Adapting Health Systems to Face the Impacts of Climate Change in Nepal

Introduction

Climate change is increasingly being recognized as a crucial public health challenge around the world. Nepal is no different, with rising temperatures, extreme weather events, and shifting disease patterns straining health systems throughout the country. To discuss ongoing initiatives, gaps, and future directions to meet this challenge, the Ministry of Health and Population (MoHP), in collaboration with HERD International, organized a stakeholder consultation workshop on February 20, 2025. In attendance were various government agencies and development partners involved in adapting the health sector to the increasing challenges of climate change.

Strengthening health systems response to climate change

This workshop was an opportunity for stakeholders to share the current scenario of interventions, learn of planned activities, and have an in-depth discussion. The MoHP commenced proceedings with a presentation focused on the steps taken to integrate climate resilience into the health sector through national policies, vulnerability assessments, and drafting of National Adaptation Plans. These plans focus on five key areas, namely advocacy, awareness, and communication; capacity building and health systems strengthening; surveillance, early warning systems, and risk management; green, climate-resilient infrastructure and sustainable health facilities; and policy, research, and financing. The presentation also included display of stakeholder mapping coverage in Nepal on climate-related interventions, which highlighted the districts where interventions have begun, and the remaining regions of the country that need further engagement.  

The Green Climate Fund Project

As the UNDP began their presentation, they highlighted that mapping stakeholder coverage ensures collection of the correct information to design interventions and allocate appropriate resources to regions that need them the most. While many national, provincial, and local level policies have been drafted, the successful implementation of these policies is the major focus for government stakeholders and development partners alike. The Green Climate Fund (GCF) project aims to use existing policies, assessments, and government priorities to enhance climate resilience in the health sector by designing interventions based on global best practices.

From the outset, including a feasibility study, project design, and activity formulation, GCF prioritizes environmental and social safeguarding. Crucial elements like gender assessments and engaging indigenous people are being thoroughly integrated into the planning stages. These topics are non-negotiable for the GCF. When the project moves into the implementation phase (2025-2030), it will do so with the aim of developing a model of innovating interventions in climate and health interventions that can potentially be scaled up nationally and regionally. The project’s success depends on the active involvement of all key stakeholders, including the MoHP, WHO, and UNDP, to ensure that Nepal is prepared to address the health challenges of global climate change.

Potential for Direct Financing to Government of Nepal

The last presentation, provided by the GFA Consulting Group , highlighted the potential for direct financing to advance climate change adaptation and health sector resilience in Nepal. This initiative is closely tied to the Sector Study on Health, Nutrition, and Social Protection in Nepal conducted in collaboration with GFA and HERD International. The proposed KfW (German Development Bank) financing focuses on a multisectoral approach in health, drinking water, and sanitation; agriculture and food security; and rural and urban habitats. KfW also works in line with Gender Equality and Social Inclusion (GESI) principles, prioritizing the most vulnerable populations in designing interventions and planning activities.

A specific focus has been placed on Sudurpashchim Province, which faces the ongoing challenges of an increase in vector-borne diseases, water scarcity, extreme weather events, and limited infrastructure in the health sector. The region also faces increased air pollution and insufficient funding for climate adaptation within the health sector. KfW’s approach is grounded in evidence-based interventions that address the specific needs of local, provincial, and federal governments. These interventions aim to inform local-level planning and support the drafting of Local Adaptation Plans of Actions (LAPAs). Additionally, KfW will provide support for higher-level planning at the provincial and federal levels, with a focus on strengthening multisectoral monitoring and reporting. This approach ensures that interventions are responsive to local conditions while aligning with national climate adaptation goals.

Discussion on Challenges of Climate Change in Health Interventions

The discussion in plenary focused around the three presentations and the need to develop a more coordinated, well-resourced, and inclusive approach to meet the challenge of climate change in health. Participants discussed ways to strengthen collaboration across various sectors, stakeholders, and development partners, itegrating health considerations into local and national planning on climate change, and securing long-term financing. As the MoHP recognized, project implementation is often scattered and localized. Many initiatives are concentrated in specific municipalities without a broader national strategy, which prevents the creation of sustainable and scalable models of intervention.

The need to include health in LAPAs was a topic of great interest for participants. As the WHO remarked, a review of more than 200 LAPAs revealed that none mentioned, let alone prioritized, health. The focus for most local governments seems to be on immediate concerns, such as water supply, irrigation, and agriculture, while public health remains overlooked. While this may be understandable, as these issues affect livelihood directly, this highlights the need to raise awareness and build adequate capacity in integrating health into climate adaptation planning.

In Nepal, financial limitations form a severe hindrance to climate health interventions. As reiterated throughout the discussion, Nepal has numerous policies addressing climate change and health, but securing adequate resources for implementation remains a challenge. Another issue raised during the discussion was the need for mitigation strategies to the impacts of climate change in health; while adaptation strategies are routinely discussed, mitigation strategies are somewhat more difficult to plan and implement due to its resource-intensive nature.

Geographic disparities in intervention areas was another issue raised during the discussion. The Ministry of Federal Affairs and General Administration (MoFAGA) was curious as to why so many initiatives target Karnali and Sudurpashchim Provinces, while other vulnerable regions, such as Madhesh Province, receive comparatively little attention. It is crucial that ongoing and future interventions consider equitable access to resources. Participants also discussed institutional roles and overall sustainability. Stakeholders like MoFAGA, the National Statistics Office (NSO), and the National Disaster Risk Reduction Management Authority (NDRRMA) requested clarity on their functions within climate adaptation for health, and how best to connect with the MoHP for future collaboration. Participants also acknowledged that most projects lack a structured transition plan upon completion, leading to a loss of institutional knowledge and affecting long-term sustainability

Recommendations for Strengthening Climate-Health Interventions

To address these challenges, participants were largely in agreement that Nepal must prioritize enhanced coordination and synergy among stakeholders to ensure that initiatives are aligned and resources are adequately and efficiently allocated. Many participants also reiterated the need to avoid duplication, which can also be prevented through enhanced coordination and collaboration.

Integrating health into local adaptation planning is another crucial step. Participants suggested that the government should mandate the inclusion of health components in all future LAPAs and update existing ones accordingly. Additionally, capacity-building efforts at the local level will be essential to help municipalities understand and implement these strategies effectively. The MoHP is committed to collaborating with relevant stakeholders and developing partners in developing guidelines and training programs to support local governments embed health considerations into their adaptation plans.

Finally, securing sustainable financial and technical resources is vital. While exploring additional financial support from bilateral and multilateral partners can bridge funding gaps, the Government of Nepal needs to take the initiative to allocate adequate funds as well. As all the presentations mentioned, and as discussed in plenary, conducting vulnerability assessments will help guide appropriate funding towards areas most in need and ensure resources are distributed proportionately across the country.

Conclusion

Nepal has taken many steps forward to address the impact of climate change on the health sector. To address continued challenges, it is crucial that stakeholders and development partners are better aligned to help integrate health into local adaptation planning, and ensure adequate resources are distributed to build climate-resilient health systems. Furthermore, Nepal needs to prioritize strategies that are inclusive across all genders, communities, and geographies to strengthen the health sector in the face of climate change. As all participants agreed during the workshop, continued dialogue, engagement, evidence-generation, and review of global best practices will be vital to transform policy and plans into meaningful action.