Improvement of water, sanitation and hygiene services in 40 community clinics in coastal areas Managing the environmental determinants of health Problem at hand Community clinics are vulnerable to high tides, storms and floods. Basic services such as water, sanitation and hygiene (WASH) which are needed to run the clinics are often disrupted by extreme weather events, affecting provision of health services to the communities in the coastal areas. Work being done To generate a paradigm for addressing this problem, WASH facilities were provided in community clinics under a partnership project ‘Rural Water Supply, Sanitation and Hygiene in Difficult and Hard-to-Reach Areas of Bangladesh’ run jointly by UNICEF, WHO and Department of Public Health Engineering (DPHE) funded by the Netherlands Government. The works undertaken include the installation of piped water systems (comprising safe water points, pipe-works, storage tanks and pumps), the construction of new latrines, separate for men and women, and hand-washing devices. Solar operated pumps were provided in few clinics to demonstrate use of green energy source. To ensure that supplied water is safe, water samples were collected from the new systems and tested for arsenic, iron and microbes. To make the system self-sustaining, a fund was generated for proper operation and maintenance through ollection of a nominal fee of BDT 2.00 per patient visit. The collection and disbursement of the fund is overseen by the clinic management committee. A guideline on operation and maintenance of WASH facilities was developed and a number of training sessions were conducted for caretakers and members of community clinics for sustained operation of the facilities. Outcomes 40 community clinics have independent water supply, clean toilets and handwashing facilities and solar power for pumping water. An increase in the number of patients attending the clinics for health services, particularly female patients, observed. Bangladesh
Transcript
Improvement of water, sanitation and hygieneservices in 40 community clinics in coastal areas
Managing the environmental determinants of health
Problem at hand
Community clinics are vulnerable to high tides, storms and floods. Basic services such as water, sanitation and hygiene (WASH) which are needed to run the clinics are often disrupted by extreme weather events, affecting provision of health services to the communities in the coastal areas.
Work being done
To generate a paradigm for addressing this problem, WASH facilities were provided in community clinics under a partnership project ‘Rural Water Supply, Sanitation and Hygiene in Difficult and Hard-to-Reach Areas of Bangladesh’ run jointly by UNICEF, WHO and Department of Public Health Engineering (DPHE) funded by the Netherlands Government.
The works undertaken include the installation of piped water systems (comprising safe water points, pipe-works, storage tanks and pumps), the construction of new latrines, separate for men and women, and hand-washing devices.
Solar operated pumps were provided in few clinics to demonstrate use of green energy source.
To ensure that supplied water is safe, water samples were collected from the new systems and tested for arsenic, iron and microbes.
To make the system self-sustaining, a fund was generated for proper operation and maintenance through ollection of a nominal fee of BDT 2.00 per patient visit. The collection and disbursement of the fund is overseen by the clinic management committee.
A guideline on operation and maintenance of WASH facilities was developed and a number of training sessions were conducted for caretakers and members of community clinics for sustained operation of the facilities.
Outcomes
40 community clinics have independent water supply, clean toilets and handwashing facilities and solar power for pumping water.
An increase in the number of patients attending the clinics for health services, particularly female patients, observed.
Bangladesh
Health care worker recording weather data
Problem at hand
Health workers were not aware of the need to use climate data in the analysis of epidemiological data for climate-sensitive diseases such as malaria, respiratory diseases and diarrheal diseases.
Work being done
Comprehensive training conducted for health assistants for measuring and recording key meteorological data.
Initiation of periodic and timely recording of parameters in a log book.
Monthly reporting of the data to Department of Hydro-Met Services at Thimphu and to the Environment Health Programme.
Trained on recording and compiling five climate-sensitive diseases (malaria, dengue, Japanese encephalitis, diarrhea and respiratory diseases) using standard protocol and basic laboratory skills to diagnose vector-borne diseases.
Recording and compiling of five climate-sensitive diseases and updating the web-based system on a daily basis using a mobile phone.
Collection of data for the climate-sensitive diseases from the out-patient department register, emergency register, outreach clinic register and the mass health screening register.
