PROJECT Development Facility

Request for Approval

Agency’s Project ID: PIMS 3248

GEFSEC Project ID:

Country: Global

Project Title: Piloting climate change adaptation to protect human health

GEF Agency: UNDP

Executing Partner: WHO

Collaborating Agencies:

Duration: 18 months

GEF Focal Area: Climate Change

GEF Operational Program: Special Climate Change Fund

Estimated Starting Date: February 2006

Estimated WP Entry Date: November 2007

Financing Plan (US$)
GEF Allocation
Project (estimated) / 6,000,000
Project Co-financing (estimated) / 18,000,000
PDF A*
PDF B** / 469,685
PDF C

Sub-Total GEF PDF

/ 469,685
PDF Co-financing (details provided in Part II, Section E – Budget)
GEF Agency
National Contribution
Others, WHO / 625,000
Sub-Total PDF Co-financing: / 625,000
Total PDF Project Financing: / 1,094,685

* Indicate approval date of PDFA

** If supplemental, indicate amount and date of originally approved PDF

This proposal has been prepared in accordance with GEF policies and procedures and meets the standards of the GEF Project Review Criteria for approval.
Mr. Frank Pinto
Executive Coordinator
UNDP/GEF / Ms. Bo Lim
Project Contact Person
Date: January 24, 2006 / Tel. and e-mail: (212) 906-5730,
Lionel Nurse, Permanent Secretary, Ministry of Housing, Lands and the Environment (Barbados);
Ronald Knight, Chief Medical Officer, Ministry of Health (Barbados);
Kamal M. Khdier, Adviser, GEF OFP, Ministry of Planning & International Cooperation (Jordan);
Sa’ad Kharabaheh, Secretary Genera, Ministry of Health (Jordan)
C. Tuiloma, GEF OFP, Ministry of Local Government, Housing, Squatter Settlement & Environment (Fiji);
W. D. L. Waqatakirewa, Chief Executive Officer, Ministry of Health (Fiji)
Alfred K. Lang’At, Permanent Secretary, Ministry of Health (Kenya);
Ratemo W. Michieka, Director General, National Environment Management Authority (Kenya);
Sergey Myagkov, GEF OFP, Cabinet of Ministers (Uzbekistan);
A. M .Hadzhibayev, First Deputy Minister, Ministry of Health (Uzbekistan)
Gado Tshering, Oftg. Secretary, Ministry of Health (Bhutan);
Senam Wangchuk, Director General, Ministry of Finance
Xing Jun, Director, Ministry of Health (China); / Date:
August 30, 2005
August 5, 2005
August 31, 2005
April 10, 2005
August 19, 2005
April 5, 2005
July 13, 2005
July 21, 2005
July 20, 2005
March 31, 2005
June 13, 2005
December 22, 2005
April 8, 2005
Endorsement letters from GEF Operational Focal Points and Ministries of Health attached

26

PART I - Project Concept

A - Summary

  1. Climate change, including climate variability, has multiple influences on human health. Direct impacts include the effects of rising temperatures and more intense heat waves and floods resulting changes from changes in the hydrological cycle. Potentially larger impacts are from indirect mechanisms, such as the effect of warming and more variable climate, on provision of drinking water, sanitation, and agricultural production, as well as on transmission of vector and water-borne diseases. The World Health Organization (WHO) estimates that climate change may already be causing over 150,000 deaths per year. These health impacts are overwhelmingly concentrated in the poorest regions of the world. Unless health adaptation mechanisms are implemented, these climate impacts are likely to increase in the future.
  1. Well-planned adaptation measures should reduce these health impacts, and associated negative effects on development. Although there is an increasing awareness in the health sector that climate change poses significant threats to human health, practioners have concentrated on reactive responses, historically. Consequently, little attention has been paid to exactly what vulnerable developing countries can do differently to minimize adverse health impacts of climate change in a cost-effective manner, while simultaneously strengthening efforts to solve current health problems. Such actions would require coordination between all sectors dealing with climate change adaptation, as well as those implementing broader development plans.
  1. Generic approaches for adaptation to climate change have been developed, but there is still limited experience in applying these in the field. None have been applied for health considerations in developing countries. By drawing upon successful health interventions, this project will address this need.
  1. The goal of the project is to "implement a range of strategies, polices and measures that will decrease health vulnerability to current climate variability and future climate change" in a range of vulnerable countries. The PDF B stage of the project will work in 7 countries in different kinds of vulnerable ecosystems (highland, water-stressed and low-lying developing regions). This stage will focus on identifying adaptations in health and related sectors, that improve health now, while increasing resilience to climate change in the future, and on identifying the constraints on implementation. The full project will focus on selecting and prioritizing cost-effective adaptations, and finally, implementing these adaptations in the field.
  1. Project development and implementation will be driven by input from national stakeholders, who are directly exposed to climatic risks to health. This will include representatives of population subgroups that are likely to suffer health effects from climate change, as well as practitioners who would be expected to address these health consequences, such as staff of disease control programmes, health centres and hospitals. The results of the project are, therefore, directly relevant to decision-makers in other parts of the world, who face similar issues and constraints. To facilitate learning, the UN agencies involved will ensure that best practice experiences are shared as efficiently as possible with other similar vulnerable countries.
B - Country ownership

