Piloting Climate Change Adaptation to Protect Human Health A joint WHO/UNDP project funded by the Global Environmental Facility (GEF)

China – Uzbekistan- Fiji- Barbados - Kenya- Jordan-Bhutan Project Overview Goal: "Increase adaptive capacity of national health system institutions, including field practioners, to respond to climate sensitive health risks" This project works directly with seven developing countries to design and implement practical measures to protect health under a rapidly changing climate. China – Uzbekistan- Fiji- Barbados - Kenya- Jordan-Bhutan

Project Rationale Strong evidence of past and future climate change Established links between climate change and health Major health vulnerabilities to climate change in developing countries Need for adaptation measures to protect human health under climate variability and climate change

Evidence of Past Climate Change Source: NASA, GISS, 2009

Estimates of Future Climate Change Source: Intergovernmental Panel on Climate Change (IPCC)

Climate Change and Health Linkages Some expected impacts will be beneficial but most will be adverse. Expectations are mainly for changes in frequency or severity of familiar health risks Modifying factors Health effects Temperature-related illness and death Extreme weather- related health effects Air pollution-related health effects Water and food-borne diseases Vector-borne and rodent- borne diseases Effects of food and water shortages Effects of population displacement Human exposures Regional weather changes Heat waves Extreme weather Temperature Precipitation Contamination pathways Transmission dynamics Agroecosystems hydrology Socioeconomics, demographics CLIMATE CHANGE Based on Patz et al, 2000

Health Burden due to Climate Change in Developing Countries

Adaptation Project Pilot Countries Seven countries in different ecosystem zones, representing different health risks from climate change Small island developing states: Fiji and Barbados Countries with highland areas: Bhutan and Kenya Water-stressed Countries: Jordan and Uzbekistan Countries with multiple vulnerabilities: China

Vulnerabilities in Highland Areas Main health risks in highland regions Physical health hazards from changing patterns of precipitation, snowmelt, and glacier-lake overflows Increase in vector-borne diseases (e.g. malaria and dengue) due to the effects of temperature on the disease transmission cycle.

Vulnerabilities in Water-stressed Areas Changing precipitation patterns are likely to affect the quality and quantity of water supply, and bring new risks through changing agricultural practices. This may exacerbate two of the largest causes of global ill health: Poor water and sanitation Malnutrition

Vulnerabilities in Small-Island Developing States High priority risks in low-lying countries include: Physical hazards (i.e. hurricanes, flooding) Infectious Diseases (water and vector borne: malaria, dengue, diarrhoeal diseases, typhoid) Salination of freshwater (decrease in water for drinking and hygiene) Food Security (drought & land salination)

Project Timeline and Budget Design phase of one year Implementation phase (Jan 2010 – Jan 2014) GEF funding US$ 4.5 million In cash and in-kind co-financing US$ 16.6 million Total Project US$ 21, 159, 000 DESIGN PHASE 1 year IMPLEMENTATION PHASE OF FULL PROJECT 4 years

Project Design Phase Activities (I) Identify main health vulnerabilities to climate variability and change for each country, e.g. Diseases associated with water scarcity Storms and floods Changing patterns of vector-borne pathogens, Malnutrition Examine current health policies to address these threats Identify strategies, policies, and measures that would address the incremental health risks posed by climate change

Project Design Phase Activities (II) Identify barriers to implementation of the various strategies, policies, and measures Assess incremental costs of necessary activities relative to the current baseline Design a proposal to implement one or more actions for each country Share information across countries and develop final project proposal

Full Project Activities Select long-term cost-effective and sustainable adaptation: Strategies (e.g. cross-sectoral fora for natural disaster prevention) Policies (e.g. for safe use of wastewater in agriculture) Measures (e.g. preparation and prevention of disease outbreaks through health education, and early warning) Implement these adaptations strategies, policies, and measures in the field Synthesize and share the lessons learnt.

Project Objectives & Outcomes Increase adaptive capacity to respond to climate sensitive health risks in seven countries. Four Specific Outcomes related to: Early Warning and Early Response Systems Capacity Building based on EWS information Disease prevention measures implemented Cross country cooperation on innovative adaptation centric health strategies, policies, and measures

Expected National Project Benefits Measurable increases in "adaptive capacity" to climate sensitive health risks Reduction in the burden of climate sensitive diseases; Reduction of the effect of climate change on human health; Better Integration of planning and implementation across sectors

Expected Global Benefits Improved knowledge of the links between climate, health, and adaptation options in the most vulnerable contexts. Identification of adaptation strategies that other countries can use to protect human health from the impact of climate change.

Project Organization Structure Project Board Senior Beneficiary: Pilot country Government Representatives Executive: UNDP Senior Supplier: WHO Project Assurance Senior Technical Advisor (UNDP/EEG) (WHO/PHE) Project Manager (WHO/Geneva) Project Support (Admin Assistant) Barbados Steering group Fiji Steering group Uzbekistan Steering group Jordan Steering group Bhutan Steering group Kenya Steering group China Steering group Global Knowledge Management Component (WHO)

National Level Project Partners National Government Ministries (e.g. Health, Environment, Agriculture) Agencies (e.g. Meteorology Agency) NGOs in health and environment fields Researchers Health Practitioners Representatives of most vulnerable community groups

Global Project Partners Global Environmental Facility (GEF) Project Funder United Nations Development Programme (UNDP) GEF agency, provides broad expertise in adapting to climate change World Health Organization (WHO) Executing agency for the project design phase, Technical support for design, selection and implementation of health protection measures.

