Integrating climate disasters with health and nutrition in Bihar
Author: Dr. Nitish Dogra, Sector Advisor (Health and Nutrition), Policy and Public Services
According to a latest University College London led commission the threat to human health from climate change is so great that it could undermine the last fifty years of gains in development and global health. Climate change impacts health indirectly through air, water, food and vectors and directly through thermal stress as well as climate disasters such as floods, droughts and cyclones. The Bihar Technical Assistance Support Team (BTAST) was set-up for a sector-wide approach to health with nutrition as well as water and sanitation issues. This project extends the sector-wide approach to climate disasters by focusing on the most vulnerable flood affected areas.
Health sector planning has traditionally focused on prevalence, in other words on cases revealed by the health system. This can be erroneous, particularly since a majority of the population is relying on health providers outside the government health system. If on the other hand we view health planning through the lens of vulnerability, it is possible to assess the true impact of climate related health conditions. On the basis of prior work related to climate vulnerability indices in the health sector, in India and beyond, the exercise aims to bring about this critical paradigm shift in planning.
A vulnerability index was derived using the Intergovernmental Panel on Climate Change (IPCC) framework of vulnerability being a function of exposure, sensitivity and adaptive capacity. This involved a two-step process of indicator finalization by the BTAST team followed by weightage by national and international experts who are well-versed with the methodology. The final tool involved sixteen different socio-economic, health and disaster indicators. It was also validated by a qualitative assessment in 3 of the study districts.
The investigation has shown that out of the fifteen districts Madhepura, Sitamarhi, Sheohar, Muzzafarpur and East Champaran are in the highest tertile (one-third) in terms of vulnerability. Other key findings are the following.
- Vulnerability did not coincide with disease prevalence and an inverse relationship was seen in many cases.
- Several factors contribute to this phenomenon including health access issues in the most vulnerable districts.
- Although health seeking behavior has increased, there is still a reluctance to utilize government health facilities.
- Women, children, elderly, the poor as well as the marginalized such as Dalits and Mahadalit are most affected.
- Besides other health outcomes related to floods, snake-bites are an important component.
- Human resources for health such as doctors, district epidemiologists and anganwadi workers remain a critical concern which adds to the vulnerability.
- Malnourishment is also widespread.
- For effective disaster management, enhanced early warning systems, strengthened emergency management services (EMS), triage training, a dedicated cadre of community volunteers and a good road network is essential.
Thus, in moving from prevalence to vulnerability for health sector planning, we provide decision makers in the country with a practical tool. We are hopeful that other countries, particularly those in the South Asia and South-East Asia region also adopt this tool for the benefit of their systems and society. At a larger level, inter-departmental coordination and convergence between Disaster, Environment, Health, Women & Child Development as well as Public Health Engineering Department is crucial for overall planning. This is linked to both the system and society at large.