e) Other funding streams under specific legal frameworks for managing nat ural resources include: I. National Environment Fund (NEF): Established under t he National Environment Act (2019), the NEF focuses on mobilizlng and managing funds for environmental conservation and protection. II. Wildlife Fund: Operates under the Wildlife Act, emphasizing the importance of financial resources for wildlife conservation efforts. Ill. Tree Fund: Governed by the National Forestry and Tree Planting Act (NFTPA), the Tree Fund is dedicated to supporting forestry and tree planting initiatives. ================== 34

5.5.2 External Financing Mechanisms and actions a) Funding from the UNFCCC and the Paris Agreement, such as the Global Environment Facility (GEF); the Green Cl imate Fund (GCF); the Global Fund, the Adaptation Fund (AF), the Special Climate Change Fund (SCCF); the Least Developed Country Fund (LDCF); and Loss and Damage Fund (for compensation and rebuilding). b) Funding from Development Partners (at Bilateral, multilateral, or philanthropic levels). These include the Development Special Fund for Africa of AfDB; the Global Climate Change Alllan ce of the European Union; the World-Wide Fund for Nature (WWF); funding streams from the World Bank, IMF, and other development Initiativ es.

5.5.3 Additional Innovative Financing Mechanisms a) Insurance - including climate change-related insurance schemes, health insurance, insurance in light of damage to property, etc. b) Leveraging private sector financing for d imate change - for example, through Corporate Social Responsibility (CSR), Environmental and Social Governance (ESRJ, etc. c) Partnerships and collaborations with research and academic institutions are need ed to tap into existing and emerging research and capacity-building fund portfolios (for example, collaborat ion with the Centre of Excellence for Sustainable Health, CESH at Maker ere University School of Public Health). ================== 35 6. MONITORING AND EVALUATION FRAMEWORK

6.1 Introduction This section provides the strategy for undertaking Monitoring and Evaluation (M&E) during the implementation of the H-NAP in Uganda. The section covers the strategy for data management, reporting and use, and M&E coordination me.chanisms for implementing the H-NAP. It also provides information on learning and knowledge management, performance reviews, and evaluations. The section presents the Theory of Change (TOC) and the results framework matrix for the H·NAP.

6.2 Data Management, Reporting and Use Implementing the H-NAP will require an effective regular and periodical feedback mechanism that will generate quality data to inform decision-making and enhance learning during the implementation. This section provides the proposed data flow diagram, the routine monitoring data generation, analysis, and management processes. The section also highlights the mechanisms for data quality assurance, reporting, and use of data by decision-makers. Reviews -....... Monitoring, programme ------ and statlsttcal reports Independent tevieYIS- Analysis and synthesis ( --- O,Ua quality \ assessment Country data informatron generation Figure 5: Data management, reporting and use

6.3 Data flow diagram Da.ta will be collected by the implementers (mainly the health facilities) through the existing data capture tools used by the facilities. The Ministry of Health will integrate indicators or aspects al the I-I-NAP into the existing tools and support the health units (public, private, and CSO health facilities) ================= 36 to collect and report on the indicators. The generated data will then be captured by the district data base, cleaned, aggregated, and reported to the ministry. The reported data from the districts will then be compiled by the ministry's resource center and shared with UBOS, OPM, NPA, and other line ministries like MWE. At all levels of the data flow chat, the MEL team at the ministry and district will ensure adequate supervision and quality assurance, providing the necessary technical expertise. National Reporting t o OPM Reporting, sharing Feedback, M&E & dissemination. UBOS Reporting, sharing & DQA, feedback dissemination. MOH (DHIS, HRIS, SCMS) Technical Support Supervision, DQA, Data collection, feedback, M&E cleaning, aggregation, District Database (DH IS, reporting HRIS, SCMS) Data collection, cleaning, Technical Support aggregation, reporting Im plementers Supervision, DQA, Public/Private Health feedback, M & E facilit ies CSOs/Projects Figure 6: A figure showing data flow

6.4 Routine Monitoring data generation, Analysis and Management Standard data colle~tion procedures will utilize Lhe existing data capture tools as outlined earlier. The Monitoring and Evaluat ion (M&E) teams at both district and minist ry levels will incorporate Health- National Adaptation Plan (H-NAP) indicators into the existing data captu re tools across all levels. Quantitative data abourthese indicators will be captured and reported at facility, district, and national levels. The designated focal person for H•NAP at the ministry will spearhead the integration pro~ess ==================· 37 and en-sure that routine data on these indicators are included in the reporting tools. Data will be analyzed routinely at district and nat ional levels to identify key issues and provide insights to·relevant stakeholders. Separate datasets concerning the H•NAP will be extracted from the District Health Information System (DHIS), Human Resources Information System (HRIS), and Supply Chain Management System (SCMS), and made accessible for analysis at both district and national levels, enabling quarterly and annual reporting on Indicators linked to National Development Goals.

6.5 Data Quality Assurance Mechanisms The Division of Health Information will assume responsibility for formulating a comprehensive plan for data quality assurance, elucidating procedures and methodologies for managing and enhancing the quality of data gathered, par ticularly through the HM IS. Data validation will rely on an exhaustive system designed to scrutinize collected data for completeness and precision, with the specific method employed contingent upon t he data source. Regular Data Quality Audits and Data Quality Surveys will be conducted to gauge the accuracy level o f the collected data. The primary aim o f Data Quality Audits (Assessments) and Adjustments (DQAA) will be to ensu re that the data employed by stakeholders in decision-making is reliable and precise. After assessing the data's expected accuracy, appropriate adjustments will be made to provide a more accurate portrayal of various indicators' status. Data Quality Assessments (OQAs) will be conducted across all levels of healthcare service delivery, adhering to the M inistry of Health (MoH) DQA guidelines and utilizing approved tools. Special attention will be given to conduct ing DQAs, including incorporating the computed validat ion/data accu racy index into district annual reports, providing targeted assistance for outliers, and cond ucting routine (quarterly) data checks on a sample of districts, among other measures. Health facility in-charges will perform regular data verification for facility-based data to ensure accu racy and completeness, at least on a monthly basis. The DQA process will encompass various stages, including data collection methods, aggregation, and analysis, which will be conducted quarterly, The key OQA activities will Include; 1) Training of staff in conducting DQAs 2) Conducting regular DQAs 3) Data adjustments 4) Compiling and disseminating OQA reports

6.6 Reporting and utilization mechanisms The Ministry of Health will utilize its existing reporting systems, including the District Health Information System {OHIS), Human Resources Information System (H RIS), and Supply Chain Management System (SCMS), to report on the implementation and outcomes of the Health-National Adaptation Plan (H-NAP). The Department o f Planning, Financing, and Pol icy will spearhead the Implementation of these reporting systems. The M inistry of Health will ensure thorough documentation o f accomplishments, successful endeavors, lessons gleaned, best practices, and encountered challenges, thus contributing to the knowledge base on H-NAP. Progress report findings will undergo internal review and discussion by the Planning unit team before dissemination. Quarterly and annual reports detailing executed activities, progress made against predetermined targets and ind icators, as well as narrative depictions of achievements, challenges, and support requisites, will be compiled and submitted to Top Management at the Ministry of Health, the Office of the Prime Minister (OPM), the National Planning Authority (NPA), and other pertinent stakeholders. ================== 38

6.7 M&E Coordination Mechanisms This section provides the coordination mechanisms for M&Eduring the implementation of the H-NAP. The section identifies the M&E coordination structure and the key roles and responsibilities of the relevant actors.