B.1. Country Eligibility

6.  The project will be global in scope, with 7 countries participating in the PDF B phase. Rather than proposing projects on an ad-hoc basis, the project strategy is to work with a set of countries with different kinds of health risks caused by climate change.

7.  The participating countries were included according to the following:

·  Populations in three different ecosystem zones: low-lying developing countries, desert/desert-fringe countries, and highland communities;

·  Strong interest from the national health sector, as well as Ministries and stakeholder groups from other relevant sectors, to address climate sensitive health issues, expressed through documentation produced by Ministries of Health, and national communications to the United Nations Framework Convention on Climate Change (UNFCCC);

·  Synergy with ongoing or planned WHO, UNDP and GEF projects operating in the country or region;

·  Strong motivation of the relevant WHO and the United Nations Development Programme (UNDP) country and regional offices, to address climate-sensitive health impacts.

8.  Applying these criteria, WHO and UNDP have utilized their network of regional and country offices to identify eligible countries. These are Barbados and Fiji (low-lying developing), Uzbekistan and Jordan (desert/desert-fringe), Bhutan, Kenya and China (highland populations). Each of the countries has ratified the UNFCCC.

B.2. Country Drivenness

9.  In terms of cost effectiveness, the project will deliver benefits to seven GEF-eligible countries through on-the-ground definition of long-term strategies for adaptation, and implementation of policy changes and specific intervention measures. As such, the project could have been presented as an equivalent number of medium-sized projects (MSP’s) entirely driven by each of the individual countries.

10.  An added advantage of the proposed global approach is the opportunity for learning and exchange of lessons among those countries sharing similar types of vulnerability, and those facing different types of climate change impacts. Consequently, the proposal of a single, global full-sized project (FSP) will yield greater benefits than an equivalent number of nationally executed MSP’s for which coordination and exchange of lessons would be more complex and less cost-effective.

11.  All the countries participating in the project have highlighted the importance of health concerns, including prominently featuring health concerns within their National Communications to the UNFCCC, (e.g. Bhutan initial national communication, foreword, first paragraph[1]) see Annex A. They also highlight lack of examination of health adaptation policy options as a key need (e.g. UNFCCC documentation from Kenya[2]). National health agencies are now more forcefully stating the importance of detailed coverage of health vulnerability and adaptation within the next round of national communications (e.g. proposal from the China Centers for Disease control, Ministry of Health, for full involvement in the national coordination committee on climate change).

12.  All participating countries have a strong motivation to carry out the project, and to integrate the findings into national policy and practice. Previous activities (e.g. WHO awareness raising workshops), and ongoing consultations with each country have confirmed that health and other relevant national ministries, as well as WHO and UNDP country and regional offices, are committed to working on adapting to climate change which threatens health. Endorsement letters from both the national Ministry of Health and the GEF Operational Focal Point in each country are attached.

C – Program and Policy Conformity

C.1. Program Designation and Conformity

13.  The project meets the criteria of the Special Climate Change Fund (SCCF). The project treats climate change adaptation as issue that must be integrated into the long-term planning of national health processes. In turn, health considerations should be integrated into other planning processes for agriculture, environmental protection and economic development. At the practical level, this means that adaptation to climate change can only be cost-effective and sustainable, if it is driven by the national policy development agenda.

