Strengthening climate resilient health system capacity in Lao PDR

Context

Lao Peoples’ Democratic Republic (Lao PDR) faces environmental risks and health impacts related to industrialization, urbanization, pesticide use, extreme weather events and disasters caused by climate change. Addressing these risks will be the largest development task across the country. The Ministry of Health is tackling them through practical action at health facility level and at strategic level.

Lao PDR has committed to promote low carbon sustainability and climate resilience in its health system and facilities during COP26 in 2021, as the health effects of climate change have grown to be a significant burden for its health system. A health vulnerability assessment (MOH 2010, and 2018) concluded that water-borne diseases, vector-borne diseases, undernutrition, food insecurity, mental health and effects of water scarcity such as poor sanitation and hygiene, in addition to the direct impacts from extreme weather events including injury, are priority climate-sensitive health issues in the country.

Implementation process

To achieve its commitments, Lao PDR developed a Health Adaptation Plan aiming to strengthen health adaptation and mitigation capacity in the long-term (2022-2030). The plan includes 160 adaptation measures. The implementation of several actions and activities has already started, such as:

Integrating climate and health/diseases surveillance and establishing an early warning system to predict climate sensitive diseases for early response. The Ministry of Health has recently launched a pilot Climate Integrated Early Warning and Response System (CI-EWARS). This innovative system combines weather data—such as rainfall, temperature, and humidity—with health monitoring to predict outbreaks of climate-sensitive diseases. The system was jointly developed by the Ministry of Health, the Ministry of Natural Resources and Environment and WHO, with support from the Global Environment Facility (GEF) and the Green Climate Fund (GCF). As we look towards 2050, with expected increases in rainfall and temperatures, CI-EWARS aims to give health authorities tools to better prepare and protect communities from the health impacts of climate change.
Developing and expanding safe-clean-climate resilient health care facility initiative to over 70 hospitals in the last 3 years. This initiative strives to ensure that health facilities are resilient to worsening climate conditions and extreme weather events, while also adopting sustainable practices. This initiative includes the following approaches and interventions:
- SAFE Water and sanitation. the WASH FIT tool is used to ensure water safety, with climate resilience considerations.
- Cleaning and disinfection practices that follow WASH FIT/Standard Operating Procedures (SOPs) to ensure environmental sustainability
- Resilient, low carbon and sustainable technology, such as autoclave sterilization for infectious and sharp waste management and reduced plastic use. In 2020-2022, over 100 HCFs shifted to sustainable on-site non-combustion technology for waste management, of which 100% central and provincial hospitals and 50% of all district hospitals. Other efforts also include energy efficient lighting in healthcare facilities, to save on energy use.
- Staff capacity development for climate resilient infrastructure, including a climate change and health training program, as well as targeted training and technical support for infrastructure, operation and maintenance staff.

Lessons learned

We learned that the integration of climate, health, disease surveillance and health determinants data is an important first step. This allows to understand the current and future situation of the changing climate and its effects on health, to know who is vulnerable and to identify adaptation actions accordingly.

Challenges

It is crucial to enhance coordination and collaboration across technical units/centers and teams in the areas of health data information, disease surveillance and environmental health, as well as water and climate change. It is also important to strengthen data sharing practices within the health sector and with other health-determining sectors.

Success factors

Supportive leadership in health and environment sectors: one important enabling factor is the government’s strategic direction for the health sector to achieve universal health coverage and SDG 6 on clean water and sanitation. Similarly, at COP26, the Ministry of Health made bold commitments to build a climate resilient and low carbon sustainable health system.
Intersectoral coordination and engagement of key stakeholders across multiple sectors.
Routine monitoring and resource mobilization from the government and development partners. This includes technical and funding support from WHO and other development partners (GEF, UNDP, GCF).
Health care workers' efforts and training. This is ultimately what allows to implement actions on the ground. The Ministry of Health developed and rolled-out integrated packages, tools and training programs for healthcare workers, including:
- Climate change and health adaptation for public health specialists (integrated into the public health school curriculum);
- Short training for autoclave operators (3 months duration);
- WASH FIT training for safe-clean-green-climate resilient healthcare facilities team;
- Healthcare waste management training materials and training delivery for the healthcare workforce, to expand this initiative.

Recommendations

Advancing climate and health goals and targets require a whole-of-society and a whole-of-government approach. Strong leadership from the government, alignment of all development partners’ support with the government’s priorities and close coordination to minimize duplicated efforts will be crucial to drive systematic and transformative change towards a climate resilient society.

Key resources

Combining climate and health data to predict disease outbreaks in Lao PDR (WHO News Release)

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