6.7.1 Functionality of the M&E system At t he national level, the Minister of Health performs the monitoring and evaluation funct ions. However, these roles have been cascaded and anchored within the planning department of the ministry of health. The M&E unit was created within the department to oversee and coordinate M&E activit ies at the nat ional level. The unit will work closely with program-specific M&E to align all M&E activities, deliverables and expect ations to be in line with MOH SP. An M&E lead will provide M&E leadership together with a team of M&Eof ficers. The M&E unit will work closely with the DHI and the Health Information Innovation and Resear ch (HII RE) TWG to actuali2e t his plan. The success of this M&E system wil l largely requir e the availability of adequate staff employed in the M&E unit with necessary M&E technical knowledge and experience. As such, this component emphasizes the need for human resources to run t he M&E functions. Table 6: Organisational structures with M&E functions Actor Lev·e1 Role Ministers of Senior Top • Working closely with the Cabinet through the Par liamentary health M anagement • Health Committee for: • Overall political and policy oversight . • Articulat ing the policy direction for t he sector, considering broader government objectives. • Review of sector progress against the policy imperatives set out in contribution towards the NHP and NDP Permanent Top • Providing governance and partnership oversight to the Secretary, M anagement .sector. Director • Reviewing of sector progress against t he policy imperatives General of set out in t he NHP and NDP. Health • Monitoring adherence to the sector's policy direction (One Se.rvices, M&E platform). Directors and • Mobilfzing resources for operationali zing the plan, Commissioner • Monitoring health sector performance and six-monthly s reporting to OPM on sector performance. This performance reporting will be based on the quarterly submissions to OPM on progress against key actions and outputs towards outcomes. Health Policy National • Monitor and advise on healt h policy Issues. Advisory • Monitori ng adherence to the sector's policy direction (One Committee M&E platform). (HPAC) • Monitor implementation of the partnership arrangements e.g. the Compact and aide memoire recommendai ions. • Guide the sector performance review s. SME&RTWG National • Developing and r eviewing the results framework for the (MoH MOH SP, and ensuring that relevant departments (and representative relevant non-state actors) develop results ind icators s from t he consist ent with the MOH SP. different • Reviewing, consolidating, and val idating the varfous sector programs, reports before dissemination to the relevant stakeholders. ================= 39 CSOs, HDPs, • Facilitating utilization of M&E and Research Information M edic-al knowledge translation and dissemination) in liaison wit h t he Bureaus., relevant sector departments, programs, and the Policy Privat e Sector Analysis Unit. and academia) • Periodically reviewi ng available research/survey • information t o update the current evidence on the best • practices to guide Planning, decision- making, or Policy Formulation. M&E Unit National- • Overall coordination and oversight (monitoring and cooFdination • .supervision) of M&E activities in the sector. of M&E at • Dev elopment and dissemination of the sector M&E plan for MOHHQ the MOH SP. • Ensuring the harmonization of the institut ional, program and project M &E plans with the MOH Strategic M&E Plan. • Identifying capacity-building needs and training for health workers and managers in M&E. • Organizing sector performance reviews . • Supporting LGs in organizing regular performance review meetings. • Producing periodic sector progress reports . • Providing quarterly data and explanatory information on progre.ss against perfomiance indicators to MoFPED and OPM through the Output-based Budgeting Too l (OBT). • Maintaining a Recommendations Implementation Tracking Plan which will keep t racko( review and evaluat ion recommendations, agreed follow -up actions, and the status of these actions. • Monitor and evaluate the implementation of the MOH SP Departmental Specific • Provide oversight for monitori ng Implementation of w ork specific M&E Program areas plans and preparation of quarterly and annual performance r eports. • Participating in data quality assurance . • Providing quality data on relev ani performance indicators t o MoH and relevant stakeholders. • Participate in M&E capacity-building activities. • M&E support supervision and mentoring. • Participating in the development of the program M&E plans, Mid- and end-term evaluation of the national strategic plan, and preparation of the periodic sector performance reports. • Maintaining a Recommendations Implementation Tracking Plan which will keep track of review and evaluation recommendations, agreed follow -up actions, and status of these actions. • Utilizing M&:E findings to inform program, policy, and resource allocation decisions. HMIS Division National • Coordinating, harmonizing and operationalizing the HM IS and e-HM IS at all levels. • Strengthening capacity for collection, validation, analysis, dissemination and utilization of healt h data at all levels. ================= 40 • Conducting regular data validation in the districts, health facilities and other health institutions to ensure quality dat a. • Ensure that HM IS and e-HMiS data is made easily and prompt ly available to all stakeholders while ensuring that the sha ring of reports respects the Access to Information Act, 2005. • Conduct data review meetings, including data use conferences t o enhance data ut ilization at all levels. • Updating the master health facility inventory of all reporting health facilities in the country. • Ensure the ICD 10 coding of all diagnoses as outlines in the HMIS, and consequently update these In the eHM IS. • Generatinl! the health statistical report annually. Regional Sub-nat ional • Liaising between the nat ional level and the districts on M&E Monitoring Level at the regional level. Teams • Capacity building for data collection, v alidat ion, analysis, dissemination and utilization of healt h data at regional level. • Conducting data validation in the r egion . • Supporting the development and implementation of the M&E plans of t he districts and RRH in the region. • Monitoring and reviewing the implementation of the M &E plans in the region by compiling and analysing quarterly and annual reports. • Maintaining a Recommendations Implementation Tracking Plan which will keep track of review and evaluation recommendations, agreed follow -up actions, and progress of these actions. • Suooortine operational research and survey activities District District lev el • Providing governance and leadership oversight in the Executive district. Committee • Monitoring implementation of the annual work plan and (DEC) District Development Plan. • Monitoring adherence of all stakeholders to the policy direction (One M&E platform). District Social District level • Monitoring Implementation of the annual work plan and Services District Development Plan. Committee • Mobilizing resources for o perationaJizing the d istrict M &E (DSSC) plan. • Participating in the district perfom1ance review meetings DTPC District level • Monitoring implementation of t he annual work plan and District Development Plan. • Mobilizing resources for operationalizing the district M &E plan. • Ensure timely reporting t o the respective entities (MoFPED, MoLG and MoH). • Coordinating all lPs and CSOs to ensure alignment with institutional arrangements and district priorities ================== 41 District Health • Monitoring implement ation of the annual w ork plan and Man agement District Development Plan (Performance Reviews). Team (DHMT) • Participating in the district performance review meetings. District Health • Dev elopment of a district M&E plan. Teams (DHT) • Identifying key performance indicators and targets. • Coordination of M&E activities in the district t o ensure alignment with institutional arrangements and district priorities. • Supervision and mentoring of HSDs in M&E. • Conducting data quality audits. • v Training of health workers in M&E. • v Maintainrng a functional district HMIS with an up-to-date district database. • v Compile and submit periodic district reports to the district, MoFPED, and MoH • ix) Conducting district performance Reviews Health Sub- • Supervise and mentor lower-level health facilities in M&E. District Team • Aggregation, v alidation, analysis, dissemination and (HSD) utilization of district data. • Maintaining an up-to-date HSD database. • Compile and submit periodic HSD reports to the district . • Conducting HSD Performance Reviews . • v Maintaining a Recommendations Implementation Tracking Plan, which will keep track of review and evaluation recommendations, agreed follow-up actions, and progress of these actions. • v Utilization of M&E results Health Facility Facilit y level • Ensuring the development of facility M&E plans. Managers • Determining performance t argets for the key output indicators. • Resource mobilization and allocation for M&E activities . • Maintaining an up-to-date health facility database. • Compile and submit periodic reports to the relev ant bodies . • v Conduct data verific-ation before submission of reports. • v Conducting health facllity performance reviews . • v Disseminat ion and utilization of data. • ix) M aintaining a Recommendations Implementation Tracking Plan, which will keep track of review and evaluation recommendations, agreed follow-up actions, and progress of these actions Village Health Community • Collection, compilation, analysis and repo rting on Teams (VHT) • community health data, including births and deaths, through the community registers. • Use data t o discuss performance within the community and agree on priorit ies to focus on Community- • To provide information on; the delivery of v arious services) based CSOs, transparency and accountability of resources accorded; and administrative • challenges and gaps experienced In the deliv ery of various units at the .services. grassroot s, • They will also participate in the validation of the outcomes of implementation of the MOH SP in their respective areas, ================== 42 and health • Communities will also be engaged in the review process consumers using participatory appraisal mech anisms like focus group discussions and community meetings or dialogues like the Constituency (HSD) Health Assemblies, barazas, open days, CSOs National, sub- • Contribut ion in the development of M&E standards and national, and plans. district level • Pa,ticipating in sector monitoring processes at LG and national level. • Providing performance reports and quality data to t he relevant program managers at the national and district level. • These will be compiled as part of departmental reports and review ed by relevant working groups for onward t ransmission to SMC or DTPC. • Particl paling in the M&E-related committee meetings at all levels. • Conduct independ ent M&E audits and share findings for performance improvement·. • v Community sensitization and advocacy for accountability mechanisms. Health • Contribution t o the dev elopment of M &E standards and Development plans. Partners • Participating in sector monit oring processes at LG and (HDPs) and lps national level. • Participating in the M &E-related committee meetings at all levels. • Utilizing M&E findings for policy dialogue, resou rce mobilization, and planning. • Providing feedback to domestic and international • constituencies on health sector performance and results. • v Supporting t he health sector through financial, technical and other forms of assistance to strengthen M&E performance. Actor Level Role Ministers of Senior Top • Working closely with the Cabinet through the health Management Parliamentary • Health Committee for: • Overall political and policy oversight. • Articulating the policy direction for the sector, taking broader government objectives into consideration. • Review of sector progress against the policy imperatives set out in contribution towards the NHP and NOP Permanent Top Management • Providing governance and partnership oversight Secretary, t o the sector. Director General • Review ing of sector progress against the policy o f Health imperatives set out in the NHP and NOP. Services, • Monit oring adherence t o the policy direction Direct ors and (One M&E platform) of the sector. Commissioners ================== 43 • Mobilizing resources for operationalizing the plan. • Monitoring health sector performance and six- monthly reporting to OPM on sector perfom,ance. This performance r eporting will be based on the quarterly submissions to OPM on progress against key actions and outputs towards outcomes. Health Policy National • Monitor and advise on health policy issues. Advisory • Monitoring adherence to the sector's policy Committee direction (One M&E platform). (HPAC) • Monitor implementation of the partnership arrangements e.g., the Compact and aide memoire recommendations. • Guide the sector performance reviews. SME&RTWG National (MoH • Developing and reviewing t he results framework representatives from for the MOH SP, and ensuring that r.elevant the different departments (and relevant non-state actors) programs, CSOs, HDPs, develop results indicators that are consistent M edical Bureaus, with the MOH SP. Private Sector and • Reviewing, consolidating, and v alidating t he academia) various sector reports before dissemination to the relevant stakeholders. • Facilitating utilization of M&E and Research Information knowledge translation and dissemination) in liaison with the relevant sector departments, programs, and the Policy Analysis Unit . • Periodically reviewing available research/ survey • information to update the current evidence on best • practices to guide Planning, decision-making or Policy Formu lation. M&E Unit National coordination • Overall coordinat ion and oversight (monitoring of M&E at MOH HQ and • supervision) of M&E activities in the sector . • Development and dissemination of the sector M &E plan for the MOH SP. • Ensuring the harmonization of the institutional, program and project M &E plans with the MOH Strategic M&E Plan. • Identifying capacity-building needs and training fo r health workers and managers in M&E. • Organizing sector performance reviews. • Supporting LGs to organize regular perfom,ance review meeti ngs. • Producing periodic sector progress reports. • Providing every quarter, data and expla natory information on progress against pe,iormance indicators to MoFPED and OPM through the Output-based Budgeting Tool (OBT). ================= 44 • Maintaining a Recommendations Implementation Tracking Plan which will keep t rack of review and evaluation recommendations, agr eed follow-up actions, and status oi these actions. • Monitor and evaluate the implementation of t he MOH SP Departmental Specific Program areas • Provide oversight for monitor ing specific M&E implementation of work plans and pr.eparation of quarterly and annual performance reports. • Participating in data quality assurance . • Providing quality dat a on relevant performance indicators to MoH and relevant.stakeholders. • Participate in M&E capacity-building activities . • M&E support supervision and mentoring. • Participating in the development of the program M&E plans, M id- and end-tem1 evaluation of the national strategic plan and preparation o f the periodic sector performance reports. • Maintaining a Recommendations Implementation Tracking Plan which will keep track of review and evaluation recommendations, agreed follow- up actions, and the st atus of these actions. • Utilizing M&E findings to Inform program, policy, and resource allocation decisions. HMIS Division Nat ional • Coordinating, harmonizing and operationalizing the HMIS and e-HMISat all levels. • Strengthening capacity for collection, validation, analysis, dissemination and utilization of healt h data at all lev els. • Conducting regular data validation in the districts, health facilities and other health institutions to ensure quality dat a. • Ensure that HM IS and e-HMIS data is made easily available to all stakeholders in a timely manner while ensuring t hat the sharing of reports respects the Access to Information Act, 2005. • Conduct dat a review meetings including data use confer ences to enhance dat a uttlization at all levels. • Updating the mast er health facility inventory of all reporting health facilities in t he country. • Ensure the ICD 10 coding of all diagnoses as outlines in t he HMIS, and consequently updating these in the eHMIS. • Generating the health statistical report annually . Regional Sub-nat ional l evel • liaising between the national level and t he Monitoring district s on M &E at t he regional level. Teams =================== 45 • Capacity bui lding for data collection, v alidation, analysis, dissemination and util ization of health data at regional lev el. • Conducting data validation in the region . • Supporting the development and implementation of the M &E plans of the districts and RRH in the region. • Monitoring and reviewing the Implementation of the M&E plans in the region by compiling and analysing quarterly and annual reports. • Maintaining a Recommendations Implementation Tracking Plan which will keep track of review and evaluation recommendations, agreed follow-up actions, and progress of t hese actions. • Supporting operational research and survey activities District Executive District level • Providing governance and leadership oversight Committee (DEC) In the district. • Monitoring implementation of the annual work plan and District Development Plan. • Monitoring adherence of all stakeholders t o t he policy direction (One M&E platform). District Social District level • Monitoring implementation of the annual work Services plan and District Development Plan. Committee • Mobilizing resottrces for operationalizing the (DSSC) district M&E plan. • Participating rn the distr ict performance review meetings DTPC District level • Monitoring implementation of the annual work plan and District Development Plan. • Mobilizing resources for operationalizing the district M&E plan. • Ensure t imely reporting to the respective entrties (MoFPED, MoLG and MoH). • Coordinating all lPs and CSOs to ensure alignment with institutional arrangements and district priorities District Health • Monitoring implementation of the annual work Management plan and District Development Plan Team (DHMT) (Performance Review s). • Participating in the district performance review meetings. District Health • Development of a district M&E plan. Teams (DHT) • Identifying key performance indicators and targets. • Coordinate M&E activities in the district to ensure alignment with institutional arrangement s and district priorities. • Supervision and mentoring of HSDs in M&E . • ConductinJ< data qualltv audits. ================== 46 • Training of health w orkers in M&E . • M aintai ning a functional district HMIS with up- to-dat e d istrict dat abase. • Compile and submit periodic district reports to the district, MoFPED and MoH • Conducting drstrict performance Reviews Health Sub- • Supervise and mentor lower -level health District Team facilities in M&E. (ftSD) • Aggregation, validation, analysis, dissemination and ut ilization of district data. • Maintaining an up-to-date HSD database. • Compile and submit periodic HSD reports. to the district. • Conducting HSD Performance Reviews. • M aintaining a Recommendations Implementation Tra.cking Plan which will keep track of review and evaluation recommendations, agreed follow -up actions, and progress of these actions. • Utilization of M&E results Health Facilit y Facility level • Ensuring the dev elopment of facility M &E plans. Managers • Determining performance t argets for t he key output indicators. • Resource mobilization and allocation for M&E activities. • Maintaining an up-to-date health facility database. • Compile and submit periodic reports t o the relevant bodies. • Conduct data verification before submission of reports. • Conducting health facility performance review s. • Dissemination and utilization of data. • Mai ntai ninga Recommendations Implementation Tracking Plan will keep t rack of review and evaluat ion recommendations, agreed -upon follow-up actions, and the progress of t hese actions. Village Health Communll't • Collect, compile, analyze, and report on Teams (VHT) community healt h data, including births and deaths, through t he community registers. • Use dat a to discuss performance within the communitv and agree on priorities to focus on Community- • To provide information o:; the delivery of based CSOs, various services) transparency and administrative accountabil ity of resources accorded; and units at the • challenges and gaps experienced in the delivery grassroots, and of various services. health • They will also participate in v alidating the consumers outcomes of impl ementation oi t he MOH SP in their respective areas. ================== 47 • Communities will also be engaged in the review process using participatory appraisal mechanisms like focus group discussions and community meetings or dialogues like the Constituency (HSD] Health Assemblies, barazas, open days, CSOs National, sub-national • Contribution in the development of M&E and district level standards and plans. • Participating in sector monitoring processes at LG and national level. • Providing performance reports and qualit y data t o the relevant program managers at the national and district level. • These will be compiled as part of departmental reports to be review ed by relevant working groups for onward transmission to SMC or DTPC. • Participating in the M&E-related committee meetings at all levels. • Conduct Independent M&E audits and share findings for performance improvement . • Community sensitization and advocacy for accountability mechanisms. Health • Cont ribution in the development of M&E Development standards and plans. Partners (HDPs) • Participating in sector monitoring processes at and lps LG and national level. • Participating in the M&E-related committee meetings at all levels. • Uti lizing M &E findings for policy dialogue, resource mobilization and planni ng. • Providing feedback to domestic and international • constituencies on health sector performance and results. • Supporting the health sector through financial, technical and other forms of assistance to strengthen M &E performance.