Recording data of unusual local events such as extreme rainfall, storms, snowfall, mass gatherings for local festivals, and flowering of certain plants, in order to obtain accurate data without compounding effect.
Outcomes
Yearly presentations in review meetings conducted by Environmental Health Programme using the hydro-met data and five climate-sensitive diseases to see if changes in climate variables are linked with increase or decrease of climate-sensitive disease burden.
Spreading awareness by conducting various health awareness programmes in the community on prevention and control of dengue and malaria and probable incidence of climate-sensitive diseases in non-endemic areas.
Integrated surveillance for climate-sensitive diseasesIntegrated risk monitoring and early warning
Bhutan
Problem faced
Drying of drinking water sources and reduced water for hygiene and sanitation.
Water- and food-borne diseases and gastrointestinal diseases due to drinking from contaminated water sources or washing hands with contaminated water.
Nutritional deficiency due to food insecurity resulting from drought.
Work being done
Coordination and collaboration with other ministries to address drinking water and sanitation, and other hygiene issues.
Establishment of the emergency responding coordination mechanism to facilitate the collaboration with international agencies such as WHO and UNICEF through its country offices.
Collaboration with relevant national agencies for seeking new naturalized mineral water sources and utilization of underground water by pump, and cooperation with international organizations and NGOs in the light of technical and material issues for its implementation to cope with a long lasting extreme drought.
Outcomes
Preparedness for droughts with provision of alternative and safe water and sanitation services.
Stronger partnership between national and international organizations forged.
Intersectoral collaboration to prepare for droughtsEmergency preparedness and management
Democratic People’s Republic of Korea
Problem at hand
Ahmedabad witnessed a deadly heat wave with peak temperatures of over 47 °C on 21 May 2010 causing a spike in illness and over 300 all-cause deaths that day.
Work being done
The Indian Institute of Public Health Gandhinagar (IIPHG) supported by Natural Resource Defense Council (NRDC), USA, helped the city municipal government to launch the Heat Action Plan (HAP) in Ahmedabad in 2013.
The plan included the following four interventions:
public awareness and community outreach;
early warning system and inter-agency emergency response plan;
building capacity among health-care professionals; and
reducing heat exposure and promoting adaptation measures
Outcomes
Despite temperatures breaking a 100-year record in 2016, a reduction in all-cause mortality was reported in 2015 and 2016 compared with 2010 in Ahmedabad city because of HAP.
Best practices from Ahmedabad HAP have been scaled to Vidarbha region in Maharashtra, Odisha, Hyderabad, Rajkot and Surat.
Indian National Disaster Management Authority (NDMA) has recognized heat wave as a natural disaster having significant health impact and instructed the states and districts to prepare their HAP.
National guidelines and educational videos on heat waves have been prepared.
Cool roof initiative
Ahmedabad Heat Action PlanIntegrated risk monitoring and early warning
India
Addressing climate impacts on dengue and malaria
Climate-informed health programmes
Problem faced
Indonesia's land area has geographical and geological characteristics that are highly vulnerable to changes in climate, natural disasters, and extreme weather events. High pollution levels in urban areas, fragile ecosystems, and economic activities dependent on fossil fuels and forest products makes the country more vulnerable.
Dengue haemorrhagic fever (DHF) and malaria are endemic in Indonesia and these are highly sensitive to climate change. Malaria and DHF cases are expected to increase along with changes in temperature and rainfall. These will affect the poor who do not have the resources to overcome them.
Work being done
Indonesia has developed National Adaptation Plan (NAP) on climate change involving various stakeholders, including health.
To increase community resilience toward climate change impact of DHF and malaria, the government has implemented behaviour change through community participatory approaches such as Participatory Adaptation of Climate Change Transformation (PACCT) tools which consisted of preparatory, planning, implementation and evaluation.
Study on the relationship between climate change, DHF and malaria has been carried out.
Advocacy on DHF and malaria vulnerability assessment results are disseminated to health workers, policy-makers at provincial and regency/municipality levels in West Sumatra, East Java, and Bali.
Capacity-building for health workers and the community in developing adaptation strategies in response to changes in DHF and malaria pattern due to climate change.
