Optional Sectoral Module HEALTH In a resilient city, the health care system is responsive to the changing health risks in its service area (reflective). It has excess capacity and is able to accommodate both projected and sudden increases in demand (redundant). Faced with a shock or stress, the health care system is able to provide emergency health relief to affected communities while continuing to offer basic health services to the entire population (robust, redundant, and coordinated). Within a resilient health care system, basic health care services are affordable and accessible to all segments of the population (inclusive). In a resilient city, the burden on health care is lessened through structural improvement in living conditions which removes underlying health risks. APPLICABLE RELATIONSHIP TO RESILIENCE TOPIC GUIDING QUESTION RESILIENCE QUALITY QUALITY Institutional Who manages the health care Coordinated Close coordination among health Capacity facilities and services in the service providers facilitates city, including hospitals, clinics, planning for future demand, and community health centers, accelerates emergency response and other health service and targeted distribution of medical delivery points? If there are staff and equipment. multiple providers, are they well-coordinated in terms of management, development planning, and emergency response? 1 Revised 2018 Institutional Does the city have programs Robust Removing imminent health risks Capacity for minimizing public health caused by poor living conditions risks through structural and inaccessibility to basic services improvements in housing, allows residents to think beyond transportation, energy systems, basic vulnerabilities and start water supply and sanitation? developing coping strategies for potential disturbances. Institutional Are hospital and health systems Coordinated Hospital and health systems cannot Capacity familiar with and in contact be expected to manage all risks with environment ministries, alone; it is important that they link met-services, or disaster up and rely on others with more preparedness and response nuanced understanding. It is helpful teams? if these relationships are initiated before a disaster. Institutional Does the city have a disease Reflective Disease surveillance systems are Capacity surveillance system that essential public health platforms monitors changes in health for monitoring and preparing risks, including climate-sensitive for changes in health risks. risks? Can the surveillance Incorporating climate-sensitive system provide early warnings health risks into public health about potential health surveillance systems allows for disasters? identification of appropriate intervention and adaptation to these risks. Public health surveillance systems can be used to trigger early warning systems. Institutional Does the city have an effective Coordinated An effective and coordinated Capacity communications strategy to communications strategy about disseminate accurate and potential heath risks can help the on-time information about population prepare for and/or avoid potential health risks to the such risks. The communication population? strategy should be able to reach all segments of the population, specially the most vulnerable. This should be a joint effort between the surveillance system agencies and the health care providers. 2 Institutional Are health professionals able to Coordinated There is a need for a strong and Capacity detect and respond to climate committed health workforce, and weather stress? Are they characterized by health personnel trained and prepared to deal who is ready to deal with difficult with a health-related climate or and dangerous situations. Health environmental crisis? systems that earn the trust of the population by reliably providing high-quality services before crisis have a powerful resilience advantage. Finance Have climate and environmental Redundant There is an increasing number funds been considered for of funds and financing facilities health system upgrades? E.g. available for climate upgrades. GCF, GEF, NDC-Partnership Health systems in many cases may support facilities, which could now be eligible. help increase climate-smartness of health systems Finance What are the funding sources Robust; A health care system that strives for for health care facilities and Coordinated complete coverage and continuous services? To what extent is the operation relies on sustained and funding discretionary at the predictable funding. When a local local level? To what degree government has discretionary are funding sources and uses control over funding for health, coordinated across agencies? it can be held accountable for achieving pre-determined health standards and coverage (number of hospitals beds) with the available funding. Where human resources and financing for health services are limited, coordination among agencies (both public and private) helps improve coverage, efficiency and targeting of both ordinary health services and emergency response. 3 Finance Is contingency financing Redundant A contingency fund covers available for health care unexpected disruptions in the facilities and services? health system as caused by external factors such as health service demand increase due to an epidemic outbreak or disaster event. A contingency fund can also help overcome sudden changes in demand as caused by urban immigration. Access Do all segments of the Inclusive Exposure to diseases is exacerbated population have access to basic by the presence of multiple health services?, including vulnerabilities (e.g., poverty, lack preventative health measures? of self-care skills, etc.). Access to Are basic health services basic health services is essential financially accessible to all for improving the health status groups? of vulnerable groups. Ability to provide affordable health services to all groups in the city prevents health care costs from becoming another driver of poverty and exclusion. Access Do all segments of the Inclusive Physical access is important to population have physical access all segments of the population. to health facilities? (e.g., are Distant or inaccessible facilities clinics and hospitals located are the cause of many deaths; within walking distance and if this characteristic is even more not, is there transport available important in an era of increased so that people can access if ill or disaster risk or climate threats. in an emergency?) 