3.3 Climate-sensitive disease control/water programmes strengthened 3.3.1 Prevention training for heat-related disorders in agricultural and industrial workers 3.1.1 Improve vector-borne disease control programmes, ensuring effective response for disasters and health impacts of climate change 3.1.2 Climate-resilient water safety plans in vulnerable townships 3.1.3 Assess nutritional status and identify most vulnerable states and regions to climate related impacts to nutrition 3.1.4 Develop and implement nutritional programmes in most vulnerable states and regions 3.1.5 Carry out integrated assessments of ambient air quality, climate change and related diseases patterns 3.1.6 Carry out water scarcity and health impact study in dry zone area 3.1.7 Implement climate-resilient water safety plans in vulnerable townships 3.1.8 Conduct advocacy meeting of for climate-resilient infrastructure in vulnerable areas and communities 3.1.9 Develop information, education and communication materials for stakeholders and community within and outside health sector 3.1.10 Raise awareness among community, including schools on health impacts due to climate change Nepal 3.1 Health care infrastructure strengthened to the impacts of climate change 3.1.1: Assess climate resilience of health facilities in different ecological regions. 3.1.2: Climate-proofing of health facilities piloted based on national guideline, in selected Terai, (lowland), hill and mountain regions 3.2 Capacity of health personnel improved to identify and treat to climate-sensitive health issues 3.2.1: Orientation to health management personnel on climate resilient water safety plans. 3.2.2 Conduct training on climate change and health, including prevention, control, management and surveillance of climate-sensitive diseases and risks to health personnel in pilot districts. 3.3. Climate-sensitive disease control/water programmes strengthened 3.3.1: Implement climate-resilient water safety plans in selected districts of the Terai (lowland), hill and mountain regions.
Accountability and rule of law: will be upheld by following the clauses included in the agreement signed between UNDP and WHO regarding policies on monitoring, evaluation, audits and transparency in project implementation. The legal context is also defined in this agreement. Gender Equality and Women’s Empowerment: Gender indicators with gender disaggregated data are incorporated in the project's Results Framework for monitoring progress during implementation and evaluations. In terms of the UNDP Gender Marker, the project has been rated GEN 2. Table 7: Project Risks and Mitigation Measures Project Risks Description Type Probability (p) and Impact (I) Mitigation Measures Owner Status Risk 1: Technical capacity. Stakeholders do not distinguish vulnerability to climate change from baseline weaknesses in disease control practices and management of environmental determinant of health (especially related to food and water security) Operational P = 2, I = 3 Will undermine impact of project due to lack of perceived correlation between new effort and improving health treatment Integration of monitoring and evaluation systems with surveillance and early warning systems will support correlation of health metrics against climate change factors. Maintain proactive awareness raising and communication programmes, coupled with technical training and application of health information and early warnings to help differentiating climate and drivers for the implementation of integrated adaptation interventions MOH, WHO, Project manager No Change Risk 2: Turnover of government staff who will be managing various project components and potentially negate benefits of training Operational P = 3, I = 2 Rapid turnover of government staff leading implementation activities results in loss of capacity and institutional knowledge; disrupts progress, and potential changes in direction of activities. Degrade the long term To reduce negative impacts of staff turnover, the project will appoint supporting project management unit staff to ensure continuity and smooth transition. The project will focus on institutionalization of all outputs and outcomes to ensure sustainability of MOH, WHO, Project manager No Change
sustainability of project. project products and achievements through emphasis of a approach to capacity building efforts and on development of detailed training material over heavy investments on individuals. Risk 3: Poor inter-ministerial collaboration, considering cross-sectoral nature of health, to effectively integrate health into adaptation planning. Organizational / Institutional P = 2, I = 4 This is a key sustainability risk for the project as almost all activities require collaboration between ministries or departments. Insufficient collaboration could cause significant delays to all four outcomes The project will support coordination through its activities, building to the extent possible on existing coordination mechanisms. Further, a stakeholder engagement plan has been developed as part of project preparation activities. The plan will be revisited and revised as needed during implementation to ensure it is comprehensive and inclusive given local contexts. MOH, WHO, Project manager No Change Risk 4: Ensure that DDT and other environmentally harmful pesticides are recommended for newly developed mosquito control Environmental P = 2, I = 1 Review of newly developed guidelines and policies to ensure this is not implemented nor recommended as a means of control. Project Manager No Change