Outcomes
Vulnerability maps for DHF and malaria developed in 20 cities and regencies over 5 provinces covering West Sumatera, East Java, Bali, DKI Jakarta and surrounding areas, and central Kalimantan.
Climate information utilized for developing early warning for DHF training conducted for consultants, facilitators, and health workers for local community health-care centres in West Sumatera and East Java provinces.
Indonesia
Driving policies to strengthen health systems resilienceClimate and health financing
Problem faced
The Republic of Maldives is highly vulnerable to climate change due to its low-lying geography that makes it susceptible to inundation, its dependence on economic activities sensitive to climate change, such as fishing and tourism; and dependence on imported fossil fuels for its energy that represents a major source of greenhouse gas emissions. While Maldives made significant commitments to the pursuit of a low emission climate resilient development agenda, local planning was not reflective of national-level commitments.
Work being done
An innovative programme ‘Low Emission and Climate Resilient Development’ (LECReD) funded by the Government of Denmark has brought together UN partners (including UNDP, UNICEF, UNOPS, UNFPA, UN WOMEN, WHO and FAO) with equally diverse national and local partners to address this multi-faceted development challenge of climate change.
The World Health Organization is one of the seven members of the UN Country Team in the Maldives supporting the LECReD project to address vulnerabilities essential to adapt, mitigate and build resilience to climate change impacts of human health in the Maldives.
The programme assists the Laamu atoll and its islands to realize low emission and climate resilient development and mainstream issues into local level development planning and service delivery for greater community-level ownership and to support the national agenda.
The project responds to the United Nations Development Assistance Framework Outcome 9: ‘Enhanced capacities at national and local levels to support low carbon lifestyles, climate change adaptation, and disaster risk reduction’.
Outcomes
Under the partnership the following outcomes are for the health sector:
Launching of the nationwide vector control campaign
Solar power feasibility assessment for the health facilities in Laamu atoll
Resilience strengthening interventions in the hospital sector to improve the functioning of hospitals in emergencies and disasters and to assess vulnerability
Table-top simulation exercise for disaster risk reduction emergency preparedness
Water quality surveillance programme initiated to protect health and develop community capacity to manage available resources
Dengue outbreak assessment and support response
Training on vector control.
Maldives
Community participation in vector control
Health emergency response to �oods
Emergency preparedness and management
Problem faced
Torrential rains and the onset of cyclone Komen triggered severe and widespread floods and landslides in July and August 2015 across 12 out of 14 states and regions in Myanmar.
An estimated 1.6 million individuals were recorded as having been temporarily displaced by the disaster, 132 lives were lost, and 5.2 million people exposed to the floods and landslides in 40 most affected townships.
US$ 1.51 billion (3.1% of GDP) damage sustained, including agriculture, livestock, fisheries, housing, private properties.
Severe impact on the health system and its capacity to deliver essential services.
Work being done
Under the guidance of the health care management subcommittee, Ministry of Health officials and humanitarian agencies, concerted efforts were made to provide life-saving health interventions and restore essential health services.
The MoH immediately mobilized an emergency budget for the deployment of medical teams and rapid response teams and for procurement of emergency medical supplies.
The World Health Organization supported emergency operational costs and medical supplies in disaster-affected areas.
Other efforts include provision of health services through mobile clinics and activities to prevent water-borne diseases.
Emergency health care through the mobile medical teams, activities to prevent water-borne diseases and vector-borne diseases, replenishment of damaged cold chain equipment for routine immunization, and nutrition interventions were also undertaken.
Outcomes
Six disease outbreaks were reported through WHO’s Early Warning, Alert and Response System (EWARS) in the disaster and post-disaster phase.
Effective coordination between MoH, health partners and community to control outbreaks.
Myanmar
New water supply system for the people of NabokTakpa
Managing the environmental determinants of health
Problem faced
The people of NabokTakpa, ward no. 5 of Jiri, used to drink water from a nearby stream called Chakhey. The water was turbid and often used to dispose carcasses of dead animals, especially in the rainy season. But this was the only source of water supply for locals. People frequently fell sick with fever and diarrhoea.
Work being done
Members of 46 households with support from Gorkha Welfare Scheme (GWS) constructed a new water supply system. The whole system consists of 2 intakes, 5 reservoir tanks and 47 public taps. During construction, the discharge at source was measured and water was tested.
