reduction measures are cost-effective in mitigating the negative impacts of weather extremes. For instance, China’s investment of US $3.15 billion on flood control between 1960 and 2000 is estimated to have averted losses of about US$ 12 billion while the Rio de Janeiro flood reconstruction and prevention project in Brazil yielded an internal rate of return exceeding 50%<sup>19</sup> .

# **Public Health**

39. Climate change has a potential to exacerbate the challenges faced by the health sector today, namely control over water-borne diseases and malaria as well as coping with disaster-related pressures. Water-borne diseases are already a major cause of children’s morbidity and account for 27% of all post-neonatal deaths<sup>20</sup> . While warming climate increases vulnerability to different infections, the primary cause of disease in Tajikistan is inadequate access to clean water as well as poor sanitation and hygiene. Deteriorating health infrastructure, particularly in rural areas further compounds these problems.

40. Current government health reforms aimed at development of family medicine should be continued with a particular attention to the needs of rural areas. Apart from raising qualifications of medical professionals working in rural areas, rehabilitating the facilities and providing medical equipment, it is also important to integrate community outreach and education activities (particularly on hygiene issues) into primary health care. According to WHO estimates, hygiene education and promotion of hand washing can lead to a reduction of diarrheal cases by up to 45% as well as reduce the spread of many other infectious diseases<sup>21</sup> . Similarly, improvement of access to safe drinking water has a strong influence on health outcomes. For instance, the incidence of dysentery, diarrhea and viral hepatitis in five villages of the Soghd region, where the Red Crescent Society helped construct spring water supply systems, has declined by 41% on average over 2007-2008<sup>22</sup> . Some immediate results could also be achieved by educating the communities about different ways to treat water, like chlorination at the point of use, boiling, or use of filters.

41. The health sector should be prepared to respond to a potential increase in climate shocks. This will involve prevention of heat-related illnesses (e.g. heat strokes), ensuring that primary health care facilities particularly in remote rural areas have stockpiles of essential medicines as well as access to transportation to take patients to urban centers in case of emergencies, and increasing vaccination against major infectious diseases. It is also important to sustain the success of malaria control measures, which have resulted in reduction of malaria cases from almost 30,000 in 1997 to 635 in 2007<sup>23</sup> . Vector control programs, training of medical staff in malaria prevention and treatment as well as community education campaigns should continue to prevent any future outbreaks.

42. The above mentioned adaptation priorities are in conformance with the directions of reforms outlined in the latest Poverty Reduction Strategy of Tajikistan 2010-2012. In fact, poverty reduction is an integral part of climate change adaptation. Higher income levels, improved health and education as well as better access to quality public services and infrastructure enhances the capacity of households, particularly the poor, for autonomous adaptation.

> 19 UNISDR.2008. _Climate Change and Disaster Risk Reduction_ . Briefing Note 01.Geneva

> 20 UNDP. 2005. _Investing in Sustainable Development: Millennium Development Goals Needs Assessment_ , Dushanbe

> 21 WHO. 2004. Water, Sanitation and Hygiene Links to Health. Facts and Figures 22 International Federation of Red Cross and Red Crescent Societies. 2009. Annual Report. Central Asia (Focus on Tajikistan)

> 23 WHO. 2008. _World Malaria Report 2008_ .

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