Award ID: 00105394 Project ID(s): 00106651 Award Title: PIMS 5400 FSP Building Resilience of Health Systems in Asian LDCs to Climate Change Business Unit: UNDP - GEF Project Title: PIMS 5400 FSPBuilding Resilience of Health Systems in Asian LDCs to Climate Change PIMS no. 5400 Implementing Partner (Executing Agency) World Health Organization Outcome/ Atlas Activity Responsible Party/ Implementing Agent Fund ID Donor name Budgetary Account Code Atlas budget description Amount Y1 (USD) Amount Y2 (USD) Amount Y3 (USD) Amount Y4 (USD) Total Budget Notes (Annex 8) Outcome 1: Institutional capacities are strengthened to effectively integrate climate risks and adaptation options in health sector planning and implementation WHO and Various (Country Specific) 62160 LDCF 71200 International Consultants 54,400 67,500 14,400 24,400 160,700 1A 71300 Local consultants 110,600 128,600 111,600 73,150 423,950 1B 71400 Contractual Services - Individual 48,500 52,000 43,500 40,500 184,500 1C 71600 Travel 27,104 36,380 14,184 12,185 89,853 1D 72100 Contractual Services - Companies 112,300 115,000 103,500 104,000 434,800 1E 72200 Equipment and Furniture 15,000 - - - 15,000 1F 72500 Supplies 24,200 12,200 9,200 7,000 52,600 1G 74200 Audio Visual & Print 27,000 5,000 - - 32,000 1H
Production Costs 75700 Training, Workshops and Conferences 118,500 173,500 113,500 108,500 514,000 1I Total Outcome 1 (Includes M&E Costs) 537,604 590,180 409,884 369,735 1,907,403 Outcome 2: Effective decision-making for health interventions is enabled through generation of information and improved surveillance and/or early warning systems WHO and Various (Country Specific) 62160 LDCF 71200 International Consultants 89,800 95,500 34,050 26,050 245,400 2A 71300 Local consultants 74,850 80,600 73,200 54,600 283,250 2B 71400 Contractual Services - Individual 10,000 20,000 15,033 10,000 55,033 2C 71600 Travel 44,788 45,380 27,638 26,638 144,444 2D 72100 Contractual Services - Companies 225,500 198,500 181,366 138,000 743,366 2E 72500 Supplies 52,200 48,800 30,700 24,700 156,400 2F 72800 Information Technology Equipment 16,000 17,000 17,000 10,000 60,000 2G 75700 Training, Workshops and Conferences 105,000 110,000 78,000 52,000 345,000 2H Total Outcome 2 (Includes M&E Costs) 618,138 615,780 456,987 341,988 2,032,893 Outcome 3: Climate resilience is enhanced in health service delivery WHO and Various (Country Specific) 62160 LDCF 71200 International Consultants 60,800 61,300 43,900 52,900 218,900 3A 71300 Local consultants 151,600 144,600 110,100 86,600 492,900 3B 71400 Contractual Services - Individual 50,000 60,000 50,000 38,000 198,000 3C
71600 Travel 56,288 60,288 38,744 33,584 188,904 3D 72100 Contractual Services - Companies 223,500 291,500 174,500 132,500 822,000 3E 72200 Equipment and Furniture 34,000 47,000 46,000 1,000 128,000 3F 72500 Supplies 56,700 103,200 81,700 34,400 276,000 3G 75700 Training, Workshops and Conferences 236,000 200,000 160,000 119,000 715,000 3H Total Outcome 3 (Includes M&E Costs) 868,888 967,888 704,944 497,984 3,039,704 Total Outcome 1-3 2,024,630 2,173,848 1,571,815 1,209,707 6,980,000 Outcome 4 Regional Cooperation and Knowledge Management WHO (Outcome 4.1 Enhanced regional cooperation and knowledge exchange for promoting and replication of interventions) 62160 LDCF 71200 International Consultants 67,500 67,500 67,500 67,500 270,000 4A 71400 Contractual Services - Individual 40,000 40,000 40,000 40,000 160,000 4B 71600 Travel 43,750 43,750 43,750 43,750 175,000 4C 72100 Contractual Services - Companies 15,000 30,000 15,000 60,000 4D 74100 Professional Services 30,000 50,000 30,000 50,000 160,000 4E 75700 Training, meetings and workshops 125,000 0 125,000 125,000 375,000 4F UNDP (4.2 H-NAP are effectively integrated into ongoing NAP processes) 62160 LDCF 71200 International Consultants 100,000 100,000 200,000 4G 75700 Training, meetings and workshops 100,000 100,000 200,000 4H
