Enhancing Health Workforce Capacity for Climate Action in Nepal

Community engagement for climate action, Helambu Nepal. Credit: WHO Nepal

Context

Located in the Himalayas, Nepal is a landlocked country of approximately 30 million people, with an elevation range from 70 to 8,848 meters. This dramatic geography contributes to its acute vulnerability to climate change. The country has been experiencing an average annual maximum temperature increase of 0.056°C since the 1970s, a rate that is faster than the global average and more pronounced in the mountainous regions.

This warming trend is causing a cascade of environmental crises, including rapid glacier melt, which increases the risk of glacial lake outburst floods (GLOFs). Nepal has already experienced over 26 major GLOFs since 1970, and at least 47 glacial lakes are currently identified as potentially dangerous. The changing climate also leads to erratic monsoon patterns, seasonal water stress, landslides, floods, droughts, wildfires, and a loss of biodiversity, all of which pose direct and indirect threats to public health by jeopardizing food and water security and livelihoods.

The health impacts are stark and varied. Nepal is experiencing a surge in vector-borne diseases, such as dengue, which has now been reported in all 77 districts with expansion from low land to highland and from seasonal to perennial distribution. Water-borne diarrheal diseases, including cholera, are also emerging, alongside malnutrition and non-communicable diseases (NCDs) exacerbated by heat stress and air pollution. The increasing frequency of extreme weather events contributes to more heat-related illnesses and injuries. These burdens are disproportionately felt by vulnerable communities, which are often remote and have limited access to healthcare and a poor capacity to adapt.

Implementation process

In response to these challenges, Nepal’s national strategies are aligned with the priority areas of the Belem Health Action Plan (BHAP), focusing on building a resilient health system.

a. Policy Development and Strategic Planning: Nepal has integrated climate change into its health sector through comprehensive policy frameworks. A key document is the

Health National Adaptation Plan (H-NAP) for 2023–2030, which aligns with the National Adaptation Plan (NAP) for 2021-2050, and wasformulated with support from the World Health Organization (WHO). The H-NAP’s vision is to create a "Climate Resilient Health System". Its strategic objectives include raising awareness, building human capacity, managing disease risks, promoting climate-resilient infrastructure, and mainstreaming climate adaptation into health policies at all governance levels.

Furthermore, the country’s third Nationally Determined Contribution (NDC3.0) for 2025–2035 features dedicated health-related targets. These include upgrading 280 health care facilities (HCFs) to be low-carbon and climate-resilient by 2035, managing healthcare waste in 2,800 HCFs using non-burn technologies, and strengthening climate-sensitive disease surveillance in all municipalities.

b. Institutional Strengthening and Capacity Development: The National Health Training Centre (NHTC), under the Ministry of Health and Population, established in 1993, has been central to executing Nepal's capacity-building efforts. The NHTC has developed and disseminated several training manuals on climate change and health, targeting policymakers, managers, and frontline workers.

Key initiatives include:

Training of Trainers (ToT) programs to cascade knowledge effectively.
Sub-national workshops and training on climate-resilient water safety planning.
Integration of climate content into existing curricula for environmental health, WASH, and healthcare waste management.
Training of 500 health service providers, policymakers, and managers annually budgeted in the H-NAP.

The Nepal Health Research Council has developed a training manual on climate change and health research, provides training to health professionals and researchers and generates evidence on climate change and health. Research topics include climate change and vector-borne diseases, climate change and diarrheal diseases and health risks of heat waves in Nepal.

The Epidemiology and Diseases Control Division and the Integrated Health Management Information Section of the Ministry of Health and Population are also working to generate evidence and strengthen surveillance of climate sensitive diseases and risks, including using DHIS-2 monthly data and Early Warning and Reporting System weekly data. The pilot study shows promising results for predicting dengue epidemics three months in advance using the DHIS-2 platform data.

c. Public Awareness and Cross-Sector Engagement: Nepal has undertaken national and sub-national advocacy campaigns utilizing social media, informational materials, and a dedicated government website on climate and health to raise public awareness.

Significant efforts have fostered increased collaboration with sectors such as WASH, environment, nutrition, and disaster management to develop shared resilience strategies. A Memorandum of Understanding (MOU) has been signed between the Department of Health Services (DOHS) and the Department of Hydrology and Meteorology (DHM) for sharing of data for research and surveillance of climate sensitives diseases and risks.

d. Engagement in Global Platforms: Nepal actively participates in, and organizes, global events and dialogues. For example,the “Sagarmatha Sambaad’ global dialogues were held in May 2025 with the theme: "Climate Change, Mountains, and the Future of Humanity". This multi-stakeholder platform, which convened around 350 participants from numerous countries and organizations, promoted integrated climate action and resulted in the "Sagarmatha Call for Action".