6.8 Human capacity for M&E The M&E Section will build health managers' capacity at all levels in data management, data analysis, and report generation on climate change programs. Semi-an nual data-sharing forums will be organized at the national level, where MOH HNAP will be held. M&E data wil l be shared and improvement plans will be generated. At the sub-national, di.strict and facility levels, the HMIS unit will continue building the capacity of health data managers in climate change data captu re, records management, data analysis and reporting.

6.9 Partnerships to plan, coordinate, and manage the M&E system The M&E unit will collaborate with other MOH departments, government agencies, development partners, and program-specific implementing partners to drive the M&E agenda of MOH at .all levels. Partnership will be sought from program-specific implementing partners oi climate change to support district and subnational-level M &E activities, including data quality improvement, quality facility reporting, M&E tools management & development, and data utilization.

6.10 National multi-sectoral M&E plan The M&E, and HMIS/ data units will be responsible for managing this MOH HNAP M&E plan,'the HMIS guidelines, the EMRguidelines, the DQA protocol/plan, and related M &E plans. There will be sectoral coordination among t he MoH, other MDAs and implementing partners to ensure inclusion and routine monitoring of health indicators wit hin the human capital development program.

6.11 Annual costed M&E work plan A detailed costed MOH SP M&E work plan including speclfled and costed M&E activities of all relevant stakeholders and ident ified sources of fund ing will be provided in this HNAP. Effo,ts have been made to capture all related activit ies, as outlined in the implementation plan of the HNAP.

6.12 Advocacy, communication and culture for M&E The unit will champion the knowledge of and commitment to M&E and the M&E system among policymakers, program managers, program staff and other stakeholders. This wil l be done through M &E TWGs, dissemination of M&E publications, during work planning and M&E activities.

6.13 Routine program monitoring The Division of Health Information (OHi) will collaborate wit h the district teams to support the management, and production oi M&E tools for use at facility and community level. The OHIS 2 system wil l be used for reporting routine climate change data from facility level. Data from OH.IS 2 will routinely be analysed and interrogated to check for consistency, quality and completeness. Appropriate measures will be employed to ensure data is always of high quality (valid, reliable, comprehensive and timely). The M &E unit will work wit h the HMIS unit and the program M&E teams to collect and updated t he MOH HNAP routine database and matrix.

6.14 Surveys and Surveillance The unit t hrough the planning department, wi II work with UBOS to ensure Indicators listed in this HNAP that require surveys to generate are planned for and collected in a timely manner. Appropriate measures will be put in place to ensure data produced is timely, valid and reliable data from the surveys and surveillance systems.

6.15 National and sub-national databases The M&E unit will develop and maintain a national health database that w ill pull data from d ifferent data sources to one repository for MOH HNAP data elements. The database wi II be as real-time as can be .and will be available to all levels of health service delivery from district to national. Data will be ================== 49 desegregated by region, gender, and age where applicable. High level program.specific data will also be made available.

6.16 Supportive.supervision and data assessment Periodic data quality assessment (DQA) and cleaning will be integrated In the implementatio n of this HNAP to address obstacles to produci ng high quality (valid, reliable, comprehensive and t imely) data. A national DQA and cleaning exercises will be conducted at least once a year for all hospitals and large volume health centres. The DQA activity will be led from the national level, and a data quality improvement plan developed for each facility where data is collected . Data cleaning will be carried out on a more regular basis as need be and will be coordinate from the district level.

6.17 Evaluation and research Evaluation and research agenda of the HNAP M &E plan will be led by the M &E unit, working closely with the Health Research unit, UBOS and instit utions of hig her learning. Evaluation and research questions will be developed/identified, and studies conducted to meet ident ified needs and enhance the use to evaluatio n and research findings.

6.18 Data dissemination and use Platfor ms for disseminating research findings from surveys, evaluations and routine data will be sought. On an annual basis, the unit will produce the HNAP progress report detailing its performance against its targets to all health sector stakeholders. Efforts will be taken by the M&E unit and planning department to provide necessary data statistics to MOH at planning and policy formulation stages t o enhance use of data from the M&E system to guide t he formulation of policy and the planning and improvement of programs.

6.19 Learning and Knowledge Management

6.19.1 Learning Mechanisms for H-NAP The M inistry of Health (MoH) w ill guarantee that all stakeholders are provided with guidance and evidence of t he ministry's initiatives in a manner that aligns with their expectations. These. stakeholders encompass the broader Government (Office of t he Prime Minister), Parliament, cit izens, and all other health consumers under the Access t o Information Act. All Monitoring and Evaluation (M&E) findings and research outcomes from stakeholders will be translated, and the data/ information derived wi ll be utilized for decision-making, policy discussions, reviews, and advancements.

6.19.2 Knowledge Management Processes The Monitoring and Evaluation {M& E) team at t he M inistry of Health (MOH) will incorporate elements of the Health-National Adaptation Plan (H-NAP) into the ministry's existi ng knowledge management system . Thi s integratio n aims to ensure that the knowledge products pro duced are documented and handled effectively to facilitate learning among different stakeholders. The management of knowledge related to the H-NAP will be carried out using the ministry's current systems and procedures. ================== 50

6.20 Performance Reviews and Evaluations Achieving effective implementation of the Health-National Adaptation Plan (H-NAP) will necessitate conducting perfom1ance reviews and evaluations. These assessments offer timely feedback on the performance and outcomes of adaptation Interventions carried out by diverse actors and units nationwide. This section out Ii nes the primary performance reviews and evaluations planned for the H-NAP implementation. 6.20. 1 Periodic audits of the M&E processes The Ministry of Health, in collaboration with the Ministry of Water and Environment (MoWE) and the Monitoring and Evaluat ion (M&E) directorate at the Office of the Prime Minist er (OPM), will ensure the regular auditing of M&E processes for the Health-National Adaptation Plan (H-NAP). This initiative aims to identify any deficiencies in the M&E processes, devise corrective actions, and pinpoint areas for improvement to enhance the production and utilization of M&E information. These enhancements are ·crucial for facilitating evidence-based decision-making among implementing entities. A select committee or M&E working group, comprising M&E technical officers from the Ministry of Health, MoWE, OPM, and other stakeholders such as Civil Sodety Organizations (CSOs), academia, and key stakeholders at the district level, will conduct these period ic audits. Audits will occur every two years, and comprehensive reports will be compiled to guide the review of M&E processes for t he H-NAP

6.20.2 Annual Performance reviews The Ministry of Health (MOH) will conduct yearly performance evaluations to assess the progress and outcomes of the Health-National Adaptation Plan (H-NAP). These annual performance reports will be compiled and disseminated to important ministry decision-makers and relevant stakeholders. The insights gained from these r eview s will guide the development of annual plans and the subsequent implementation of H-NAP activities.

6.20.3 Midterm evaluation of the H-NAP The Monitoring and Evaluat ion t eam at the ministry will oversee the organization of an independent evaluation team to conduct t he midterm evaluation of the Health-National Adaptation Plan (H-NAP). This evaluation will adhere to the policy stipulations outlined In the National Public Sector Monitoring and Evaluation (M&E) policy for Uganda (2013). Subsequently, a thorough evaluation report will be compiled and disseminated among key sta~eholders within the government system

