July 27, 2021

Building climate-resilient health systems in Cambodia: Case Study on Climate Change and Health

In Cambodia, the impacts of climate change are increasingly posing risks to people’s health, while straining the country’s health system. Since 2019, the country has been piloting a project to help increase the resilience and capacity of its health systems to respond to these climate-sensitive health risks.

Background

Climate change is already being felt in Cambodia. Average temperature and the intensity and frequency of extreme weather events, such as floods, droughts and heatwaves, have all gone up, and this has had important consequences for the health and development status of the country. The impacts of climate change amplify existing vulnerabilities in communities, including poverty, food insecurity and poor health status.

Growing health risks from climate change in Cambodia include vector-borne diseases, malnutrition and diarrhoeal diseases, along with other conditions such as rodent-borne diseases, respiratory tract infections, noncommunicable diseases, heat-related illness and mental health impacts.

The country already has several policies in place to help the health sector cope with these rising impacts — such as the National Strategic Plan for Climate Change Adaptation and Disaster Risk Reduction in the Health Sector 2019–2023 — but there is an urgent need to further strengthen the health system to protect and improve the health of communities in an unstable and changing climate.

Health system resilience includes making sure that hospitals are able to keep operating as the climate changes (e.g. have sufficient clean water and are protected against floods), and that they can use early warning systems to make sure they are prepared in advance for surges in climate-sensitive diseases such as dengue.

The Challenge

In 2019, Cambodia joined the project Building Resilience of Health Systems in Asian LDCs to Climate Change, along with five other Asian least-developed countries (LDCs): Bangladesh, Lao People’s Democratic Republic, Myanmar, Nepal and Timor-Leste.

The four-year project (2019–2023), funded by the Global Environment Facility (GEF) and implemented by the United Nations Development Programme (UNDP) and World Health Organization (WHO), aims to strengthen the capacity of the health systems of these six countries to adapt to the impacts of climate change. It aims to strengthen institutional capacity to improve health sector planning and effective decision-making to ultimately develop climate-resilient health system.

“Addressing climate change impacts through building health system resilience means enhancing early warning capacities for climate-sensitive diseases and linking climate indicators to local-level health outcomes,” said the project Manager of the UNDP/GEF project on Building Resilience of Health Systems in Asian LDCs to Climate Change in Cambodia and Lao People’s Democratic Republic.

In order to contribute to developing a climate-resilient health system, Cambodia and the other participating countries are working towards the following four goals:

  • Strengthened institutional capacity to effectively integrate climate risks and adaptation options in health sector planning and implementation.
  • Effective decision-making for health interventions, through the generation of information and improved surveillance and early warning systems.
  • Climate-resilient health service delivery.
  • Improved regional cooperation and knowledge exchange and the integration of a Health National Adaptation Plan (HNAP) into the national adaptation planning process.

The Solutions

Since joining the project, Cambodia has made significant progress towards building a more climate-resilient health system.

First, it has strengthened its institutional capacity in several ways. It established a national Technical Working Group for Climate Change and Health to help coordinate stakeholders from the health sector and other health-determining sectors. This has also led to improved data sharing and collaboration for climate-informed health surveillance.

The technical working group for climate change and health brings together health professionals and professionals from health-determining sectors (e.g. environment) so that they can work together collaboratively to address climate change impacts on human and population health.

Climate change considerations have also been integrated in health sector planning, such as through the development and adoption of a Health National Adaptation Plan, improved educational programmes, and the sharing of information on climate-sensitive diseases on the Ministry of Health website.

Second, health surveillance and early warning systems have been expanded. By being climate informed, Cambodia’s health early warning systems enable more informed and effective decision-making on climate-sensitive health risks across the health sector. Examples include training on diarrhoea surveillance for health professionals; the development of guidelines for dengue** rapid diagnostic tests** (Fig. 1); and the development of a rapid response plan and improved surveillance for dengue outbreaks.

“This has improved our dengue response because the roles and responsibilities of each staff and agency [involved in dengue detection and prevention] are now clear and everyone knows what to do. We are also expanding the dengue sentinel sites so we can detect and identify the occurrence of zero type dengue cases. This means [health] staff can be well prepared for changes in the zero type of dengue,”

–Dr Vibol Chan, Technical Officer in charge of the Dengue Programme at the WHO Country Office for Cambodia.

Third, the climate resilience of health service delivery in Cambodia is being strengthened, with a particular focus on improving water, sanitation and hygiene (WASH) in health centres and communities. Tools were developed for assessing climate-resilient WASH in 25 health centres and communities in the Ratanakiri province (Figs. 2 and 3), and the assessment found that approximately 44% of the health centres surveyed had been affected by an extreme weather event (e.g. flood, drought, or storm) from 2015 to 2019.

Climate-resilient water safety plans were then piloted in 10 health centres and 15 villages. The main aim of these plans is to ensure drinking-water is available and safe to use in both the rainy and the dry seasons, when most health centres face a lack of drinking-water for staff and patients. So far, water treatment equipment has been installed at 10 health centres, which will help strengthen the resilience of health centre infrastructure to extreme weather events, such as flooding, droughts and storms.

Lessons Learned

The project stakeholders, experts and community members have shared several key lessons they have learned from the project so far:

  • The contributions of a Technical Working Group and experts in conducting assessments and developing recommendations were essential in the development of climate-resilient water safety plans for health centres and communities.
  • Strong leadership and coordination of ministries, provincial authorities and other sectors was critical to the implementation of activities, especially during the COVID-19 pandemic.
  • There is a strong need for ongoing and continuous capacity-building and technical support across climate change and health activities for national and provincial staff in the Ministry of Health, as well as for health professionals and support staff at a national level.
  • The participation of stakeholders from national and subnational levels, as well as local communities, indigenous populations and health support groups, was a key aspect of developing climate-resilient health systems. It ensured local needs were addressed and the most vulnerable populations were reached.
  • Field visits, observation and monitoring highlighted issues in communities and health centres, which were not always identified in the assessment tools, and
  • Women are a key beneficiary of the implementation of climate-resilient water safety plans. This is because women are still responsible for the daily water supply in households in many communities.

 

 

Source: World Health Organization

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