Supporting health system recovery and resilience to climate change in Nepal

Our Health Infrastructure Team in the Nepal Health Sector Support Programme (NHSSP), funded by UKAid, played a key role in reconstructing hospitals and clinics after the devastating earthquake in 2015. Using the tools and techniques the team developed during that time, they are now moving to respond to the threat of future climate change hazards. The team is using a purpose-made Geographical Information System (GIS) to identify health facilities at risk of disasters such as flooding or earthquakes, and to plot changes in the range of diseases such as malaria and dengue fever.

The combination of mapping seismic and climate change vulnerability will help the Government of Nepal infrastructure planners to identify key areas and facilities for interventions.

Nepal sits in a very tough neighbourhood – lying in a seismically unstable zone, with topography ranging from the world’s highest mountains to lowland forest. Swept by the annual monsoon rains, the country runs a constant risk of natural disasters. To add to this, climate change is shifting patterns of disease and increasing the likelihood of floods, landslides and glacial lake collapse.

Rolling out a tailor-made damage assessment

In post-disaster situations, government and donors need accurate damage and cost assessments to design programmes for service recovery and facility reconstruction. After the 2015 earthquake – which destroyed or seriously damaged over 400 health facilities in the 14 most severely hit districts – our team developed a digital data collection system that enabled survey teams to make faster and more precise assessments of structural damage, repairs and reconstruction costs.

“We had to capture and analyse damage information in a very short space of time”, says Team Leader Sunil Khadka.

The new electronic method replaced the outmoded paper-based approach, and allowed the Government of Nepal to Build Back Better

The National Reconstruction Authority – the government agency leading Nepal’s efforts to respond to the disaster – is using our data.

“Our figures give the NRA a more accurate picture for its budget and forward planning”, says Sunil. “We’re helping the government to Build Back Better.”

Responding to disasters and addressing gender disparities

Using the UN’s 2015 Sendai Framework on Disaster Risk Reduction as its starting point, the team has reported on the depth of preparedness planning at health facilities as Nepal moves forward into its new federal government arrangements.

Natural disasters are not gender-neutral – global data shows that women and girl children are more at risk in earthquakes and floods.

The earthquakes confirmed this trend, with 55% of fatalities in the 14 most severely affected districts being female, and a higher risk of gender-based violence and trafficking in the post-disaster period. The team’s report stresses that the Gender and Social Inclusion (GESI) perspective must be a distinct component of disaster planning. Actions could include the provision of women and family friendly spaces on hospital grounds as safe havens post disaster.

“Women are more likely to die in large scale disasters due to social, cultural and economic factors”, says Sitaram Prasai the Gender and Social Inclusion Advisor. “Our infrastructure work must address this reality in the way we plan and develop health facilities.”

Climate change – a risk to Nepal’s health infrastructure

The team has recently assessed the risk to health facilities from climate-change hazards, including landslides, floods and glacial lake outbursts.

“Much of the government’s work on climate change looks at changes in disease patterns, or risk to livelihoods”, said Subash Bhattarai, the team’s Policy Development Coordinator. “Given the shortage of health facilities in Nepal, we wanted to assess specifically the risk to our infrastructure.”

Using the Health Infrastructure Information System, the team has highlighted the real dangers to health posts and clinics.

Six out of Nepal’s seven provinces have districts with the highest combined risk category of exposure to landslide, flood, storm, drought, hailstorm, cold wave and avalanche.

Prashan Shrestha, the Team’s GIS manager, demonstrates that the system can also produce more targeted data.

“We identified over 30 health posts that could face destruction if the moraine dams burst at the Tsho-Rolpa and Imja–Tsho glacial lakes – it would cost over NPR 3 billion (GBP 2.5 million) to replace these facilities”.

Across 31 districts in Nepal  for which data is available, the team can point to 54 health posts and 15 hospitals located within 25 metres from a river, and so face a high risk of flooding as rainfall patterns change and the rate of glacier melt increases. The team has also combined landslide incidence data and site slope analysis to provide an overview of infrastructure at possible risk of landslides.

“Some districts face real dangers”, says Subash. “For example, nearly 60 per cent of health posts in Ramechhap are built on steep slopes, and could be lost through earthquakes or landslides.”

The team is now taking its findings forward into government planning processes, and improving the coverage of its analysis.

“We are working closely with the Ministry of Health to mainstream resilience and disaster-risk planning for health infrastructure”, says Sunil. “We aim to improve the range and detail of our data, but our work has already proved valuable in identifying the present and future risks facing health facilities across the country.”