6.20.4 Endline evaJuation of the H-NAP The Ministry of Health will commission an independent evaluation team to conduct an endline evaluation of the Health-National Adaptation Plan (H-NAP), with t he participation of key stakeholders from line ministries and other relevant agencies. Following this evaluation, a comprehensive end line evaluation report will be compiled . The findings from this report will be utilized to inform the development of the second iter-ation of t he H-NAP. ================== 51 Table 7 : M&E Framework matrix for the H-NAP 2025-2030 Goill I Tt, J.trnnmhcn lhe ddll.~11/;:,~ md-it~.,,,f the lie,1lth ~ .s:tCn1 1c, d lmate dlantto .ind mlateiJ huard:i I Speclt1c Pl.l'...-..se/Outcqn-e-•1: lmprQw(l~>0nhn=1t10n ,and l11du:;ev.f~ hn.ihiamJ hea1ltt .id~p\.itivn obnn,nf.li-~ qoss_.ill leyE!I~ ~ ult Corpp:;irer,t P.l'o posed aotlo ns Pf!rfo rrm rre 4=--'e.l of Five-· Baseline Meens of An1'lui I ta n.let!ic ~ pc,nlrg J!c:e.rc.y lrditt1 tors """It Year 2024/225 v'erif'~~tb n 2i.'2G '2£/27 'Zl/ 28 'ZB/29 '19/30 frequsn:y A 1ran,w1" rk !l Clirn~~!'!· J. J Es\, l)llsl\ and ClhnaLe.and Health Olilpul , l'arr.a t 0 Func:llonal 0 1 Q 0 0 0 1)c-olf EMO-Mql·I lo, +~nhuneed ir.➔ n sfot'm;it lrnH:l icinalfte :a l:lhnal<J coon.llnat lo11 Cllnl.:tl l! and -CQQrd1n.1tfo1, and Mealll', me~ha11lsr11 wh hm lht! MaaJth ~ nrJ Int:lu~lv'~ ""' kl• .\ia"'lil.11 w (lr (lli 1;1tlbu M0!-1 EnVironmenttl coonJin~1lio11 ..:Jimate :11111 and n'IOChaniSm Wilhln the He<1lth Depi!rtnll?nl !Yle-::hill'llsm '"I•'" <1tl.11Jl<1..tion ,gg~rn:11100 MOH Environffi':!nt.il l~allh D!?partmcnl e,tablished cvhkH'ICe~ bv rninutm/ planulng·a t reporis irvc,V l• Y.'11 qi l . 2 OWt!lop ,guhlt!lil'H!So Gull'.l!!lines·for Output 1 0 1·Gut1Jelr,~ fQr I 0 Q 0 0 0 1'1e-0H EMQ.M~H Op!?r'~ 1tion for mairm rruming rna in~1rcarriil'lgclir.-.., ta rnulntt~.irni~ d irn:t te :t nd llll!a llh in .and he:tllh IO the climale a nd 1he l\ej1lll1-;.ea-0r healti, 5eet~•· h~ llh i.·, 1/1e de\E!IO.....,,d, health ~ i.1or 0 hlll!f•mine;t~rlaI 0 :L3 8.'ti! bllsh inl tlr- mii,l.r.1.crial $leerin" lnlur•mjmr.terial steering co,nmilte:e;. Qn he;1l.lh 'and ,clirnale Output ' .!.1 e:erlng ' 0 (1 0 O•'!E.!•Otf 1£H O-""oM comniitteeo n he;1lt11 c9n·,rn1ttees6 n and cllm:ilc .dm-.g.e d 1=1nge (Including C.SOS '.llllm:1~echan:;:e 11,nd udlng C.SOs,amJ. <1m.l 11\~ pflvat csector and ,~ ~Ith as 1he private~~or); est.i~ll$hC!d evident~d bv mluutes !l.4 f.!.1:a lll jsh the Climate Chal'!S,e and Oui1.1ut l 0 Techni£!JI l 0 0 0 0 One--0H EMO.MOM d im.ite Clu rig.a and Health Technical Wor~lngGroups 1-teall h' Te:l\1',k-~I War~~ G,o uµs. IT'NGs) a,, 1;\'otklng Gro up (T\'IGs~-cm blished Cllnl.'tl l! Change frw§.,! and Mt>.ahh a!> (.!itirlarv.:.;:d 1/y minutes and repnrts Ell~ct~ Oulr.om,-:2; lul\'JtraOon uf t lhn.!!tt, <11111 hl.ldltll lu M nA./1; 111d '/1tJfM:ldti11Cl91':ifo thl!h:~ POC.UW i,rt11m11ns E1q:ected t l(m;it~ l.S DevE!l<ip g ul~Jellnes AVail3bllity.of Output l ·o G ui i.le II 1"1eA l 0 0 0 0 One-<1fr EMO.Mo'H Output•2,j; translo rm.it lpr malnstrP.aming guideli1-w for Ohnul1! {11\J tf• • d hn;J1.C.{1111:I hffifhh 111 11111ln1.tre.11nlngcllm 1tt! ltr.r1ltt. i.i<:t ic;lns lo• deosblp otlw,r MDAs,. lov.,1 and health lo Olher rmihstt&;l med ..aml govcrnmerJ and lhe MDAs, lo-c;II Into ymgranui l:1s,OverneJl'l'<".i? 1-11'ivc1te sector .guvemrncnl antJ tl\e of gOWn'lmtm1 nriv'.ile ~ tor ajJ<!nr.ll;?S'd!'H I !1.6 AdVO:ate 1or t4umber QI adV«acv o utput 100 0 Beports 2<l 2\) 2\) 2(J 2<) Annually EMIJ. non-st.a te ~:llrn~te an~ h£>.a lth events: hehJ . MoM/ MWE m.10rJ; aer<,ssstak.eholr.Jersa1 cco Jll le\oels 52 l. 7 Oissemina1i01l 01 Nu,nberof Output 20 'O Dlstemlnatloll 15 5 0 0 0 Flr:-1 tW·o MOH EHO \he H-NAf, across d1.ssemii1.1tion me...>tlns v~rs M 1NE CCO $k:f.!ho lders.. t ~II 1rtet!tlh_gs co,1tlucted 1n inul E$ NGO,. l&(els.- Nat.km.1~ c.so, regional; and sub~ OHT natlor~I 14:\vel l Jf Tia in IP.<i!k?r.; al Nun·,ber uf wpr~holls Output S(l 0 Report-s 10 10 lO 10 10 An(,ually F.f.10-MoH varlau~ n.it!9nal and <'ie:1rnlu;Ct-ed omQ,ng $Ub-nallom1I lal/els lo:i dart -at varkf us lndui.ling·publk and 1·1i1 tional and•slib- llfiv.it e ,,al krna I !wel.s. l11dudin.tp. publk: and orllfitlil l ,9 rrc1i11 mMbi Nrnnlw rol l rah,lng 0 1Hpul s 0 Trolnlrt! repo,t,..- J 1 I 1 l J\11111,rnlly f.HD-MoH 1>r~ct il k111el"$ Ih ,c,:llmaJew ents helcl anti health messaging l..lO'Supp<>rl Numl.lerol 0 1Jtpul 3Q 0 (:;iiinpaig1l s s 5 5 JO J\111!U!JIIY f.HD-MoH co1nmunlty-le.,~I co mm unitv• l-2Vel 1'ninutes \~Hmm.and ytll,llh wn men and Youth induslve <1 ~Voc-acv lndw:ivea ttvoaicv a rnp:1ignso n health (:dmpo~ns (in<!luJlng (!(jenl~l l\edl~h.. :SRH, ·vo11th; an,t \...ornen; amor1g o th~~rs:,and ~u~1po11etl dhm te drnnge lni~ .r~tiou l.ll lrll-O}Jrale ho,ilth U$Jnl.l:1 National Output l ·o Comrnuniaatkin l 0 0 0 0 One-<:>fr cco- and di male 1nessagh1g Climate Clu11:1g.a St rat<.,gy MWf./MOM lnlu I ha Mln1$1.ryol Co1n1rn11,l~1tio11s Healll\ Siraltlg'/ fUNCCS~ (klrnlT1unl-c.1tbm mvbe~ strnteg'/nnd mviS!! the Ug_.anda National Oirna1e Ch;1•~ e. Co rlim u1lic.1t lO ns Slrnle.gy fWNCCS). S,_.lflc p..,............ ou&:·o m:t--3: Im ,act. oh: ll"""te. chill,_ an l'i!sa Ith address- EKj::ected 2. CJinlU\~~ 2. !J Tra i1\ heilllh ·Nurnbero1 trall'll!'1{',.? Oui1.1ul lOO 0 Trnlni~ iepi:)rb 20 20 l<l 20 20 Annually EMO.MOM QutpUl,;3,l J ~maf1 \\'O•k.e r.s iu climate :1nd c,c,ndu<.1ed @m11rehe(1SWe heilllh 1$, ltll 1nf?asuras I•¥iOrkforte 2.2 lnteg_rJ 1~ dlrrwte Pe 1tieni.,ge or c,urrkul-;i Output lOOlG 'O Currkula th.:rl 10¼ 20% 30)(. 75% lOOlG Annually EHIJ.:Mo'H add1•esstr.g and lw.alU, in t u1m:ula Vrnt ipt~ rat~ c•U1r1Jti'.! i I'll(l!,ra le l~ alth1mp.ict s for. lhe h«illh a n\1 heallh •<;llmate:-Cllif~t! of t li!Tl.l\U. workfoi•ce a1, d hr.altll change ·2:3 r r~Mtk: IEC l'.lc«.'t!ntaJe·-c,I Output 100K, 0 b bserv,a ~lo n.QI 0 2(1% ,o)<, 75% 100¾ Annually EHO-fyjoM lmplr.m~nlt!d. i'rolt!rlal, 10 thl' he~llh hea,IIIW:are ladlitle;,i l(_C mtiLerla!S workfol'ct'.! o n .dlmaJe with IEC rn:1ter1iilso n piuvided anrl health dlm=1te :1nd heahh 53 V I ('.o nd 1.H,1 Number ol'..supelVl$b h Output !!) 0 Supprvislon 1~ 18 !1.8 18 1~ Annuallv EI-IIJ.MoH ~u1, crvlskm <1nd <1nd mE!ntoi'slUp vi!.:its Vt lb rrwnlorshlj) vlsi~ •-.i~ co1idu<.ied .al regional 11~:IQual ,11111tliJtrki, ~11d tllslrk:~~ W I 11,v;,1 l .S Sup pp rt dl;;tri::ts to Pe1ven1aagt:! o f disJricts Ou.tpul 10QJ<\ 0 Minut!'.'!:s 0 30% SO¾ 75,'J(i 10QJ<\ Annuallv EHO--MoH .issign ~ di!fmle~1111.l with Gllm:11e..i11d ..iss;,W,nlng tot.ii ll!)lilth fd,:;al pe~o1l s l~ alth foe.ii perstu1s- pert.ons assluned ' -3 3.~ t\eYf!IOp,ge1\der.- Guidelluas and 01Hp1H 1 0 J\vaikilillily an,I 0 1 0 0 0 On,1--uff EMD-Mofl Vuluc,~ b!IH ~ po.nsi" e guidelines -st.1ndMtlized U!a! ot ,¥, ea pachy and ~a111;b rdb:~d apprQi.lthts lor \(A,'\ gul~ellnes, 'l»qls .i111d app root he.s for V,-\A <1nd rl~Ra.sse.ssment!l and star'1llarthi .adapl'a~ion and risk <1S$1e5smen~ .al rn1tiunal and sub• -,cl$5EISSi'nqnt at natloml ilnd sub- nation.ii levels lliltklr1;1114:Nel5 ~ ·1,4?1(1Mll 3;2,Sup!Ji,)rt dl!,1 ri::ts to Pe1~e111aagt:! o f dlsJricts Ou.tpul 10(t!<\ 0 V./11\ reports 0 100M 0 0 10(t!<\ 2"1~rnd S'' EHO--MoH <,:prnJU(;~ 1)J.'rjadk support Qd 1,0 Vf!::11' dinut4:< :and hBa lth conduct pt:rlodit VM •t llrna~e.and hea~h VM

3.3. Map du\ ln"St ii ut io nSi1rv6 lvf!d I11 Output l 'O t,,fo pr,, Ing report l 0 0 0 0 One-<1H EHD,:Mo'H institution? Involved in •d ltria~e.and 1-iea~h -1:1111~ 1.c and h1Nf hh 1nu l>P~d·Qul