4 Nutrition Does the city have programs Robust; Negative coping strategies that to help the poor and otherwise Redundant poor and vulnerable households vulnerable residents avoid adopt to overcome food shortages malnutrition and poor diet (e.g., reducing the amount of food during food crises? In case of eaten, eating less nutritious food, food crisis, does the city have etc.) can have deteriorating impacts spare food resources to provide on their health. Food crises can be nutritious and healthy food to avoided through adaptive programs all segments of the population? aimed at improving accessibility to [Lens 3 – CRF 3] secure food sources, and shifting to sufficiently nutritious types of food. During a food crisis, cities which have spare capacity to provide nutritious and healthy food to all segments of the population avoid nutritional deficiencies among the populations that have no alternative to the negative coping mechanisms. Planning Does the city have the capacity Reflective Reflective capacity management to adjust and/or increase of health facilities requires regular the provision of basic health service demand estimates to be services in line with projected made based on demographic and sudden population growth, changes (e.g., type of services accelerated by rural to urban needed to accommodate their migration, influx of refugees health needs). Ability to adjust/ etc.? scale up the provision of basic health services according to changes in the population and/or during emergencies is essential for ensuring public safety and well- being of all residents. Facilities Do facilities implement low- Robust Implementing low-carbon carbon approaches including: approaches can improve investing in renewable energy health through a reduction in and energy efficiency, waste environmental pollution and minimization, sustainable climate change, as well as more transport and water efficient and less costly health consumption, etc.? systems. 5 Facilities Is new health infrastructure Robust The design and architecture of development ‘climate-smart’? health facilities should incorporate (e.g., use on-site renewable ‘climate-smart’ approaches, which energy sources, water efficiency can improve the delivery of services methods, and passive solar and reduce costs. heating and cooling strategies, etc.) Facilities Are facilities equipped with Robust Well-stocked and well-prepared medicines and diagnostic facilities are essential in in meeting capabilities to address new new demands associated with climate-sensitive health risks, emergent climate-sensitive disease i.e. treatments for certain risks. vector-borne diseases, rapid diagnostic labs, and cholera beds? Facilities If there are open air clinics or Robust Facilities must anticipate hospitals, are they equipped environmental shifts as a result of with vector-barriers or climate change which will influence deterrents (e.g., mosquito nets insect distribution and infectious and insecticides)? This may be disease transmissibility. important in regions where this is not an issue now. Facilities Are facilities equipped with Redundant Energy supply is critical. solar generators and water purification systems that will function in extreme weather related black-outs? Facilities Are health system supply Robust Guaranteeing the supply chain is chains susceptible to climate critical in maintaining appropriately or disaster impacts? i.e. are stocked hospitals and clinics. essential medicines coming via ports which may be susceptible to hurricane risk or might critical roads be washed out during extreme weather? 6 Facilities Are all the relevant types of Robust; An effective health system has health services available in Coordinated a diverse set of health services the city? Are any vital services which reflect current and projected missing (e.g. specializations, medical needs of residents. Cities operating theatres, etc.)? If missing vital functions in their necessary, is there an agreement health system should safeguard for patient transfer to facilities their population by collaborating that offer these services? with health institutions that provide such services. Facilities Are existing health care facilities Robust Health care facilities play a key located in disaster prone role in emergency response and areas and/or vulnerable to therefore need to be located in safe the consequences of climate areas. For the purpose of reducing change? If yes, are there plans to impacts of potential disasters, retrofit existing exposed health exposed health facilities should be facilities? Are new facilities built appropriately retrofitted. in safe areas or designed to be resilient to the hazards that are relevant for the areas in which they are built? System How prepared is the health Robust A few ways that a health system Continuity system for emergency can be better prepared for situations? Do all hospitals have disasters is by training the staff to emergency preparedness plans? handle emergency situations and warehousing of relief material, such as medicine, equipment and machinery, in protected areas. System Is the probability that health Reflective For the purpose of preparing Continuity facilities will remain operational backup equipment, it is useful to in post-disaster situations know the total capacity of facilities assessed? If yes, does the that can continue to function after assessment include information a disaster, as well as the coverage about hospital capacity and that can be achieved with these. proportion of healthcare beds exposed according to hazard intensity? 7 System If a major health facility in the Redundant Preparation of backup systems for Continuity city has been impaired, does damaged facilities with disrupted/ the system have the flexibility limited health services is essential for the patient demand to be for continued provision of health absorbed by other facilities? If services during a disaster, when accessibility to health facilities they are needed the most. is compromised, are there alternative modes of health service delivery? System Are alternative models of health Redundant During disaster events access Continuity service delivery assessed? In to health services may be case of disaster, does the city compromised. In such cases, have the capacity and material alternative service delivery to establish emergency response methods need to be identified to cells where needed? ensure that medical assistance can reach those that need it. Temporary emergency response cells can be established in affected areas to offer immediate treatment to injured individuals. 8