In Cambodia, the impacts of climate change are increasingly posing risks to people’s health, while straining the country’s health system. Since 2019 Cambodia has been piloting a project to help increase the resilience and capacity of its health systems to respond to these climate-sensitive health risks.
"Strengthening the resilience of the health system to climate change is a country priority for Cambodia, particularly as it is vulnerable to both flood and drought. Changing rainfall patterns - including shorter wet seasons and longer dry seasons - are already changing the locations and magnitude of climate-sensitive diseases (e.g. water- and vector-borne diseases). Through improved early warning systems, monitoring and faster diagnoses of climate-sensitive disease incidence, the health system can better protect and improve community health for the future."
–Dr Nargiza Khodjaeva, Technical Lead. NCD and Health through the Life-Course, Cambodia WHO Country Office
Background
Climate change is already being felt in Cambodia. Average temperature and the intensity and frequency of extreme weather events, such as floods, droughts and heatwaves, have all gone up, and this has had important consequences for the health and development status of the country. The impacts of climate change amplify existing vulnerabilities in communities, including poverty, food insecurity and poor health status.
Growing health risks from climate change in Cambodia include vector-borne diseases, malnutrition and diarrhoeal diseases, along with other conditions, such as rodent-borne diseases, respiratory tract infections, noncommunicable diseases, heat-related illness and mental health impacts.
The country already has several policies in place to help the health sector cope with these rising impacts – such as the National Strategic Plan for Climate Change Adaptation and Disaster Risk Reduction in the Health Sector 2019–2023 – but there is an urgent need to further strengthen the health system to protect and improve the health of communities in an unstable and changing climate.
Health system resilience includes making sure that hospitals are able to keep operating as the climate changes (e.g. have sufficient clean water and are protected against floods), and that they can use early warning systems to make sure they are prepared in advance for surges in climate-sensitive diseases, such as dengue.
"Climate change is clearly linked with global health problems. In responding to climate-sensitive health risks in the country and to make the health system resilient, capacity building for heath and non-health workforces is needed. With support from the Technical Working Group for climate change and health, the key priority is to adapt health systems to climate change, and to engage them with multi-stakeholders from the whole system and wider society."
–Dr Kol Hero, Director, Department of Preventive Medicine, Ministry of Health, Kingdom of Cambodia
The Challenge
In 2019, Cambodia joined the project Building Resilience of Health Systems in Asian LDCs to Climate Change, along with five other Asian least-developed countries (LDCs): Bangladesh, Lao People’s Democratic Republic, Myanmar, Nepal and Timor-Leste.
The four-year project (2019–2023), funded by the Global Environment Facility (GEF) and implemented by the United Nations Development Programme (UNDP) and World Health Organization (WHO), aims to strengthen the capacity of the health systems of these six countries to adapt to the impacts of climate change. It aims to strengthen institutional capacity to improve health sector planning and effective decision-making to ultimately develop climate-resilient health systems.
In order to contribute to developing a climate-resilient health system, Cambodia and the other participating countries are working towards the following four goals:
- Strengthened institutional capacity to effectively integrate climate risks and adaptation options in health sector planning and implementation.
- Effective decision-making for health interventions, through the generation of information and improved surveillance and early warning systems.
- Climate-resilient health service delivery.
- Improved regional cooperation and knowledge exchange and the integration of a Health National Adaptation Plan (HNAP) into the national adaptation planning process.
The Solutions
Since joining the project, Cambodia has made significant progress towards building a more climate-resilient health system.
First, it has strengthened its institutional capacity in several ways. It established a national Technical Working Group for Climate Change and Health to help coordinate stakeholders from the health sector and other health-determining sectors. This has also led to improved data sharing and collaboration for climate-informed health surveillance.
The technical working group for climate change and health brings together health professionals and professionals from health-determining sectors (e.g. environment) so that they can work together collaboratively to address climate change impacts on human and population health (Fig 1).
Figure 1: GEF Technical working group discussion, chaired by Dr Kol Hero, Director of Preventive Medicine Department, MoH and H.E Lun Sopheap, Deputy Governor of Ratanakiri.
Climate change considerations have also been integrated in health sector planning, such as through the development and adoption of a Health National Adaptation Plan, improved educational programmes, and the sharing of information on climate-sensitive diseases on the Ministry of Health website.
Second, health surveillance and early warning systems have been expanded. By being climate informed, Cambodia’s health early warning systems enable more informed and effective decision-making on climate-sensitive health risks across the health sector. Examples include training on diarrhoea surveillance for health professionals; the development of guidelines for dengue rapid diagnostic tests (Fig. 1); and the development of a rapid response plan and improved surveillance for dengue outbreaks.
