Lao People’s Democratic Republic is already feeling the impacts of climate change, and these impacts are increasingly affecting people’s health and straining an already overloaded health system. Since 2019, the country has been implementing a project to help increase the climate resilience and capacity of its health systems to better respond to climate-sensitive health risks.
“Strengthening health system capacity to be climate resilient is a country priority in Lao People’s Democratic Republic, which is vulnerable to flood and drought. Shortening rainy seasons and lengthening dry seasons are already having an impact on the incidence of climate-sensitive diseases such as water and vector-borne diseases, by increasing chances of outbreaks occurring. The health system needs to be resilient and ready to mitigate, as well as to respond at all times, in order to protect and improve community health.”
– Dr Oyuntogos Lkhasuren, Technical Officer, Environmental Health, WHO Country Office for Lao People’s Democratic Republic.
Background
The effects of climate change are already being felt in Lao People’s Democratic Republic. In particular, extreme weather events – including floods, droughts and heatwaves – are all negatively affecting people’s health, well-being and livelihoods. Importantly, climate change impacts are amplifying vulnerabilities that already exist among populations in the country, such as poor health status, poverty and food insecurity.
Climate-sensitive diseases and health risks that are of particular concern include vector-borne diseases (particularly dengue), diarrhoeal diseases and malnutrition.
Lao People’s Democratic Republic is acting to improve health sector capabilities to respond to increasing climate change impacts. For example, the country is currently finalising its Health National Adaptation Plan (HNAP), and recently published its Nationally Determined Contribution (which includes sections on human health). However, there is an urgent need to strengthen the health system in order to safeguard and improve community health outcomes in a volatile and changing climate.
“With a changing climate Lao is experiencing a higher frequency of climate-extreme weather events, like storms and floods, which are followed by increased numbers of waterborne and vector-borne diseases in communities. We have no fully ready nor proper-designed response action for these type of events. When it happens, we just do what we can do. The other climate-extreme event that we have limited experience responding to, and find very challenging, is drought. Thus, we do need support to strengthen climate change adaptive capacity at the health facility level and of course the whole health system. We should advocate for climate change health risk mitigation in all health project design from the start.”
– Mr Anoulack Luanglathbandith, Head of Water and Sanitation Division, Provincial Health Department of Savannakhet, Lao People’s Democratic Republic.
“Number of dry and hot days are increasing and it is affecting water quality and quantity in rural villages and in health centres. Water shortages occur during dry season in Northern provinces because the gravity-fed systems have insufficient water (and streams dry out). Water shortages affect daily activities at health centres as well as for villagers. For example, it becomes challenging to promote personal hygiene, washing hands, and as well provision of health-care services with good hygiene. Even keeping health centres [a] clean and safe place for visitors and the patients becomes challenging.”
– Dr Bounthanom Phimmasone, Deputy Head of Environmental Hygiene Division, Ministry of Health, Lao People’s Democratic Republic.
The Challenge
In 2019, Lao People’s Democratic Republic joined the project Building Resilience of Health Systems in Asian LDCs to Climate Change, along with five other Asian least-developed countries (LDCs): Bangladesh, Cambodia, 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.
“Building resilience means investing in human capital as well as strengthening health system information systems, including linking weather and climate indicators to health outcomes at the local level,” 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, Lao People’s Democratic Republic has made significant progress towards building a more climate-resilient health system.
Strengthening institutional capacity
Lao People’s Democratic Republic has strengthened its institutional capacity in several ways.
The country has established formal and informal communication mechanisms between the health and environment ministries to help share environmental health information between the health sector and other health-determining sectors. This has led to improved data sharing and collaboration for climate-informed health surveillance.
“In recent years in Lao People’s Democratic Republic, there has been more collaboration between MOH [Ministry of Health] and MONRE [Ministry of Natural Resources and Environment] at technical department level, which has led to data sharing on diseases and climate-related information. The climate data now gets input in DHIS2 [the national health information system] and is showing the initial relationship between diseases and temperature/precipitation. For example, we can see that when rainfall increases, pneumonia or other respiratory diseases increase as well. As understanding of this relationship grows, the more effectively the health sector can prepare good responses and practical adaptive measure in the future.”