Total Outcome 4 321,250 431,250 521,250 326,250 1,600,000 Project Management Unit WHO/UNDP 62160 LDCF 71400 Contractual services 87,500 87,500 87,500 87,500 350,000 PMU1 72500 Supplies 2,500 2,500 2,500 2,500 10,000 PMU2 72800 Information Technology Equipment 18,000 18,000 PMU3 73300 Rental & Maint of Info Tech Eq 500 500 500 500 2,000 PMU4 74100 Professional Services 4,000 4,000 4,000 4,000 16,000 PMU5 74596 Service to Projects - GoE 1,000 1,000 1,000 1,000 4,000 PMU6 75700 Training, meetings and workshops 5,000 5,000 5,000 5,000 20,000 PMU7 Total PMU 118,500 100,500 100,500 100,500 420,000 Grand Total 2,464,380 2,705,598 2,193,565 1,636,457 9,000,000 Global Environmental Facility Sources of Co-Financing Type Y1 Y2 Y3 Y4 Total LDCF 2,464,380 2,705,598 2,193,565 1,636,457 9,000,000 Summary of Funds Sources of Co-Financing Type Y1 Y2 Y3 Y4 Total Bangladesh National Government In Kind/Grant $1,325,000 $1,325,000 $1,325,000 $1,325,000 $5,300,000 WHO In Kind/Grant $175,000 $175,000 $175,000 $175,000 $700,000
ANNEX 1: EXPECTED OUTPUTS and RESULT INDICATORS PLANNED ACTIVITIES (Grouped and Summarized from National Reports) TIMEFRAME RESPONSIBLE PARTY (Refer to Budget Notes – ANNEX 9) PLANNED BUDGET Y1 Y2 Y3 Y4 Funding Source Budget Description Amount Outcome 1 Expand and strengthen existing TWG to accommodate for CC and H. X X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous 400,000 Workshops and Annual meetings by TWG to monitor and develop Terms of References and MOU’s X X X X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous) 100,000 Conduct or update CC National Vulnerability Assessment as a basis for developing HNAP X X Various (Refer to TBP – Section VII) GEF Contractual Services – international and Local Consultants 650,000 Conduct baseline assessment of staff to establish knowledge gaps and develop training requirements X Various (Refer to Total Budget Plan (TBP) – Section VII) GEF Contractual services, training, workshops, travel, printing costs, audio-visual, professional services, transport 215,000 Prepare and deliver University Courses curriculum and training plans / sessions X X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous 90,000
Assess staff capacity and behaviour post training X Various (R efer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous 130,000 Identify, Assess and create / update National Standards, guidelines and SOPS for managing CC. X X Various (Refer to TBP – Section VII) GEF Contractual Services – international and Local Consultants 120,000 Develop Framework and MOU for sharing of needed data between MOH and other stakeholders. X X Various (Refer to TBP – Section VII) GEF Contractual services, training, workshops, travel, printing costs, audio-visual, professional services, transport 135,000 Monitor agreements to ensure data is shared; update as necessary X X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous 67,403 Outcome 2 2.1 Develop guidelines and tools for surveillance systems for climate sensitive diseases. X X X Various (Refer to TBP – Section VII) GEF Contractual Services – international and Local Consultants 115,000 2.2 MOU for sharing of key stakeholder data with MOH. (Especially meteorological data) X Various (Refer to TBP – Section VII) GEF Contractual services, training, workshops, travel, printing costs, audio-visual, professional services, transport) 67,893
2.3 Develop Early Warning Systems for climate sensitive diseases prediction, prevention and preparedness (may include Vulnerability Maps; Identify priorities and key affected areas) X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 650,000 2.4 Integrate CC, Weather monitoring, surveillance and early warning systems and pilot in selected areas X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 950,000 2.5 Train health staff in implementation of data analysis tools for CC X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous) 250,000 Outcome 3 3.1 Climate proofing of health care facilities piloted including better supporting WASH FIT. X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 1,770,000 3.2 Monitor and report on Health care facilities where staff have piloted new policies and procedures. (technical capacity improvements) X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 114,704 3.3 Improve community and health care provider knowledge of the prevention, recognition and management of CC health risks X Various (Refer to TBP – Section VII) GEF Training, workshops, meetings, exposure visits (travel), transport, Miscellaneous) 480,000 3.4 Develop IEC materials for stakeholders and community (promote WASH FIT at health centers) X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 150,000
3.5 Create and implement disaster management, safety and response plans, guidelines for health facilities for key areas. (including water safety plans) X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 350,000 3.6 Develop Communications materials to promote WASH FIT and behavior changes X Various (Refer to TBP – Section VII) GEF Contractual Services – International and Local Consultants 175,000 Outcome 4.1 Definition of normative aspects related to climate-resilient health systems by developing regional-level guidelines, manuals, and other relevant technical documents in the priority areas of intervention (e.g. climate-resilient health care facilities (CR-HCFs) and climate resilient Water Safety Plans (CR-WSPs)), as determined by countries; X WHO GEF Contractual Services – International and Local Consultants 200,000 Regional events for different topics (on policy, science and implementation of interventions) and conferences; X WHO GEF Contractual Services – International and Local Consultants 500,000 Systematization of regional experiences and promotion of North-South and South-South cooperation and knowledge exchange (which may include virtual communities of practice and platforms) X WHO GEF Contractual Services – International and Local Consultants 500,000