3.11 De\lE!l<>p ;i o ne•stOp' A o ne-tt o p data Output l ·o OnM tOp d!lt-0 0 1 0 0 0 One-<1H EHD,:Mo'H data ~ PO$.it6rv I Qr 1~pqsi1Prv li;,rdlm.it~ ~ pos;lto 1'y tor dhnat c arni 1~ -hh (11\\1h~ llh Llt.'l!~~ped · cllmate a mJ • 11.l Dt.--velop 'ii pbltfo1m A pla 1form or ~yst~rn Output , 0 health Integralell 0 ·1 (1 0 0 O•'!E.!•Utf EHO-MoH hil~ r{llflr, ,111rk!r DHIS2 1ha1 uuder OHIS2 lh,;11 tethilulogy In riSk inMgr.ates dill'late and lntegm ~ clirn,l le.,a,,d ro.ul ine data monltQflng. h1.'!<l lth data for eilrty haalth dilta for 1:1arl1 ~olk.-Gtlon ~ i111iJ ei!rN;: warniQg.. wa ml!'lg.devaloped an~tJ;;!so n \\"i!l'nlll!} envir.o nrn<eo\al 1:isk.o;, haaml~, a11d epld~mlokigrJal t mnd} A.2 Upd'ilt4:< the SiJ1Veill:11'lc es',(_l;ten1s· Output l 'O St rengthened 0 1 0 0 0 One-<1H EHD,:Mo'H i u.rv~illa n<;e sv,stt!rn to updated tQmQn~o r SUl'Willan<.~ m6111t0 n ,;limaLe- dlmaw~.sensl1iw systern ~ m,itive dl~$t'!~a nd \lis,e.:i$t!:;>and ulllite. vtmze. dlglal heah h digital health platfo~nE k1reartv platlotm1: for Qa rfv wan1ing !<-ySlerns,, \¼I mlng -sy,;,te:ms; 1li~.se -suiv~lllt1ncil, Jl~ s-esur"8lll:ince, ,_ and 1eiernedk il'lt! 3nd telernedkln!! 54 wo,kl'l \¥Ith orivale 'Wtll'klng wlth priv:;1lt! secldr $t.>.::lor •1.3 ~ nchl't ,nize ..1nd Ol>M.--Ols3S,er Output ] 0 SVm;hIQ nl red 0 1 0 0 0 Oyer the EMIJ.Mol-1 ~nhance 1hc llJtabaSC,.,,M OM b r M~ Disa.ster lifes:pan OI ihteroper.iLJilltyol IOHIS2), and MWf. d.il<1b;1~, MOM lha l)ldn 0 11M .. Disaster c.co clim:1t<1 ffll'if.:asl i□l·IIS2!. • nd d:11-ubJ'St', 1-,1'o~1 ~nchrm1ized MWE.. cco jOMl~2~; a nd tV, 1N E- cl!ma1e fol'e..:a~ O::Dd hnnti fQl'eca$1. AA ClevE!l<>p ii 03:Shboa nJ o n dlma\u Output ] ·o Dashbo~irl.l 0 1 0 0 0 One-oH EMO.Mo'H da$hb<,m d <It the •t hi'lnge.a nd h~ .hh al llill ional,au~ w h- lhf;I ni1tio1la I am-I nationii! ltNel subnational ~vets rJuv.:loppdwlthin the Of.1162 A,5 MOM perinclk!allV Peitentage o l climate Output l O(YJ(i 0 Report-s ] (YJ(i 20'J(, 30JG 75% l O(YJ(i Anf1ually F.~10-M<>H oommunl¥1ter;cllm:1 t~ ..anr-1 heal\h updales and h~ lth up·date. <1mJ ~~,:lvwarnl~ and ea11v wamlngs to corn,nunicatcd to suhn.~lianal ,sul)11.itlqnt1I Sl'ilkeho ltJers lo sa~holtJers t?lb b:rn1tiqn whh VMM~ A.(; lntegr-.t I(' 1,1dlgenous kn0wledg'.'! Output ] ·o 5 1JNt!'/ 0 0 1 0 0 Qlm1+~rly EHO.Mi.iH 1ndigenou~knowi?t.lge i,11 risk .ina o/.sis and ~ ports/Com mu In rlskanill~ ir; <1nrl t.-ommunka1~ ,1 nlca\lon a;,,nmuni{;;Jtioo !ntegta t~d bullt!tins ,,51 dlmatc S,l l\!'llise <:urrc nt liealtll inlrn?trud uru Output 1 0 B~lsud Mt>..ilth 0 0 1 0 0 O•'!E.!•Otf Health l'eSiller1l I~ l1h lnlrn t.ructure ~ 1\(Jani~ r-~VGE!I.I for- lnlrn~tn,.ICU,ire In frn51, rue,,, r 1nrr.astruc1u ["!, sta n 'dards for di ,m te. prootl~ <:limat.J•pruofin~ $la1H;l:1rds for <illm:1~0- • Clop,rlrrn,n\/ l lihnofQ&ie proofing EHIJ. •$J.and 1JoM/ CCO 1.i up~tv ; llplu "1WE S,2 Moll~or ·Num!JUrot' vis.It; Oui1.1u1. 90 0 Mo ni to rlrtg. ]8 '.Ill '.Ill ]8 ]8 Annually EHO.-MOH t-Omr,Uanc:e with t™.! <:011d11<:ltid ~o monitor ~ porti;; revls.-el.l Mealth oorn1Jll;1nce whh 11\e lnfr.t'.strud ·ur'e r.?vised 1-tea Ith :St<1ndards'h:ir <;llm:1 tu- lnlr.i1o1 rutturu 11r&.1fi~ $Ul 1\(Jani~ fordima~~~ Ol'OOliri!!. S,3 rraln kw r,,umbei"ol t rainings Output 36 Q H ~lnh~ rePl(rt,; 0 U1 0 ,s 0 2••1.and -1 1• H:tallh stukeliolder!l ,,cornJucted for key y.,., lnfrasll'UCI\JI' lheall'h,.;ar.e man.1gers ~rnl <;on1ra<:tm '$)on Sia keholder;S lh.~ Hheare rnanage1!. • CJep:111n~ n1/ d inn tC-pfoolh'\i,I. for and 00 nt ra etors~on EHIJ. hea1 l1h lulrastru<.1.ur.e MoHICCO 55 d lrnat-e-pmofh:ig fcfr M'Nl:/Minht health inlra~1ructuru rv ol Lands $,4 Advo~ I~ k1M,he reroe1'r'ii1ger1( Outpul lOQ>I SurvL,y JejK.111 0 21')¾ ,10¼ rh¾ lQQ)/, Qm11t ~rtv lnfr.r,;\ru<;l\H' fnstallation o h !lea n l~ alt l~<'lrt? facilities 6. ~l)l;!lgy: and d i mal e- with ok!an l!nergy Dep:1rtn~ nt/ Sn'lilr1 1ethnol0gles 1e<:hn;0~gil!~ I hill EMC> s-uch 'il!>S'olar pow ered rodu«- elet tricity MoM/Mlni!,.t r ~qulpmenta ndoobr lnfrast.md um y9l Energy !>,stem, lle•kh Jjsr'u1>tions lacilitles S15 (;I rnJ u-e.1..su Pl>O11, Pe~ent\'tge o l Output ]00¼ 0 Digll;nl r ~ tlo rm lOM 2Q')(, 30¼ 75% ]00¼ /\nnuallv EMIJ.Moi-1 ~UIJt!fVlskm lot heallhcarc latililie.5 lO manage (.ligltaliu tiOn o l •SUplJo.rt-Bd k) digit izC! rti<:-OrtJ.k~ ptng· reco n;lstr\ ltedltlV.: 11(e lt'.>«,in:ls facilltv,lavt?I 6 6,1 ~ rlducl joinl Joi111 muij i-sectora I Ou.tpul l 0 P-1!P.OrtS l 1 1 1 & Annwlty MoM, Manage'nH! mu~ 1-s(#d <11'a I r~ le. riska ~nl ~nl 10 f\.tM IF, 111 qf rt:lat ed to w?lter, pfoad iv:elv mahl1ge M'A'~,OPM envlronm!!n Si:lnitatlon, kmd ,111d, health risk:sri:b ted 16 tal sr,M, IIUI tiliOn ii ml air w.;r ler1Sjl111ti1lk.:11~ f~11J 1Jete.nnlna11 qudlltvgiVing e rnph;1sis and, SRM, riul rilkm .and t.saf hqal1h to 11'1=1 most,vulncrablo .air qualhyglvlng 1>.:1pulJtions t ha l cmphaiis to the: mo~1 indui.lth\iomen, girls, .vulnerable popul:1tl01u; V'Ju\h1 dl5abled, k,1.w 11\al ir1d utk! W(,lrYH~n, fneome, Ri?h~ ees; ijirt;, \<iulh~di;.;lbled, elderlv,. mdlgOll(>US, b w iric:0mtt.. r'f;fug~ , <1morti o ll1i1r., i:l!Jertv, i1\digei\01,1 s, among o thers 6,2,Q:)ndut:t publk Numl:)!;?rol publk Output 730 0 /1.cliv~y 1'eRt,1rts 146 146 146 l •I{r 11m Anuually EHO-MoM a'Wdre11essto l'lqease <1w<1rene~ e~1ns l'IQ1,sehold ,es.ilir.nw aimed t<, lln:rea$t'! to 11'19 lmpadsal hou~ hold msilkmce d in~ t~ change b n to I he hn1)~ ol 'WASH,. lood s~urilV, dimalt ch.rnge on r1111rlq~rn 11nd..rlr WA)iH, foo d~ udtv, quallty 11utrltit1n..;r1HI air quallty -c,,1T1p.1 lgns t-onrJm;ted l~rne per

