Building Resilient Health Systems in Pakistan through Equity-Centered Adaptation
Categories: Health National Adaptation Plan (HNAP), Climate change & health Vulnerability & Adaptation Assessments, Health National Adaptation Plans, Country experience, Eastern Mediterranean, Climate Resilient Health Systems, Action Line 2: Evidence-based policy strategy and capacity building, Health equity and climate justice, Assessments of climate and health risks and GHG emissions, Climate-related emergency preparedness and management, Health systems wide resilience, Heat and cold, Vector distribution and ecology
Country: Pakistan
Pakistan Trickle Down session conducted at community level. Credit: Pathfinder International Context
Pakistan faces growing climate-induced health challenges, from increasingly intense heatwaves to devastating floods and recurring droughts. The 2022 floods submerged nearly a third of the country, disrupted the lives of more than 33 million people, caused damage worth hundreds of billions, and destroyed over 2000 health facilities across Pakistan. Climate-related health risks such as dengue, malaria, diarrheal diseases and heat-related mortality and morbidity have also surged in recent years. These crises disproportionately impact vulnerable groups, including women, children, the elderly, people with disabilities and people living in poverty.
Under the guidance of the Ministry of National Health Services, Regulations and Coordination (MoNHSRC), Pakistan has adopted a coordinated approach to integrate climate considerations into its health strategies. Key interventions include the development of a Health National Adaptation Plan, province-level Climate-Health Vulnerability Assessments, and country-wide adaptation programming at provincial and district levels in coordination with implementing partners such as Pathfinder International. These efforts align closely with the Belem Action Plan, prioritizing surveillance, equity, governance, workforce capacity building, and gender integration.
Implementation process
Climate Informed Health Systems Evaluation
The MoNHSRC oversaw climate-health vulnerability and adaptation assessments in Khyber Pakhtunkhwa, Punjab, and Balochistan from 2022–2024. These assessments identified priority climate-sensitive diseases, vulnerable populations, and critical infrastructure gaps. Common findings across all regions included of the absence of contingency plans, inadequate climate-resilient infrastructure, a lack of surveillance systems of climate-sensitive diseases, and gender disparities in access to health services.
Capacity building and contingency planning
Aligned with the MoNHSRC’s health strategies and action plans, Pathfinder International collaborated with provincial departments of health and People's Primary Healthcare Initiative (PPHI) to assess and strengthen 61 health facilities in Charsadda, Khyber Pakhtunkhwa and multiple districts in Sindh. Tailored contingency plans, including emergency referral protocols and health workforce mobilization mechanisms, were developed and disseminated through localized training sessions. Emergency preparedness training focused on sexual and reproductive health, maternal care, gender-based violence, and response to flood and drought emergencies.
Gender-focused and community-driven adaptation
A network of 2,084 Lady Health Workers and 84 Master Trainers was trained on climate-health linkages and referral mechanisms to ensure continuity of care in climate-exposed communities. Simultaneously, 352,000 referral slips were distributed to support integrated care delivery. Pathfinder International - in partnership with UNFPA - trained 22 Master Trainers and over 700 healthcare providers on the Minimum Initial Service Package (MISP) to enhance community capacity to respond to and withstand climate shocks.
Additionally, a network of 720 Climate Champions was mobilized across different climate-affected districts in the provinces Sindh and Khyber Pakhtunkhwa through partnerships with various community-based organizations (CBOs). Women aged 18 to 55, selected for their literacy and deep understanding of local contexts, were engaged to lead climate resilience efforts. Pathfinder International, in collaboration with the CBOs, implemented activities at the individual, household, community, and institutional levels to strengthen women's leadership in building climate-resilient communities.
Development of the Health National Adaptation Plan (HNAP)
The MoNHSRC, in coordination with Pathfinder International, has initiated the first full Health National Adaptation Plan aligned with WHO criteria and the 2023 Pakistan National Adaptation Plan (NAP).
Lessons learned
Localization is key:
Tailoring contingency plans, SRHR messaging, and referral protocols to each district's sociocultural and environmental context (e.g., Sindhi language radio, Charsadda’s flood-prone setting) ensures uptake and community ownership.