C.2. Project Design

Problem statement

14.  The understanding of the relationship between climate, health, and ecosystems is improving rapidly. WHO estimates that by the year 2000, the climate change which had occurred since the mid 1970s was responsible for more than 150,000 deaths per year These estimated health impacts are significant (e.g. compared to those from outdoor air pollution), and overwhelmingly concentrated on the poorest populations. These impacts are estimated to approximately double by the year 2030. Although direct and immediate impacts such as deaths in heat waves and floods can often be dramatic and provoke immediate policy-responses, the most important long-term influences may well be through changes in natural ecosystems and their impacts on disease vectors and water-borne pathogens.

Figure 1. Comparative size and distribution of the health burdens of climate change and air pollution, in Disability Adjusted Life Years (1000s).

15.  There is an increasing awareness in the health sector that climate change poses significant long term threats. Previous international and national assessments of climate change impacts, however, have focused on assessing past impacts, and highlighted vulnerabilities to future risks, rather than on evaluating response measures. In addition, the health sector in the poorest and most vulnerable countries has historically concentrated on reactive responses, such as disease treatment. It has had little capacity or incentive either to consider how to develop long-term approaches to reduce risks in the future, or to work with other sectors. This is a dangerous situation, running the risk that potentially effective health adaptation options remain unidentified, unimplemented, or worse still are implemented too late. It is well known that emergency response is often more expensive, and less effective.

Project Strategy:

16.  The project goal is to "implement a range of strategies, polices and measures that will decrease health vulnerability to current climate variability and future climate change".The project will implement climate change adaptation into the health sectors by improving adaptive capacity in seven countries showing different kinds of health vulnerabilities to climate change. The current baseline situation, is that these health risks are dealt with mainly through reactive and curative interventions. The project will identify, evaluate, promote and implement adaptation strategies, policies and measures to minimize health impacts from climate change, through preventive approaches.

17.  The PDF-B will:

·  Systematically review the health vulnerabilities under climate change for each country;

·  Analyse successes and failures of past health interventions under current climate;

·  Work with cross-sectoral groups to screen locally-appropriate strategies, policies and measures to increase adaptive capacity and to identify barriers to implementation;

The full project will:

·  Work with the cross-sectoral groups to complete cost-effective analysis of policies screened during the PDF-B phase, in order to prioritize among alternative methods of intervention;

·  Implement strategies, policies and measures that maximize cost-effectiveness, within the feasible budget of the GEF. All will concentrate on long-term adaptation for a preventive approach, to deal both with gradually evolving risks, such as salination of water supplies, and for better advance planning and early warning to address health effects of weather-related extreme events, such as natural disasters and disease epidemics;

·  Synthesize lessons learnt to provide a field-tested framework that can be extended to other vulnerable countries.

Baseline situation

18.  Conceptual frameworks have recently been developed to promote climate change adaptation, such as the “Adaptation Policy Frameworks“ (APF) developed by UNDP and partners[3], and the 'Methods of assessing human health vulnerability and public health adaptation to climate change’[4] developed by WHO. Together these two publications provide a systematic approach to adaptation. This is a necessary next stage for assisting vulnerable countries to carry out the individual steps of assessments for identifying specific policies where climate change adaptation should be integrated into operations of health systems and related sectors.

19.  These frameworks and methods have not been systematically applied in developing countries yet. Current experience with vulnerability assessments lie within the National Communications, but with little practical application in the field. If this situation continues, vulnerable populations remain exposed to potentially avoidable climate risks to health.

20.  In countries, the health adaptation baseline can be expressed by using quantitative indicators of health vulnerability to climate, including the current level of health impacts caused by diseases that are known to be sensitive to climate variations. These indicate, for example, that over 25% of all deaths and illnesses in Africa are caused by diseases that are strongly sensitive to climate[5], with even higher rates of incidence in especially vulnerable countries throughout the developing world. More detailed indicators, by country, by specific cause (e.g. deaths and injuries in floods and other climate-driven disasters, burdens of specific infectious diseases) and progression over time, are available from databases held by WHO and other agencies.