Sagarmatha Sambaad, Nepal
Credit: WHO Nepal

Lessons learned

Nepal's journey towards a more climate resilient and low carbon health system has yielded critical insights for other nations:

Cross-sectoral collaboration is essential: Health adaptation cannot be achieved in isolation. Effective planning requires engaging with actors in WASH, meteorology, agriculture, and disaster risk reduction, amongst others. Rather than working in isolation, working together within a planetary health approach supports enhanced management of environmental health risks, including climate change-related risks.
Awareness must be followed by technical training: While advocacy is crucial, it is insufficient on its own. It must be paired with technical skill-building to translate knowledge into action.
Indigenous knowledge and practices are invaluable and play a critical role in coping with, and adapting to, climate risks. They should be preserved and promoted wherever they are applicable.
Decentralization is key to impact: While national institutions like the NHTC provide vital structure, strengthening the capacities of provincial and municipal governments is critical for on-the-ground resilience.
Evidence-based planning is paramount: Sustained investment in research and robust data collection systems is necessary to inform policies, target interventions, and monitor the health impacts of climate change.
Global partnerships are catalytic: Support from the WHO and other development partners has been indispensable for initiating key activities, especially for a country with limited domestic resources.

Challenges

Despite its progress, Nepal faces significant hurdles:

Topographical Complexity: The country's rugged terrain makes the uniform implementation of health programs difficult, particularly in reaching remote and hard-to-reach communities.
Resource Constraints: There is a substantial gap between the financial needs for climate action and available resources. Full implementation of the NDC's mitigation targets through 2035 is estimated to cost US$73.74 billion, of which 8562.9 billion is conditional on international support. Similarly, adaptation priorities are estimated to require US$18-20 billion. This reliance on external funding poses a significant challenge for implementation.
Inadequate Multi-sectoral Coordination: Collaboration between health and other sectors often remains project-based rather than systemic and institutionalized.
Insufficient Data and Early Warning Systems: Nepal lacks comprehensive, tailored surveillance and forecasting systems for climate-sensitive health risks, which hampers timely response capabilities. However, use of available routine data of HMIS in the DHIS-2 platform, integrated with local and global environmental and climatic data, will be potential digital solution for predicting epidemics of climate-sensitive diseases and risks.
Orientation-focused Training: Many capacity building activities have been limited to introductory orientations, falling short of the in-depth, skill-based training needed for health professionals to fully integrate climate considerations into their work.
Limited Localized Research: There is a scarcity of research on the specific climate change impacts across Nepal’s diverse ecosystems and populations, which limits the ability to design targeted interventions. Increased domestic and international resources are needed for climate and health research and innovations in Nepal.

Success factors

Several key strategies have proven successful:

Institutional Leadership: The NHTC/ MOHP has provided a strong, dedicated institutional anchor for structured and sustained capacity-building across the health system.
Manual Development and ToT Models: The creation of locally relevant training manuals combined with a cascading ToT model has been effective in disseminating knowledge to a wide audience of health workers.
Policy Integration: Embedding climate resilience goals into high-level national plans like the H-NAP and NDC3.0 has ensured alignment with global frameworks and raised the profile of health within the national climate discourse.
Strong Development Partner Engagement: Consistent technical and financial support from the WHO and other partners has been instrumental in rolling out training and awareness programs.
Sub-national Ownership: The growing commitment from provincial governments, some of which have started co-financing training programs, demonstrates increasing local ownership and a move toward sustainability.
Use of DHIS-2 platform for strengthening surveillance and research of climate sensitive diseases and risks.
Use of Digital Platforms: The launch of a dedicated government website for climate and health has improved information dissemination and stakeholder access. Furthermore, the development of a dashboard for climate-sensitive diseases and risks using both climatic and non-climatic factors provides valuable digital solutions for resource allocation and timely response for prevention and control of climate sensitive diseases and risks.

International experts dialogue on mountains, people and climate change, Nepal
Credit: WHO Nepal

Recommendations

Based on Nepal’s experience, the following are recommendations for other countries implementing the Belem Health Action Plan (BHAP):

Localize BHAP Strategies: Adapt the plan's priorities to fit the specific national context, including climate vulnerabilities, institutional setups, and health system capacities.
Invest in dedicated training institutions: Establish or strengthen institutions with a clear mandate for developing the health workforce capacity on climate issues.
Adopt a phased approach to capacity building: Move beyond basic awareness to provide layered, technical, and operational training that empowers health professionals to act decisively.
Foster multi-sectoral coordination: Institutionalize collaboration between health and other critical sectors like meteorology and disaster management through formal platforms and joint action plans.
Enhance use of technology: Leverage digital tools like e-learning, AI, and telemedicine to expand the reach of training and services, especially in remote areas.Digital solutions and scale up of prediction of climate sensitive diseases using routine data of HMIS in DHIS-2 platform have proven valuable.
Prioritize data and research: Establish robust surveillance systems, support climate-health research, and integrate data into planning and evaluation cycles to ensure evidence-based action.
Engage political leadership: Secure high-level government commitment to ensure resource allocation and the integration of climate-health into broader development agendas.
Leverage global financing mechanisms: Strengthen national capacity to access international climate funds such as the Green Climate Fund (GCF) and Adaptation Fund to bridge resource gaps.

More Information

Ministry of Health and Population Government of Nepal Ramshahpath, Kathmandu, Nepal http://www.mohp.gov.np/

WHO country office Nepal, https://www.who.int/nepal

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