Technicians from Kathmandu University (KU) frequently measure the water availability, check quality of water at source and gather information on its use, as well as monitor water-borne diseases and hygiene behaviours as part of the climate change and water, sanitation and hygiene (WASH) research project.
Outcomes
A well-constructed and maintained safe water supply to 80 households and 2 schools.
The incidence of diarrhoeal diseases has significantly reduced in the community after the use of water from this scheme.
Nepal
Implementation of zero-waste concepts
Climate-resilient and sustainable technologies and infrastructure
Problem at Hand
Risk of spreading of infectious diseases due to lack of waste management at district general hospital (DGH), Monaragala.
DGH Monaragala, the second largest hospital in Uva province of Sri Lanka, is a 441-bedded government hospital that caters to a population of over 500 000 in the district. The hospital generates various categories of waste:
Electronic waste: discarded electric and electronic appliances
Waste water: sewage and wash water.
Work being done
Segregation of solid wastes into seven categories by using colour-coded bins.
Display of written instructions in Sinhala, Tamil and English around the waste-bin areas to ensure process is followed.
Transportation of waste by colour-coded handcarts.
Temporary storage of transported waste in colour-coded waste storage compartments.
Sale of plastic, paper, glass, nut shells for recycling/reusing and handover of e-waste to the district branch of the Central Environmental Authority for disposal.
Infectious and sharp wastes are hydroclaved, shredded and disposed.
All biodegradable wastes are used for production of compost and biogas. Compost is used for organic farming and biogas is used for boiling water and cooking.
All hospital waste water is treated in sewage treatment plant. Dried sludge is used for compost. The effluent is finally treated by ultraviolet rays and disposed. Effluent quality is monitored regularly.
Outcomes
Waste that goes for landfilling is reduced.
Income generation through biogas and compost that is produced from waste.
Reduced carbon footprint of the hospital.
Sri Lanka
Biogas plant
Segregation of waste
Reducing greenhouse gas emissions in health sector activities
Climate-resilient and sustainable technologies and infrastructure
Problem faced
Increasing carbon footprint
Work being done
The 17th SomdetPhraSangkharat Hospital is 250 bed-hospital that services 1000 patients per day. Due to the awareness about climate change, the hospital has conducted a GREEN and CLEAN programme that follows sustainable and ecological sanitation concepts. The implementation focuses on waste generation and waste recycling.
The CLEAN strategies include:
C: Communication: to raise awareness and responsibility for actions
L: Leader: to play a key role in greenhouse gas reduction
E: Effectiveness: to effectively implement the GREEN concepts
A: Activity: to continuously practice the GREEN concepts so that everyone participates in creating a positive change
N: Networking: to collaborate and participate with networks to reduce carbon footprint.
The GREEN strategy is a principle to reduce global temperaturesby the efficient use of resources such as the following:
Reduced greenhouse gas emissions from the hospital.
The hospital serves as a model and motivates nearby communities.
The staff has learnt the importance and impact of climate change on health and are equipped with solutions for reducing greenhouse gas emission.
The hospital can use the savings from energy conservation for hospital improvement.
Thailand
Spreading awareness for a greener and cleaner tomorrow
Climate-resilient and sustainable technologies infrastructure
Problem faced
Timor-Leste is vulnerable to various climate change impacts such as storms, floods, droughts and sea-level rise.
Work being done
Since 2014, the Ministry of Health (MoH) and the World Health Organization (WHO) Country Office for Timor-Leste have been collaborating with schools to understand the threat of climate change and actions to prevent it.
Teaching materials on climate change and health have been developed and rolled out in schools.
Teachers and students have planted many trees to reduce the impact of climate change in the area.
School has set-up sound waste management system using the 3Rs: reduce, reuse and recycle.
Outcomes
Teachers and students over the years have understood fully well that waste and waste disposal has huge environmental impact and can cause serious health problems.
An effective collaboration between MoH, WHO and schools has resulted in spreading awareness about the environment, the impact of their actions, and the need to take responsibility.
Reduction of greenhouse gas emissions from these schools.
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