Multisectoral coordination strengthens implementation:
Stewarded by the National MoNHSRC in partnership with the Ministry of Climate Change, a collaborative coordination committee with representation by provincial government stakeholders, National and Provincial Disaster Management Authorities (NDMA/PDMA), People’s Primary Healthcare Initiative, UNFPA, and (I)NGOs such as Pathfinder International, Oxfam, helped synchronize health, disaster management, and sexual and reproductive health responses.
Pathfinder International in collaboration with the District Disaster Management Authority, also supported emergency response and relief efforts, including the provision of emergency medicines, establishment of relief camps, and delivery of trainings on community first aid and school-based disaster risk management.
Investing in female health workers and climate champions enhances system resilience:
Lady Health Workers, often the first responders, proved central to referral generation, climate messaging, and sustaining routine care during climate events. In parallel, trained climate champions played a critical role in mobilizing households, supporting disaster preparedness activities, and leading localized response efforts.
Together, these women-led networks worked as a bridge between the formal healthcare system and community-based action, helping accelerate response times and strengthening overall climate resilience.
Mental health integration remains a major gap:
While sexual and productive health, nutrition, and primary care were strengthened, few interventions systematically addressed mental health challenges arising from climate-induced displacement and trauma.
Challenges
- Infrastructural and power limitations: Over 70% of assessed facilities lacked backup electricity, water supply, or emergency staffing plans.
- Data fragmentation: Health and climate data systems remain siloed, limiting real-time surveillance and early warning capabilities.
- Capacity constraints: Most frontline workers had not received prior trained in climate-sensitive conditions, sexual and reproductive health (SRH) in emergencies, or gender-based violence (GBV) protocols.
- Gender and equity gaps: Although women and girls are among the most affected, they are not consistently represented in planning or decision-making at the community-/policy-level.
- Sustainability of financing: Many interventions relied on donor funding and lacked integrated sustainability plans within provincial health budgets.
Success factors
- MoNHSRC Central Leadership:
Oversight by the MoNHSRC provided legitimacy and enabled alignment with national climate and health priorities.
- Climate Champions and Local Networks:
Leveraging existing community health structures and introducing “climate champions” enhanced last-mile outreach and accountability, while ensuring on-ground resources during climate events.
- Integrated Training Across Levels:
Cascade models (Master Trainer > Lady Health Worker > Lady Health Supervisor) ensured consistent, scalable training in SRH, GBV, emergency response, and referral systems.
School-based disaster risk management training was conducted to equip students with the knowledge and skills to respond to disasters in their homes and communities. The trainings included essential content and practical strategies on prevention, preparedness, response and recovery, the four key stages of disaster management. This bottom-up approach of engaging students at the community level ensures context-specific action and sustained localized ownership during climate emergencies.
These efforts were carried out in coordination and collaboration with multiple stakeholders including the District Disaster Management Authority (DDMA), Department of Forestry, Women Development Department (WDD) and Community Based Organizations (CBOs). This ensured integrated, cross-sectoral trainings that reflected local realities and strengthened coordination.
- Evidence-based advocacy:
Facility assessments and CRVA data empowered local managers and Ministry of Health officials to make evidence-backed decisions on preparedness needs.
Credit: Pathfinder International
Recommendations
- Establish Integrated Climate-Health Surveillance Systems. Link DHIS-2 with climate and environmental data.
- Contingency Planning. Mandate contingency planning for all public health facilities in climate-risk zones, with periodic stimulations and staff training, including the allocation of required budgets to upgrade health facilities to becoming climate resilient.
- Institutionalize Mental Health Support. Incorporate mental health considerations in climate disaster planning and primary care systems for communities and health care workers.
- Invest in Solar Energy, WASH, and stockpiling Mechanisms. Prioritize above investments at the facility level, especially in off-grid or flood prone areas.
Key resources
- Lima Work Programme on Gender (LWPG)
- WHO One Health Approach
- Social and Behavior Change Communication Framework
More Information
Lead Organization: Ministry of National Health Services Regulation and Coordination
Partner Institution: Pathfinder International
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