Outcome 4.2 Training and technical support for MOH to create a economic case for integration of health into adaptation plan and budgeting. X UNDP – BRH (GEF) GEF Contractual Services – International and Local Consultants 200,000 Training and technical support for designing/developing bankable projects (ie. To secure public or other finance) X UNDP – BRH (GEF) GEF Contractual Services – International and Local Consultants 200,000 Total Outcome1-4 8,580,000 Project Management Costs 420,000 Grand Total 9,000,000
Development of National Standards or guidelines for climate change and health systems Creation of new and updated standards and guideline. Documentation Reviews Stakeholder Interviews Annual Project Manager New Policy. Standards and SOPS created and made available for Health staff. Technical capacity to understand the correlation and response requirements for CC&H. Establish TWG. Project Outcome 2 Health Vulnerability and adaptation assessments (V&As) conducted/updated for current and future health risks Health vulnerability to climate change assessed and adaptation options defined so as for the health system to manage the health risks posed by climate change Documentation Reviews Stakeholder Interviews Annual Project Manager Updated/ new VA Reports Technical capacity to understand the correlation and response requirements for CC&H. Establish TWG. Integrated disease surveillance system for climate sensitive disease is developed and implemented in key pilot areas Incorporation of climate/weather variables to current surveillance systems for climate-sensitive diseases Documentation and database Reviews Stakeholder Interviews Annual Project Manager Updated or new database created or requirements are established. Technical capacity to understand the correlation and response requirements for CC&H. Establish TWG. Project Outcome 3 Climate sensitive disease control programmes and plans are strengthened Service delivery of selected climate-sensitive control programmes strengthend by incorporating climate/weather considerations Documentation and database Reviews Stakeholder Interviews Annual Project Manager Updated or new programmes and plans developed Technical capacity in developing guidelines and plans. Improved technical capacity of health personnel to manage the health risks posed by climate variability and change Train the trainer programs established and training completed in piloted areas. Documentation and database Reviews Stakeholder Interviews Annual Project Manager Updated or new training guidelines and modules. Survey Reports. Technical capacity in developing training guidelines and plans.
Terminal Evaluation N/A N/A Independent evaluators To be submitted to GEF within three months of operational closure Independent Evaluator Contracted by WHO UNDP Cleared TE Report Risks: The TE team do not have access to all stakeholders and fully updated and completed information on the project. There is a delayed or ineffective management response to the TE findings by the Project Board. 3: GEF Project identification Project title Building Resilience of Health Systems in Asian LDCs to Climate Change Country Bangladesh, Cambodia, Lao PDR, Myanmar, Nepal and Timor Leste GEF project ID 6984 GEF agency UNDP Agency project ID 5400 Executing partner(s) UNDP and WHO Council/CEO approval date Project status at submission Development Stage Tool submission date 25 Aug 2017 Project baselines, targets and outcomes Indicator Unit of measurement Baseline at CEO endorsement Target at CEO endorsement Actual at mid-term Actual at completion Comments (e.g. specify unit of measurement)