6.3 Adv:o\!ate lor the diStri<.1 ~erv~ r~ Rw~kJn o f tht1 Output , 0 B~ ls~d 0 0 1 0 0 In the~"" EHO-MoM r...;y-l !>i;;111 o f1.hll E11\lfrUrme nt~l lmpay Envlrl.:mmi?ntal v.,, Em.rironrnental lm1uct AsSeS.S111cr.1. a nd Aud h lrnpacl Assei.; ffijlnt ~nd A'udl\ Regula~lons to ~ !ieS.Smcnt.anrl P.Q&ulutiOnsto strenglhon the /\,udil strengthen t I~ i1wol~ me111 0 1heallh P,egubtions h'r,(11\f~IYH?nl -Of he;11th • 56 ,_ ii,,/perts in the EV'.aild e,ipeft s iu th!! EIAand audll orucess audil uruc-=" l;iA Su ppc-)rt MOA~<1ml re11:e1'r'i"i1ger11' MOAs Olilpul 10\)>I 0 C:o mrill:anc~ 101' 2(,)% ~}(, 7S1' 10\))! AnnlidllV EMQ.Mql·I lG to ensiJte and LG ~u~1p<ht+;tl to report w mpllance whh l.t\\'? en~ure <:ompllans.;e <1nrl l'i'guktl~ nson Willi lc1W$ <1r'HJ Cl'fl'iJOnrnental mg1,llat.iol't,; on p;olhftloh envfronffijlnt-al oollutioil 6', S Suppprl di;;1n::ts to Pe,~ent.agt:i-o f dlsJricts Ou.tpul 10Q" 0 Compli:aflC(i 10¾ 2()% 30)! 75'¼ lOQJ<t Annuallv EHD--MoH lt?VlL>wcommunh y su11part«;:J IO mv1e:w r~ports ~~ @ms/projLtts ,-corn111unil'/ (such as·111e Parbh programs/ proj ects t\eYelopmerl\ M<•tlOI) l:Such d$ lhf! P11ri:sl\ fol"dimatt•rand 1'8<1Ith Oewloprm~nr Mod~li nulnstr.e;1mjng lor <.:hm':119.and heallh 11111 b11.tn>..1min11 6,6 l)ocuroent e nlitif:s Pertentage Qf a nlitlos Output SO% 0 A.:tivity report lOJG 20'J(, 30¼ •0% SO% Anr,ually F.f.lQ.MoH wllhtunfls:t<> whh fund~ !t1 lmplernenl <:lil'nate lrnplem eut e!hn:i le ,c:ha~e and heallh- <:h,rngea nd he;illh- iel .iUl t.l 1el,11ed prO;ilr.ims/{l<:tl\lit les 1,1fogm ms/a<:livlt~ 6, 7 ~ vise du1ro~s i\vailabllily of a Ou.tpul 2 0 /..ativ1ty f.elKlrl 0 0 1 0 1 -3" 1end s•.• EHO--MoH .iml l'e';pOrt!ilbillll~ :c.1f 1lo.:ume111 \vhh w ell- Vf!;)I' iiartm~r~funi~Jr the ~p~lled-0ut m les .iild mu"!~prnl l\'!-tp,onsl~lllt~s-1;11 in.magemenl ot '""1 nti is- lmder lh!:! CIYll'i JOnrnental mulli--se<:t<ira I ~ termln3nts ot health management o l (!n\firo'nm?.l'ltal r.le termln.int$61 he:illh ~.8 Rister !"umber <A mul,11- Output 10 z M eeting rePQrts 2 ~ z z 2 Annually EMIJ.Moi-1 rnultisectorill ~ tor.ii w lb bciratloo ,r.<:i lb bo ra tiOfl With 1·rte(?tillg}~ifft£'d .al 01her awe,·nn-.e, ,, 1,r6ri¥,1\lfll fnt~ l'a1larl nllnistrles; NGO;;,. 111hl bf heiilth,ger11Je1~ aca~ern.k ii1si,ltutio,n~ ,vouth, swcu.il .ind IQ 1,romqte ln1~rat k11\ repro~lud ivO h,:ah.h, of l\e.-a lth, gender, and c lhna1e <:hange YJU\h, ~ l,lil la ml 1t 1product"rve llr!altl\, and clhrmt £! c!M 1\1!,e. ~~ Promote PPPs to Numl_>erot PPPs t h.it Output 1~ 3 A<: tlv~ v f epo rt.i; 3 3 3 3 3 Annually EMIJ.Moi-1 fw.ter lnno11htio11 to fostt!r im\Oval i01\ bulld build climate re:;iliE!rv.:ti <:limatQ resilienc e In In lhe he,!llh E li)I' lh'3 ha;llth.~ IQI' 57 a :; a :; c 0 :,: i:i w 0 is 0 0 0 0 0 0 0 - C 00 0 6g ~ M "' f': ~ " - -; -; 5. i ~ ~ O· -; -; 0 0 8 0 - !m:rf.d~ 1 •.dhrrale1'n~ lt!~uu1-oo n~ bilital k,11 mo bilir.at lQn .ind gmnt lin11nd njt I,e;iIt11 di HJ $1'.'~nt \'fl'illf1.g -at wri\lng st(eams for lln:1nd 1'\J, nat ional and s-ub- r~ 1tien1,,ge ofirain~ · Output 7()¾ ·o Submission lO¼ 20% 3~M SO¾ 7()¾ Annually MoFPEO, d lmatq.an1i hal lonal lel/els whq hav.esubmh~t!d ~ porti;; M•NE, MUH, ,,.,~,11, gnmls<Jn <!llmahldlHI Mak.SPM henlth .S.l •lm:rt>..ast;? lu11dl1lg l'.le«.'t!nt~q.e·o l 11roje<:t Output S~, 0 "J\clivh l'eRCJrtiJ ]% ~ 'l% •1% S~, Anuu.ally EMO-Mo,M, for pr<ijec:l 11111n;igen1€!nl aml luulg,(!i$ MoFPEO nu nagerne11l oper.itbns funded uperatk,1ls tor <;llmatc-: cha~ a proJectsn nll progr.ams in lhe Ministry tir Flnm,~ Plannlng-.and Ec-0no mll; Dt."\/elopm~11t w ,r;;lc~ ri~ nat1Qrial ildmlnlStr.itive arrangements $,3 PrUmo le Nrnnber ol jqint Otl,tpul J5 3 /..i:ti'(itVf1?1Y.1rl:s 3 s 3 3 3 A l11!U!;Jll}1 F.H O-MoM, internalion.il and <;<1llaborntio11 and bu dget.5 MoFPEO hal lonal tollabo~ tlQns lnlt.lat l~ lorte-.:hnlcal k,r tec'lmtal a!i'd -.ml I h'1anc!al resd1.m :f' li11ancial resourc<! lnObili:Jt.ion n'IQbfli::JJIOn $:4 lncre.ise naP<H1,1I •N-a tio,1c1I l)u dgt.>t !: for Oui1.1ul S'¼ 0 Activity reports: ii' i,)/, ~)6 49< S'¼ Annually EHO.Mof~ bulijets to r heallh and health and di1natt, and budg~ts 1JoFPED clln1i1tP. ,c;llange po lk.:f~s ,d jc111ge po lk jes:and an'd ad iOns adions- $.S Ot.-velop 'ii nd Pfill)OSi)I tor pmje<;ti;; Output s 0 'Submitted ., l l Annually EMD-fyjnM ~ubmlt or<.11,osals"lt1t 1md progrd1mne;.0 11 111u]et1 ' ' 1>roiects;" and bulldioS hr.tllth s-1.;,t em pmposa 15 1>rogr-dmmeson •~.sillunct;? to ditturt!nt bulldh,"G he.ikh ~ ttern lunllingsoulte.;: resllienct- to diffemnl 1.leV?.IQjled and tundlnsr sourcCS submitted 8:GCondutt. advoca~,r The nurnllcrOI Oui1.1ut ]0 0 Activity reports: 2 2 2 2 2 AnnuallV EMO.MOM ir'ainlng to inc,~ase,. .a Woc.1 w t ra in ings •~Ol lat kin.skills for <'ie:1111h1~t!d 10 in<;re:tse. {l!)li lth ,,i lld Clhnilt~ uegotbHon forheiilth ,:h.11:~ e. llmmcing. t-0 .ind dim!J te .:hange adyu<.aH! l~wa~.,1u,1te Onar',ctrg to adVO<.i,Jlh ailo-aation o f l'eS,OUl'COS ·for adequatt! lpi' health 5',Gtem ..illoc..ith;,n of rewurc.e:; r-t!!.lliena) IUd lma~t! fo r he.aII h ~ys,t4!m varlabllitv and ch:mge ll!Sihence t o <.:lirnate. In llre \~hh aa.k:i.ns- v~rfab'llitv·~rnl (!ll;1r~e In linewilh actions 59 0 N 0 N N 0 N N 0 N M 0 0 0 0 0 "'

9.3 Dw ~lo1,.a di•la A(Jata 11~11fqrm t:!.g,, .a OUIIJl.i' J 0 Oa t.1 platf{) rrn J 0 0 Q 0 OnlViu M,UI(, EMO- platfonn e.g, R:!r:10silo1v fOr use bV e.g. reposito ry the..:I" MoH ~ p<J§lt.mvlor use bv all s,ab:iholtk:r.-; )f.?ar all stakchOldeN. lk!v.::lo•..-•d 9A Rl)po ,t o n lhe ACompn'!hensiw Oulp~II l 0 r rog~ Rar,011 0 0 0 0 l i;>nlyllle MUI(, EMO- h8:lllh and <;lin'lal f! 1e 1'6111.I Wclop(ld S'~ vaar MQH pro.i;:r-ess fgah'ist the over~~hing natlo11.il cliin11le plans.am.I Commlttn!?nls-alld o th~r I rn 1nework$ u.g I hu 'NOCs, qver{III NA(1 , NOP pragr.i mming;, et<- · · 9.S QulhJ c-apacitV for Nurn()or of'Ci1pacitv• OutpU\ JO 0 ~ra In h,1g ieptut s 2 2· 2 2 2 Qw11t!rtv' EHD-'M t1I~ ~n$JWle~e I ransla110n, bulhJi~ (?Vents for' ddld ani'l~i/tk:s1 311(1 ~nowledg~ tl'i11IS~<1l!911, evide:1'.::e ut,;e data anaM iGs,. 111l d evidunce u~e build 9 ,fi DWclop <1 gender A .gender c111d·y-0u1 h OulpUI I 0 A 111:itfqrm fq r 0 l 0 0 0 Only ln EHD-MQH and youth rt!Sponsive 1E!-S!PnSiv'.e platform · sharl~ heilll h th!! 2• 1 1>btlonn t.or sharing tor sharing lie.i hh·and .anddim:ila war he;illh ~11111 ~:lhndl t:! ·•clln~• i ti i!h~ng~ <!h~ngtt-irfll~te,1 c:ha l'@.e ...ru,lated l'E!bted ~ 1th 'and , e,seurch and l'eseart h an<I lnlarmation lo lnf9rlTI lnionnatltm tar lnfonro lion tb Inform fJOlit~:,i, pbnsi'I nd polk:y<1ctiCl1\ poltios, plrns and strdt~ ~ies developed ~1r;il.f>gles .10 . C!lmat ~• 10.1 lnu:g ratll\ll, !nlonm,tion 01\ Cum.ml OutpUl l 0 Acllvily •~porn l 0 0 0 () OnlVil\ EHD-'rv1tll~ lukum~d l11form:1 ti;;n (11i curro.nl and proje<.1edllutu~ ~ 1he l" ljrn,llh clnd l)iQ~cte,.I tf UI u,·e) , t llmi• licco11di1 Inns:. ',(!ar pl'Ogr.11'nmf'.! c.llnmtk-:.condltb ns int-0 integra,ed lnt-O i.1ra~e_gk; 1>bnnlngol str<1tcgi,; pla1ml11gol he11l1h 11r9gram1ne$ for hO<fhh ot0i~nlmine.c.lt 11 C•li m.1 l e-sensitive. •d lma t'e--sem,itive dlooase:. dlsq.i,es ](1,2 Mainstream Cilm-at c ,ch:i~g8 Ou1ou~ J 0 f\lali-Onill ~!«tl~I• J 0 0 0 0 OnlVin EHO-MOH C:llm.1te cha1tte into n,~iftStre:1rned lutQ the Polk:" the.~' tlY.? national hqalth na-tlnnalhealth pq llw ~ar polb,hmd itSI am.J.il.s lmplen'leutation lmplementatio11 ~1~te_gfl!S-,,1nd ~.rat eg~clnd guld~llnes; guideline:

10.3 Support the Nurnber ol distrk1s Outp~II 1ar, ll36 0 DistOct, plans 26 3.Q 30 30 30 Annuallv EHD-M oH l nt,rera1k111 -0I climate- -c111d cities' 111.ifls thal 1Jls'lrkts related IIR<I llll risks· integrate climate~ a lld 10 ll?kitml heahh risks cltk!s! 61 ll'ltQ rf;giorrnl " ml distr~ l nlans; 0 0 0 Annually EMO-fvjoM '.IOA Devek:lp sr.,1Crns H,at ln1~gr<1 I!! d1mat e A s'jStern that hHegl'a tes cllmate Output ' Sy,5tttms I hat lnt~nHi! cll111<1 to dl:1 rige ' 0 (I <':harige data into the -e;hange data jnto hal k11u l heahh national hqahh d!i t-u llJ'Se for ll u IJ)ose5 1.IJtabases fol' Activity reports o! lnCJhitOl'i(lg.and purpo~ ol earty'\ •Jal't1I•~ rn;,nitQr!ng .a1111early wa mhui develooed 10. ~ Su pp911. cllma ~ e Numblfl'UI cllmalt,and Outpul & 0 /..alivity r.epal'IS l 1 1 1 l Annuallv EHD--MoH ~ml health 1:a1.ad 1y hea11i, dlpadtv• bull~if\l, ·within the I.Ju II i;JI ''13 t?Ven ts \\I it hi n heil. ~ll sv.;te01; dvll 1h, l~ "h syst~m,ctvil SO<:lety <tllll I he sc1de l'V a ud l hi! co1nm'unitv communiN:-supPQrted '.10.6 B~~ standard Number of ,climate-- 0 3t11, ,r , s·• EMD-fvjoM 01,~nill~ 1:1ru <:eduf1?!, !Nnsitlll'i:! suu\1:lard Output 3 l<w ~•d St,ar'1dard 0 0 l l ' 1/WIT tQ !ul~raHt d!m.iie opern I ing p roee dures opera ling d rnnge c-onsldcrat bm :~o lntegrnt ec,:lhnat e l)lbceduro.s abo1Jt l'millencc in the: chan~e <:onsl de r.1l ions del iverv o r pub Ii.;; .aOOu, msilienc<; In lhE! llCil llh prOl,trarnm.es/ 1.l&l~'1a1y'·.t,f 11ubllQ fntervi?ntiOns h@allll pmgta mrnesj lntmventionJ; rev.lwd !10,7 Oweb p tMt ...mCI N!1t:en·1;aget1f nl'q jec.1$ 0 1.ilpul 5<)% 0 Pmjtl!;l.$ 1llul 10~ 2(,)% ~)(, 11Cnr. 5<)% AnnlidllV EMO.MOH scale up piuk~cts.a nd that int~ l"illt•!dlmat e inain:stn,'!-arn lnnovatlm1s that •t hange, gender, SP,t-1 climale da ooe. lni~ .ral<!cllmale M1I nu1ritk11\ l11 all hoallh <':)larig~, gende;i; FP/ SP.M anrt nutrition l\e'allh ptogra rrn. at rJUierenl leve~ '" p10gra1ns In h~ lth program:; al <l<\4'10pcd ~iftC!renl klvels: '.l0.6 Upda~e mr;dlul'n !"umber d mcdll1m Output 3 Q Mediurn .ahd 0 0 l j j Annuallv EHIJ.Moi-1 an~ io11g,-t erm plans <1ml lonn--lcrrn plm i. long-term plans }\!ilh at tiQnS10 Pf.e'Yen, wHh adions to pr(N'en1 \tjith .a<:UOns 10 <:lln1i1te a11d l'18a Ith .d in'J<tl!i! 111111 h6:1llh 1Jreve,11 cJima te outc-omes- <lutcomeSUpllatetJ a1hl l1e~hh O ul'<.'0 1118$ 62 ========================= Table a: M &E Implementation plan for the H· NAP Output Comp,rerl Prop::,Sl::ld .:ict Ions Fesp::, n;; Ible Perso n/Oe pi rt rren1 ,- ...- Bu:lget P3r 'l!J2S/2~ '1!J26/27 '1!J27/,B '1!J28/;19 'l!J'B/ ~ oomp:,renl A1ia1Y1ewc:>1t 1<,.1 r 3, Cl jmale- 1.1 Est<>bli$h and M OH HID - Annually - 63)45,270,000 e{llunooJ lrdnofolj,iatl.,. hJW.:ll<,1n.1llze..:i Climate 1,-c:09r11!r1.1liqn a ml lo~!k,p:hlp an~ and Hoalth lndi.Giv~cl!rn;ilt?."nll g(l'il't!mancc .:oordinat.ion he,1l(h adi1plalio11 m&chi!nb.1'rlwl1hin 111.e MOH Envlr01'lmt:11tll pl<11111111g•~t t-.-:ve1y Ht>.allh Ovpa1t n,anl ol IWel uperal klri 12 DWckJ,p gult.lelfl'I!:!$ M OH El·IO Auuu~ltv - - - - fo r m ainstr~ m lng dim.iteand h~ .hh in t llf,' he.all h SfktQr

1.3 Establish int.;.il'~ M D,~ Annlrnlly 1nintstcrbl ~1t,~ring OPM cumlTiiuee-011 h6illll) and;i,:lhn aLe chauge llncludl~ CSDs<1nd the oriw li! a:ector~!

1.11 Est.ibll$h the M DJ\s /u,nualty - C'lim:alc O,aniea nd Hw lth Tc-c:hni<:al Workin~ Gr.u un fTW Gs~ Clilni!,t~ ruJ h&ill h ""- 15 O~t!kJp guhhHlfle$ M OH EMO AIIIIUJl!v - - - . ,H:l iort<i for mainstr~ mlng lvPNE tcD 1niiJn;;lrt>.<1me~ 111~0 d hr1Jteand h~ .hh in 1irog1;i ms <,I <)'lh(!r MD/1$,. local g{'IVe,mmern govern men l and I ha afteo<;:l~.nnrl non prlv:1 tq ,gecto r ~ le.actu~ J. GA(Jvo..-ato lur M CI.I\!> Am111c1llf . . . - dimat ei11, d heahh NG0:~ ~-C:roS$ stake ho Ide~ •l'l CSOs allJ4:Nels OMT Academfa p 0 ""1:mlnalloM<JI t he M•N,\P a-c: ros:i M °""1 M~ Q,u.irterlf o.u, ttcrly - $tak.el'iolde.rs.at all NGOs jex,els- Nil tl-01'MI,. CSD!l rogfona~and , ut:., OHT m1tional krut,'! I 12 Tr'..ii(, IBiJdC~~ 1 M Cl" ' Annually Annually Annually Annually A11n1.1,:1 lly v, dous rn:1tion.il and NGO.S i.ub-nat ional level$ ~ 05 lnd ~itllng publi,: an1I OHT oriw te A<!ademb 63 .19 Tr'..iln 1'nedki M PH EMO Anr'1ui1II'( Annually Annually Annually / mnt.1<111\t pm-:titici~rt In clima1e M6.dla i-'2!!.!!)'1<!~11.h nW!ssaaire l ,,os111,.11JO•t M OH EHO Am111allf An111,1all~1 An111,1all~1 An111,1all~1 Annually -cOrnmu1l lt•tlt?Vel MVJE CCD women and youlh NGOs lnd •J!.iva ~th{o-cil.:V CSO. -t;i)ll'lpa~nS011 ha;1ltll DHT 1,ncnli:11heahh.SP.lt arnongother.;~-.,nd diln.i1e -ch.inge ln1"1:ratk'11'1 1.1 ] lnl~!;fa It'! 11€!-all h M OM El-ID Ann1rnlly Annually Annually Annually AnuuallV and.<;llmate me!lSilsln.g fi.,j'WE CCO Into tl\e M lnlslryOf A<.:ii~~l'n i11 Mtt:Jlth Comn'1unir..a1iOns ~lra(,egya nd l't.V lsa 'lhe U!r<'ulll ,Nl'1 1lonal Clim:11~ Chaf1ge Cornm11nlcallon1 Slral ..,..;, I UNccs·~ Comp(.ehenSive Z, Clhnat~-srnart ·2,l Tr.aiu h" :11\11 M OH EH □ /\IIOUally Annuallv Annuallv Annuallv / \11nually 9,031,988,160 rneas,l1rer;..add11~lng li 8llll h'\•Jortk11~f! WQ,rk~l'5'1n dirna1e ond Adl~~rnh, he11II h lmp,lt tr. o l h6:lll h OHT I ~t Hmutt? ~ln••J~ ~ Padlily 111.chaiJ.Jt::5 lrnplementc11:f 2.2 lnt~~te,{ llmate • MOH El·IO Annu~II'( Annll.illy Annll.illy Annll.illy Arn11.1<1ll\t and heallh irn :urrlcul;i AC;..-demk: Institutions for \he healt,h w<>rJ..fo1te 2.3 r,rovlde IEC M OM El-ID Annlrnlly Annually Annually Annually AnuuallV mat~nals 101he he11l1h DHT worlrto1t~ on clilnate F.a <:ilil y In-<! ha1ge$ and health :v 1Conduct i upervls1qn M DH EMO Annually .Annually .An11uc1lly .An11uc1lly Ar1nuallv ~ n d ire 111or.;h ii, vJs itsal OHT rngiQn'ill and distrk:t Facility ln-<:lm ges lowl 2.SSu1>por1 dl!:111<.ts to M O\I EH □ Anuua!IV Annually AnnuallV Annually Aon1.1ollv ;i~ign 'a d hna1e and he:ihhfo01 lpe~ns !f, V1,1l~1<1b!lllV, 3.'1 0 4:?v&kl p gi?ndcr- M OH EH □ . Annually . . . 4 1631,U0,000 Qpacily-0nd resp91l siv~ guidelines. MWE CCO <1i.l-a1,11c1tio11 dnd.slil mfardl.md a~ssrnM I appl'oad HlS fiJrVN\ and 1iskassessmunts at n-allon;;il anll :SulJ• nalinn'ill le\lel5 64 )3.2.Support dlstrkts'to MOM EMO - Annually A1\nudllV <:Qndut:t p~rlodlc MWECCO dhrnueaull he.ahh VM )3.3 r.,t:ip o ut IO!-tit.u1in1ls MOM EMO / u,nual ty - lnVol\led In c llrra ~ and he.lllh J3A Develop a·o n Mt◊ p MOM E~IO - Annually - data rnp:t,)si tQIV f9r MWE cc'o <:llmat e.anJ h~ lth 4. htttigr.i ted ri Jk 4.1 Develop .a pb 1to rm MOM E~IO - Annually - 19p43,4oopoo m dnltoring. t1nd under CIMIS? I hat '3!1tf1 W.. mltJ~ h', t~ tesdirn~te and ha:11111 data l or early' 'Wdrnine. A.2 Up~at e lht! t:ul\lellbn~~ svstern to MOH EHD, EOG - Annually - - - rnun itor ell m:1 t&- st.1nsitl~ dioo:i'sa!", and ullli~,e dlgita I health olillJonn!lior e~ri'/ w arning sy~ e rns, d~ ~ f 1,1rvelllarn,:~, and t~k!mcdi<:lnc w o1'king wilh p riw t:e weto,· A.3 S\'!Y.:hro nh:o ..inll <m ha neeth!! MOH EHO MWE CCO - Annually - - - inl el'.(,per.iUilhy ,1' OPM OPM~ Oisas1er database, M OM fDMISl ), an1I M\'Jl,'E-- CCO d iln at e fore::as.t 4,4 Devt!lop a dashb-O~rd a t the MOH EMO MV.'E CCCJ - Annually - natinm1I and-,;ub• n.ition.11la;,cl 4,5 MOM oer~ ditJl~1 MOH EHD - - A l111U!;Jll}1 - - <:o mniu1Hca tes d imatt! MWE CCO and ho.illh updat2.sa11d UNM,\ eilrtv \\l<I mii'igs ta t:ubnatk>nal ?.1dk~hOl de1s. In -collabur~1t lon ¥1l tll WNMA +t G Integra t e MOM EMD . Annually . lndktenous knowledu.e OHT 65 111 rir.k a1l.ilvsisand ..:ommu11~ _tion $. Olnw tt! rtslllf;rnt in11<1$l rue: Iu re$;, S.l P.i!•1ta1-e-urr~111 lle.:illl\ inlrastru<;tur.e M OH EHO - - Anu~ally - - 12,4 !;I) oo poo ,~ hnol;Pgles, und S,andartk f9r elllm:1~c- :.u r,p 1./'clu, ifl 01t1ofh'1g ~.2 r.,tonilo r «1rnpltan.re M OH EMO - Annually Anr,ually - with the revl:sed Health li'lfrilstructu1't? standards 1-,)t.climale- probling S.3 l'rt1in k~V' M OH EHO An11ualt,/ Annually Annually Annually Aon1.1ollv .s1ak,eho h~rs Ihe.a I th-cia r~ rrm,i.1g:e ~ and aint r.act<ilS/ <ln chm.it e•pfoot!ng lur heal~h inl qi!:1.IU-t:lurt! SA Advoe!ate fo r lhe HB:1 111) 1nrrm:1rudt11e Qua ,1♦~r1r Qua ,1♦~r1r Qua ,1♦~r1r Quartert.f 1nstallatiqn 9 f d &.1n OvpartmenVEHD•Mo H/ r.co 4.mer'gy~nd dilm1ll!- MV.'E/Mini$lf\/' -Of l.i@ ls .!.mart 1e(_;hl)Ologle5 s.uch ;is; Soll lar pq~ red -equl1nncnt -anJ solar $'Y.$_1.t!ITl$ heallll ft.l<:ilities S.S CondU;::t SIJppoH. M OH EHO Annually Annually Annually Annually Annually ~UpelViSlon lor d~itiali:at.ion or recon:J~ at he..lth<!llr~facilily lewl G. fy1~1,ag1.t1narl\ u t 6.3 Cunducl l'Jllll multi- l~ DH EMO Aunually Annually Annually Annually Annua,y 34!J73:Z7QPOO ~,11,1l~<111mC11tal seet{Jral rlsl{$ ,t'i~1teJ to M\NE CCO den~rminant90I watu,,s.1nltatlon, food f<G0:, hqalth anrt SP.H, hul rilion.and CSOs {lir 111H11itv giving OHT emph:1$.i sto the. rnos.t Vulrier.i hit! pu pul:1t lons lhat !ocludl'!. wo,ncn, girls, v.ou1l1, dl:;ablcd, bW ln<:Ol'll f!, ,'efugee~ elderly, indigenou:s;, amun2othon; G.-2 Lo,n1h.K:l !)ublk: M OH EHO A11n11altf Anm,ially Anrn,ially Anrn,ially Annu{llly a\\lart):1"ff!!:$ to lnc,ease MWE CCD household resilience tq NGOs the lrnl)ilct$u l dhmte eso, ch.ange Oil \t'h\SH, food DflT 66 sar.u11ty·, uutritlon and air llualll;v Fi,3 Ad\JQC!ate, lor lh.e M OH EMO - - Annliallv - - revision of the NEMA Envlrunm ent{ll lmpa.<:t A-.:;~m eni aml A u1Jit RQgulat,iol'IS I() 5',tengthen lh~ lnvol v~rn~nl o l heakh ~ PC!I\S in the El,\ and ~mdh Pl'.Q-C~$ GA Su1Jpoi"l MO~a mf M llAs An11uallv Annually Annually Annually Afllll.l(IIIV ~ 10ensu.ro NGO, oom 1lli1111-ce With l➔ WS CSO$ and mgul-;itions on OHT l!nvirunmental uullutl<,ri 6.SSup~1ort iJ!st 1icts to MOM EMD Annlrnlli/ Annually Annually Annually AnuuallV rL"'ll:w.-' tQrnmunity 111og~msJorQjti,ct..- (such as the P,-;iri sh O~ bpment M odel~ fol' dimatc.ind lu~kh ~ rea mim Fi,'1 OQCun'lenl e111iHes M OH EMO A11rn1~ltv AnnlidllV AnnlidllV AnnlidllV A11nu.ilh1 with fund s to hnplem !m t dimate <:.hanie tlll\1 heallh• rel;lled lllO"ramsia.d lvi1iei; G. 7 P.;yis4! 1he i·ol e!> <tml r csponi !l.1lli~les9f M OH EHO - - /l.nuuall}1 - Annual!~; partn eis underl he rnulll~ toral rn anage~ nt -Of env iron m en tal dete11nh1an ts of-heilllh 6,S. f'o ~1er m1.il~Gf:-ctoral MOH EHO / \1mually Annuallv Annuallv Annuallv { \llrlUally «•lh1bo1'a t ~111with o ther governmen t inintstri es, l'IGOs, and i1<.ide.1'ni,a lnStilU-1<111$ 1U PH) fllote lhtei!,l'<Hkm -af heah h, g!!nlk:r, Ytivt 11; ~ u;al anLI h::proLlud h/e h""' h, a1ld dimat e <;hang~. 67 G.9 Promotl! ppp4, to M OH EMO . . A l11!U!;Jll}1 . . f6stu lnn~,vatlon to bulld c;lliTiat~ resllien«i b'1lhChoalth a:ect<ir l,_. Cllmat~ ~ l:1 ted 4