"Our dengue response has been implemented with the active participation of all staff and relevant institutions involved in dengue detection and prevention. We are also expanding the dengue sentinel sites so we can detect and identify the occurrence of serotypes of dengue cases. This will allow the National Dengue Control Program to be in a better position in terms of forecasting the dengue or CHIK burden in the following year."
–Dr Vibol Chan, WHO consultant of the Dengue Programme at the WHO Country Office for Cambodia.
Figure 2: Workshop on developing rapid diagnostic test usage guidelines. Dr. Huy Rekol, Director of the National Center for Parasitology, Entomology and Malaria Control (CNM), of the Ministry of Health, led the workshop.
Third, the climate resilience of health service delivery in Cambodia is being strengthened, with a particular focus on improving water, sanitation and hygiene (WASH) in health centres and communities. Tools were developed for assessing climate-resilient WASH in 25 health centres and communities in the Ratanakiri province (Figs. 3 and 4), and the assessment found that approximately 44% of the health centres surveyed had been affected by an extreme weather event (e.g. flood, drought, or storm) from 2015 to 2019.
Ratanakiri province was selected as a pilot site for assessing climate resilient WASH, for enhancing climate resilient water safety planning, and promoting local awareness in the health system about the impacts of extreme weather on community health. We are very pleased to be working with the Preventive Medicine Department of the Ministry of Health and the Ratanakiri Provincial Health Department, as they have actively engaged with us to address climate-related WASH issues in the province.
–Dr Daravuth Yel, Technical officer for Tobacco Free Initiative, Mental Health and Substance Abuse and Health and the Environment, WHO country office, Cambodia
Figure 3: WASH assessment interviews in health-care facilities and communities.
Climate-resilient water safety plans were then piloted in 10 health centres and 15 villages. The main aim of these plans is to ensure drinking-water is available and safe to use in both the rainy and the dry seasons, when most health centres face a lack of drinking-water for staff and patients.
“The numbers of dry and hot days are increasing in Cambodia, and this affects water quality as well as quantity in both rural villages and health centers. Clean water shortages affect daily activities at health centers (e.g. providing water for re-hydration and ensuring that hand hygiene is maintained), as well as more generally for villagers. This makes it challenging to keep health centers clean and safe for staff and visitors. To address this, we are working with rural health centers to install water treatment equipment. In the past we have often faced water quality issues during rainy periods, and water shortages during the dry season. The new water treatment system is helping us to cope better with wetter wet seasons and dryer dry seasons.”
–Dr Eng Kunvuth, Chief of Technical Bureau of Ratanakiri Provincial Health Department
Figure 4: Health centre and community field monitoring by Dr Eng Kunvuth, Chief of Technical Bureau of Ratanakiri Provincial Health Department and WHO Cambodia team.
So far, water treatment equipment has been installed in 20 health centres, which will help strengthen the resilience of health centre infrastructure to extreme weather events, such as flooding, droughts and storms (Fig. 5)
Figure 5: Climate resilient water treatment equipment installation in health centers in Ratanakiri province.
Lessons Learned
The project stakeholders, experts and community members have shared several key lessons they have learned from the project so far:
- The contributions of a Technical Working Group and experts in conducting assessments and developing recommendations were essential in the development of climate-resilient water safety plans for health centres and communities;
- Strong leadership and coordination of ministries, provincial authorities and other sectors was critical to the implementation of activities, especially during the COVID-19 pandemic;
- There is a strong need for ongoing and continuous capacity-building and technical support across climate change and health activities for national and provincial staff in the Ministry of Health, as well as for health professionals and support staff at a national level;
- The participation of stakeholders from national and subnational levels, as well as local communities, indigenous populations and health support groups, was a key aspect of developing climate-resilient health systems. It ensured local needs were addressed and the most vulnerable populations were reached;
- Field visits, observation and monitoring highlighted issues in communities and health centres, which were not always identified in the assessment tools; and
- Women are a key beneficiary of the implementation of climate-resilient water safety plans. This is because women are still responsible for the daily water supply in households in many communities.
More information
You can find more information on the project Building Resilience of Health Systems in Asian LDCs to Climate Change on the WHO website.
This story is part of a series of case studies on climate change and health. Case studies are intended to highlight the connections between climate change and human health, and showcase some of the solutions that are being implemented by the health community. Case studies do not necessarily represent the views of WHO or any of its member states.