– MOH staff in charge of health information and statistics
Furthermore, the health sector is beginning to integrate climate change considerations into planning, with its HNAP in final draft form. Additionally, Lao People’s Democratic Republic has shown recognition of the importance of the relationship between climate change and health by including its climate change and health adaptation strategies as a priority adaptation area in its recently published Nationally Determined Contribution (Fig. 1).
Additionally, a survey tool has been developed to assess current climate change and health adaptation capacity and gaps in health-care facilities. Context specific training modules have also been developed for climate change and health training at the community level.
Health surveillance and early warning systems
Through early warning systems and a better understanding of the links between climate and health risks, Lao People’s Democratic Republic is able to more effectively make decisions about climate-sensitive health risks. Examples of work in this area include: (i) developing guidelines for dengue vector management, and training for implementers of these guidelines in four provinces, and (ii) building on work to link climate data to clinical outcomes (Fig. 2), a pilot **climate informed early warning system for dengue **is being established.
Enhancing climate resilience in health service delivery
Lao People’s Democratic Republic is piloting a number of activities to ensure that clinics and hospitals and their staff are resilient to climate change impacts and able to continue delivering services as the climate continues to change. In particular, (i) the country has developed and adopted Climate Resilient Water Safety Plan training modules across five provincial- and seven district-level water suppliers, (ii) **water and sanitation for health facility improvement (WASH FIT) tool **(used for making safe, clean and green health care facilities) has been developedin Lao language, training in its use provided to central-level trainers, and WASH FIT implemented in 14 district hospitals across two provinces, and (iii) health-care waste **management training **conducted in eight district hospitals in two provinces, including developing improvement plans, with follow-up monitoring and technical assistance (Fig. 3).
Climate change mitigation
To reduce carbon emissions, low-temperature incinerators are being replaced by autoclaves. Two autoclaves were installed in Savannakhet District Hospital and another two in Seokong Provincial Hospital in Q2 2020. This initiative has been scaled up with the coronavirus disease 2019 (COVID-19) response plan and funding support to over 70 district hospitals.
Lessons Learned
The project stakeholders, experts and community members have shared several key lessons they have learned from the project so far:
- Strong leadership and coordination between health and environment and public works and transport ministries, provincial authorities, and other sectors has been critical to the implementation of activities, especially during the COVID-19 pandemic;
- The climate resilience capacity at national and selected provinces and district levels and its basic foundations are well established for further expansion with additional resource mobilization. While COVID-19 challenges activity implementation, it also creates opportunities for scaling up some initiatives such as the safe, clean and climate resilient health care facilityinitiative including mobilizing complementary funding support;
- 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 national level;
- The participation of stakeholders from national and sub-national levels, including local communities and community groups, such as water sanitation (WATSAN) committees and health volunteers, has been a key aspect of enhancing the climate resilience of health systems. This has ensured local needs are being addressed, and the most vulnerable populations are being reached;
- Field visits, observation, and monitoring highlight key issues in communities and health centres that are not always identified through use of 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.
“By 2023 we hope to see a pilot climate change–sensitive disease model for early warning completed with good result that we can scale up for the whole country in the future; the ready-to-use awareness-raising materials/package for health staff and communities; the updated climate change health adaptive options which is practical to Lao context.”
– Dr Bouakeo Souvanthong, Deputy Director, Department of Hygiene and Health Promotion, Ministry of Health, Lao People’s Democratic Republic.
“Lao People’s Democratic Republic’s Health National Adaptation Plan has been finalized and implementation started. National and subnational health-care workers, environmental health and water, sanitation and hygiene staff have knowledge and skills in assessing and implementing climate-adaptive measures in health practice.”
– Mrs Souvanaly Thammavong, National Professional Officer, WHO Country Office for Lao People’s Democratic Republic.
Source: World Health Organization