Future The long term aims of the project are to: Climate change adaptation is a new field. The long term aims of the project are to: Extend lessons from this pilot project to countries facing similar stresses, but with few resources, Support broad aims of preventive approaches to protect health and, Widen partnerships for health protection from climate risks

For more information on Climate and Health Actions http://www.who.int/globalchange http://www.undp.org/climatechange http://www.adaptationlearning.net/project/piloting-climate-change-adaptation-protect-human-health

OUTCOME 1 Early warning and response system with timely information on likely incidence of climate-sensitive health risks established Indicative Activities Planned Country Analysis of relationship between meteorological variables and incidence of water-related diseases and dengue to develop early warning system, with flexibility to update as climate change and other trends alter relationships. Establishment of communication mechanisms for advance warning and definition of operational procedures for health sector response to contaminated water, and to dengue outbreaks. Barbados Mechanism to provide GLOF early warnings to emergency health services, operating procedures for health sector response. Establishment of prediction system for climate sensitive infectious diseases, covering seasonal variation, and increase and spread in transmission with climate change. Bhutan Development of over-arching coordination mechanism to link meteorological and health monitoring data. Development of algorithms for correlation of met. and health data, providing advance warning of health risks from heatwaves, with flexibility to update as climate change and other trends alter relationships. China Development and implementation of Health Information System covering hydro-meteorological disasters (HMDs) and climate-sensitive diseases, integrated between meteorological and health agencies. Development of operational procedures to manage psychosocial impacts of HMDs. Fiji Development of integrated system for monitoring water and food contamination, linked to disease monitoring. Development of operational procedures for rapid response when elevated health risks from wastewater are detected. Jordan Development of simple algorithms for correlation of meteorological and malaria data, suitable for use by district level health officers. Integration within existing operational guidelines to form decision support system for response to malaria epidemics, and expansion to areas newly at risk due to climate change. Development of protocol for updating prediction algorithms as climate and other drivers change. Kenya Development and implementation of protocols to link and correlate health and meteorological data. Development of protocols for operational response by the health sector, and for dissemination of public health warnings, in response to elevated health risks. Development of protocol for updating prediction algorithms as climate and other drivers change. Uzbekistan

OUTCOME 2 Capacity of health sector institutions to respond to climate-sensitive health risks based on early warning information improved Indicative Activities Planned Country Adaptation of global guidelines to define national standards and enforcement practice for safe use of wastewater, and response to warnings of elevated health risks. Revision of guidance to ensure that household water storage practices in response to climate change, and vector control actions do not conflict. Training and support of health sector personnel for temporal and spatial targeting of vector control interventions in response to early warnings. Barbados Definition of health working group within existing inter-sectoral coordination mechanism for adaptation to climate change. Training and support for district level health managers, and review of intervention plans, to incorporate temporal and spatial targeting of health interventions for climate-sensitive diseases. Bhutan Development and support of coordination mechanism, and development of operational procedures for meteorological and health sectors during heat-waves. Development and support of training for emergency medical treatment during heat-waves. China Development and support for coordination mechanism for climate change and health action. Development of health action plans, incorporation in HMD response plans in Health Ministry and National Disaster Management Office. Revision of Environmental Health Impact Assessment process to support disaster risk reduction. Fiji Development of a coordinated legislative framework to minimize health risks from increased wastewater re-use, with defined institutional responsibilities, coordinated by inter-sectoral board. Revision and updating of framework and monitoring standards based on project and international experience. Jordan Training and support for district health officers in the use of decision support system, including meteorological data, to increase malaria control effectiveness and address elevated transmission and spread driven by climate change. Kenya Health sector training on the linkages between climate variability and change and climate sensitive diseases, and increasing control effectiveness through spatial and temporal targeting of interventions. Development of public health information campaign for diseases predicted to increase through climate change. Uzbekistan

OUTCOME 3 Disease prevention measures piloted in areas of heightened health risk due to climate change Indicative Activities Planned Country Implementation of community based public health education campaigns on safe-use of wastewater and on dengue vector control, targeted on periods of high climatic risk. Monitoring and evaluation of effectiveness in reducing risks of water-related diseases, including severity of dengue outbreaks. Barbados Implementation of interventions for epidemic control in response to GLOFs and other climate-related natural disasters. Scale up and targeting of community level interventions for control of water and vector-borne disease, for times of peak incidence, monitoring of effectiveness in reducing summer disease peaks. Bhutan Implementation of heat-health warning systems in 3 pilot cities, monitoring of effectiveness in decreasing heat-related mortality. China Implementation of Early Warning and Response system developed above, with monitoring of effectiveness in minimizing immediate and secondary (e.g. disease outbreak) health impacts of HMDs. Fiji Adaptation of the WHO guidelines on safe waste-water practices for the national context, implementation of the health protection measures in 3 pilot sites, with monitoring and evaluation of impact on water-related diseases. Jordan Increased coverage of community level malaria control interventions within 3 pilot districts at increased risk of malaria epidemics, within high risk periods identified by warning system above. Monitoring and evaluation of increased coverage and targeting of interventions, and reduction in malaria mortality and morbidity during epidemics. Kenya Implementation of interventions of known effectiveness (heat advisories, health education campaigns), timed for periods of increased climatic risks, within 3 provinces. Monitoring and evaluation of intervention coverage, and effectiveness in reducing summer peaks of one indicator disease (diarrhoea). Uzbekistan

OUTCOME 4 Cooperation among participating countries promotes innovation in adaptation to climate change including variability Indicative Activities Planned Country Development and operation of project web site; Exchange of best practices and lessons learned making use of the ALM Lessons Learned template, the UNDP Treamworks mechanism and the WHO website; revision of guidance documents for GEF and WHO on climate change adaptation programming in the health sector All countries