7.1 Updil1e nationill M OH EHO . . Annuallv . . 8,64 ~170,000 e1,1-e:rg~11?1f disa:st~•· reduction EOC pruiJ11fl!d~(! Hll :strategics to M'IJE CCO rnan.=tg,~11'11!''' im::o rl)Onitu lhe u:;e ol or,r-A c)lmate•relat eJ erm~rgenc',/ ll ~ p:11-etl~ ~ .a ml 11H10ilgemenl llala 1i2 -1mprw e multi, MOM EtlD /u,nualty Annually An(,ually An(,ually At\nUdllV ~ t ora! colh,bor.il !on In MWE ccb re.spon~lng to NGOs <?rnergend~ .al rogion:11 CSQ;; dfllJ 1Jls1ri:ct levels

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9.3 Olzyck.u• <1 dat a M OH EMO Annual~ . . . . platfonn e.g. tepository EOC to r ust? by .all NMA t111keh~•I r!P r.; 9A Re~Orl Oil the OPM M UK4 EHO~MOH . . . . AnuuallV ht>.<tlth .ind dlm:11a IJltlf,l'eSS <lj:tilnn I he O\ler.lf$:hi ng: na IlonaI dlhiat~ nlans.and 70 <ommltment!l ali'll o lhier fr.am ewod<s e.g \l)e NOCs,.over'.,ill NA·P, NOP pr9';;raiTimll'lg, ek : 9,S Bulld cap;,-cilvfor MOH EHO / \IIOUally Annuallv Annuallv Annuallv /\miually ~11:)Wjedgt lr'.,insbtlnn, A<.:ii~~l'f liil ilml -QI ll'~r ~ rt h data an:t t,,,1.ici, :and Ortaniulllons- wldm1<.-e i.Jw

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Hm at i;,,n on comen~ NMA 111t11;&:'11mmt! amf IJl'U~ l.c 1J rru1uru~ dirna(k: condi tions Into stral~k p,h mnh\t ol health 11rogramm'5 for dirnat e-si?nsilive. dlsw""' 10.2·M a!nstrwm dlmate t hi1n4e into lhe M OH NPA An11ua!IV - - - - n.i1io11c1I h~~II h p.:,llcy OPM and its.implementallou strat~ i ~ and guldellnet; 10 .3Sl1pl)Ort 1hc MOM EMO Ann1,ally Annually Annually Annually AnuuallV 1nlegr.itiqn 9 f climat~~ OHT reli,t ed he1iltl! ri sk..'> inw r~k)n'ili and distrk:t plan~ ~0.4 Oe'Vtllop $",-sterns MOH EHO Annually' - - - - lh:1t lotegrato dirnate OHT eh.in~ data lnt~ the nati onal heahl1 tiJ 1abar.e for purposu • QI mo11ltmifgand aartv w arning ~O.SSuppor t r.lin1ill f! MOfl EHO / \llnU.illy Annuallv Annuallv Annuallv /\miually ~md health <.111..u1d 1y MWE CCO b1Jlldlng withln lhc AC;ni emb h<>~h h !"-st~m d vil OHT 71 sod ~ yand lhe c.ommunlly 10.G ~ \Ji'St! St-andanl MOH EHO - - Annually Annually Annually Qp.J.ml Ing prQCt:dures 10 lnl~ r.-tie d hnaie thange·<:Qnsi(ler.i tions .ahout ~ llleo::C In \he Jellvery of P1r1blic l~ ~ll h progr-arnnlc,'S';I flH ~r..e11tlons 'JO. 7 Ot.vClop test an~ MOH EHO J.,.nnualt,/ ,.\ nnually Annually ,.\ nnually Annually scale up pr<>j ects:--and A-cadef'(li:1 and Other msem:h lnn<Nallm'G th:11 (Jl'g~J1itjl t lort$ IIH~ rnt-a dlma1e .dange, g e1,1der<F(,/Sr.u ~ml 11u1rili-On iu heal~h pmgr..lrnsat dilteru,1l'I le-:vf:ls; l(J.S Up.dafr~medium MOH EHO - Annually Annually Al11!U!;Jll}1 a,,d k11~ -1enn pl:1 ns M'NE CCD wkh iJQ.lo115 lo rm..,ent DPM <:lhmHeand hetlll h NPA o ut-r.omes. 72 REFERENCES 1. UNAS. Owning Our f utur.es: Approaches to -Realizing Community Action for Climate Ch ange Adaptation In Uganda. Report of th e Committee on Community Action for Clim ate Ch ange Adaptation. Kampala Uganda. 2023. 2. World Bank. CLIMATE RISK COU NTRY PROFILE: UGANDA. 2021. 3. Nakatembe- C. 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ANNEX 1: SWOT ANALYSIS FOR THE H-NAP Table 9: SWOT Analysis for the H-NAP STRENGTHS 1. Uganda's commitment to key international treaties backed by a strong and clear domestic Legal, policy, and Institutional framework. 2. Resource allocation framework with budget codes specifically for climate change initiatives 3. Mainstreamlng climate change in the National Development framework - specif ically under the National Development Plan (NOP) 4. Existing Institutions such as the Regional Emergency Operation Centers (REOCs), the Public Health Emergency Operation Centers (PHEOCs), active sentinel sites, and the Uganda National Meteoro.logical Authority (UNMA). WEAKNESSES 1 . limited coordination among stakeholders, Including the limited representation of the private sector 2. Inadequate resources for climate-resilient healthcare Infrastructure and Initiatives 3. Poor implementation of physical plans 4. Climate Change related data is not well synchronized with existing government data platforms 5. Limited accessibility and use of technologies in climate change action 6. The slow pace of domestication of international commitments 7. Non-standardized disease coding 8. Poor data utilization 9. Insufficient climate change awareness and advocacy across stakeholders. OPPORTUNITIES 1. The climate change agenda is high on the global Agenda 2. Availability of climate financing mechanisms and frameworks Including private sector investment s and avenues for collaboration at global, regional, and national levels 3. The Uganda National Climate Change Learning Strategy 2012 as a framework for building a workforce with necessary climate change resilient and adaptability skills. THREA'TS 1. Corruption and human greed which jeopardizes the transparent and ethical allocation of resources 2. limited institutional independence and the potential for mandates to be overridden can compromise the autonomy of organizations Involved In climate change adaptation, hindering their effectiveness. 3. The migration of specialists to other countries for better opportunities poses a significant threat, as it can lead to a loss of skilled healthcare professionals, lmpactlng the overall capacity and expertise or the health workforce within the country. 4. Inadequate resources allocated to climate-resilient healthcare infrastructure and systems strain the health workforce's capacity and effectiveness. 5. Commercialization of research which compromises quality 6. Overbearing demands from donor partners 7. Prioritization of development agendas over emergency preparedness, potentially diverting resources away from critical response efforts. 76 ================ ,. • .. ...I. REPUBLIC OF UGANDA Ministry of Health 111) ~ r.-> Ministry of Health, Uganda Environmental Health Department Plol 6 Louroel Road. Wandegeya P. 0. Box 7272, Kampala, Uganda Websrte. WVvw.health.!fo.ag Email info@healthgo.ug Tel +25.6'.4-17 712274 Printing SJpported by lJSAID/klganda Family Planning Acti\/lly PATHFINDER~ --