disease control practices and management of environmental determinant of health (especially related to food and water security communication programmes, coupled with technical training and application of health information and early warnings to help differentiating climate and non-climate drivers for the implementation of integrated adaptation interventions 2 Turnover of government staff who will be managing various project components and potentially negate benefits of training During project formulation Operational P: 3 I: 2 To reduce negative impacts of staff turnover, the project will appoint supporting project management unit staff to ensure continuity and smooth transition. The project will focus on institutionalization of all outputs and outcomes to ensure sustainability of project products and achievements through emphasis on development of detailed training material over heavy investments on individuals MoH/WHO Project Manager N/A N/A 3 Poor collaboration, considering cross-sectoral nature of health, to effectively integrate health into adaptation planning. During project formulation Organizational / Institutional P: 2 I: 4 The project will support inter-ministerial coordination through its activities, building to the extent possible on existing coordination mechanisms. Further, a stakeholder engagement plan has been developed as part of project preparation activities. The plan will be revisited and revised as needed during MoH/WHO Project Manager N/A N/A
If the answer to the screening question 6.3 is “yes” the potential risk impacts are considered potentially severe and/or critical and the Project would be categorized as either Moderate or High Risk. 6.4 Has there been an absence of culturally appropriate consultations carried out with the objective of achieving FPIC on matters that may affect the rights and interests, lands, resources, territories and traditional livelihoods of the indigenous peoples concerned? No 6.5 Does the proposed Project involve the utilization and/or commercial development of natural resources on lands and territories claimed by indigenous peoples? No 6.6 Is there a potential for forced eviction or the whole or partial physical or economic displacement of indigenous peoples, including through access restrictions to lands, territories, and resources? No 6.7 Would the Project adversely affect the development priorities of indigenous peoples as defined by them? No 6.8 Would the Project potentially affect the physical and cultural survival of indigenous peoples? No 6.9 Would the Project potentially affect the Cultural Heritage of indigenous peoples, including through the commercialization or use of their traditional knowledge and practices? No Standard 7: Pollution Prevention and Resource Efficiency 7.1 Would the Project potentially result in the release of pollutants to the environment due to routine or non-routine circumstances with the potential for adverse local, regional, and/or ? No 7.2 Would the proposed Project potentially result in the generation of waste (both hazardous and non-hazardous)? No 7.3 Will the proposed Project potentially involve the manufacture, trade, release, and/or use of hazardous chemicals and/or materials? Does the Project propose use of chemicals or materials subject to international bans or phase-outs? For example, DDT, PCBs and other chemicals listed in international conventions such as the Stockholm Conventions on Persistent Organic Pollutants or the Montreal Protocol No 7.4 Will the proposed Project involve the application of pesticides that may have a negative effect on the environment or human health? No 7.5 Does the Project include activities that require significant consumption of raw materials, energy, and/or water? No
Lao PDR Ms Oyuntogos Lkhasuren WHO Lao PDR Environmental Health Technical Officer Myanmar Dr. Than Tun Aung Ministry of Health Deputy Director General (Disaster) Myanmar Dr Alaka Singh , WHO Myanmar WHO Myanmar Environmental Health Technical Officer Nepal Dr. Meghnath Dhimal Project Consultant Nepal Mr Ram Khrisna Adhikari Ministry of Health Under Secretary, Ministry of Health Nepal Mr RajaRam Pote Shresthra WHO Nepal Water, Sanitation & Environment Health Technical Officer Timor-Leste Mr Basilio Martins Pinto Project Consultant Director for Policy, Planning, and External Cooperation, Ministry of Health Timor-Leste Mrs Tomasia de Sousa Ministry of Health Focal Point on Climate Change and Health - Head of Environmental Health Department All Countries Mrs. Payden WHO SEARO Water, Sanitation & Health Sanitary Engineer All Countries Dr. Mohd Nasir Hassan WHO WPRO Health and the Environment Division Coordinator All Countries Mr. Jung Sub Yeom WHO WPRO Health and the Environment Division Technical Officer All Countries Dr Rabindra Romauld Abeyasinghe WHO WPRO Malaria, and other Vectorborne and Parasitic Diseases Unit Coordinator All Countries Dr. Diarmid WHO HQ Climate Change and Health Unit Team Leader All Countries Dr. Lachlan McIver WHO HQ Consultant, Climate Change and Health All Countries Dr. Pradeep Kurukulasuriya UNDP Head, Climate Change Adaptation, Environment Finance All Countries Ms. Mariana Simões UNDP Regional Technical Advisor, Climate Change Adaptation, UNDP-Global Environment Finance
ANNEX 9: Bangladesh - Ministry of Health and Family Welfare US$5,300,000 Bangladesh - WHO US$700,000 Cambodia -Ministry of Health US$2,500,000 Lao PDR – WHO US$1,036,400 Lao - Ministry of Health (US$2,385,200) Myanmar – Ministry of Health and Sports US$3,000,000 Nepal – Ministry of Health US$3,300,000 Nepal – WHO US$700,000 Timor Leste – Ministry of Health US$1,500,000 Timor – WHO US$240,000