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KP TA – 02: Climate Health Vulnerability Assessment in Khyber Pakhtunkhwa And Development Of Climate Health Adaptation Plan

Programme

Evidence for Health (E4H) is a Foreign, Commonwealth & Development Office (FCDO)-funded programme aimed at strengthening Pakistan's healthcare system, thereby decreasing the burden of illness and saving lives. E4H provides technical assistance (TA) to the Federal, Khyber Pakhtunkhwa (KP), and Punjab governments, and is being implemented by Palladium along with Oxford Policy Management (OPM).

Through its flexible, embedded, and demand-driven model, E4H supports the government to achieve a resilient health system that is prepared for health emergencies, responsive to the latest evidence, and delivers equitable, quality, and efficient healthcare services. Specifically, E4H delivers TA across three outputs:

Output 1: Strengthened integrated health security, with a focus on preparing and responding to health emergencies, including pandemics.

Output 2: Strengthened evidence-based decision-making to drive health sector performance and accountability.

Output 3: Improved implementation of Universal Health Coverage, with a focus on ending preventable deaths.

Problem Statement

KP has experienced serious climatic challenges, leading to life lost, illnesses, and additional burden on an already weak health system. The 2022 floods also affected millions of people in the KP province. Conducting Climate Health Vulnerability Adaptation Assessments (CHVAs) is crucial for effective health adaptation measures. The KP CHVA will determine existing and future risks of climate change on public health and will enable the government to assess the capacity of its health system to effectively respond to challenges.

• During the 26th United Nations Climate Change Conference (COP26) in 2021, the health community agreed on the development of two key initiatives: 1) climate resilient health systems; and 2) low-carbon sustainable health systems.
• The Government of Pakistan approved a multisectoral NAP on Climate Change in 2023. The NAP recognises health as an adaptation priority amidst implementation hurdles.
• The M/o NHSR&C conducted a scoping study, which led to the development of a Framework of Action for Climate Resilient Health Systems in Pakistan in 2023. A key recommendation was the need to conduct a CHVA that will inform future climate health adaptation plans.
• A roundtable discussion among stakeholders was held in September 2023, with agreement to develop a coordination mechanism at national and provincial levels for a coordinated response.
• The KP DOH has initiated sensitisation of stakeholders in the province on climate resilient health systems and has expressed commitment to develop an evidence-informed KP CHAP.

Objectives

The overall objectives of the technical support are as follows:

1. To institute a coordination, communication, and monitoring mechanism for conducting the CHVA and for the development and subsequent implementation of the CHAP;
2. To comprehensively assess climate-health vulnerability across KP province through the CHVA, including clearly identifying at-risk geographical areas, health facilities, and key populations.
3. On the basis of the assessment and in alignment with the NAP, to develop a costed CHAP that will serve as the roadmap for adaptation going forward; and
4. Through the above, to identify capacity transfer and building initiatives for DOH officials involved so that they are able to conduct a future CHVA independently or with minimum support.

Scope of Work and Methodology

Throughout this assignment, a team of local consultants will work in collaboration and under the oversight of an international expert, who will provide guidance and technical support. The team will cover the following scope of work:

Thoroughly and critically analyse published and available tools for CHVA and conduct a cross-comparison of commonly used tools such as the World Health Organisation Strategic Toolkit for Assessing Risks (STAR) tool, Centres for Disease Control and Prevention (CDC) Building Resilience against Climate Effects (BRACE) tool, and the Health Canada Climate Change and Health Vulnerability and Adaptation Assessment (CCHVAA) etc. After selecting the tool, the scope of work will be as follows:   

1. Formation and activation of KP technical working group (TWG) on climate resilient health systems and Steering Committee
2. Analysis of the vulnerability factors, exposure pathways, and gaps in health and social system to develop an understanding of the prevalence of climate-sensitive diseases across the diverse geographical landscapes of KP
3. Employment of an iterative methodology in data collection and analysis to adapt and refine the process based on evolving insights
4. On the basis of the assessment, projection of future health risks
5. Identify and prioritise policies and programmes to increase the climate-resilience of health systems
6. Establish an iterative process for managing and monitoring health risks with both consultations of internal and external stakeholders
7. Examine the possibility of the development of intersectoral linkages with an aim of improving health
8. Incorporate key results into a costed CHAP for KP
9. Ongoing knowledge translation and dissemination of messages to stakeholders, community partners, and other organisations to promote positive public policy change

Considering the complexity and nuanced nature of this exercise, a detailed outline of the phases has been provided for easy reference. Please note that these steps are subject to iterative adjustments, particularly following the preparatory phase.

Preparatory Phase

Step 1: Framing and scoping the assessment

1. Stakeholder engagement
2. Methodology assessment/refinement
3. Inception report detailing the chosen methodology, framework(s), and chosen tool(s) with rationales for the CHVA and development of a CHAP in KP

Data Synthesis and Analyses

Step 2: Review current vulnerabilities and capacities through an analysis of the following:

1. KP climate vulnerabilities in general, as well as status and vulnerabilities in select districts. These districts will be a sample decided during the inception phase. It is expected that they will be representative of other similar districts in either close proximity or in terms of geographical and infrastructure landscape.
2. Geographical and climate influences
3. Demographic disease patterns
4. Health infrastructure assessment - in sampled districts and health facilities
5. Environmental factors and health outcomes
6. Identification and distribution of vulnerable populations
7. Migration patterns and health risks
8. Retrospective analysis
9. Predictive analysis
10. Model integration

Step 3: Projecting future health risks

1. Retrospective analysis
2. Predictive analysis
3. Model integration