Health Vulnerability and Adaptation to Climate change Assessment in

Summary Report

Prepared by Sonia CASIMIRO TRIGO; Genito.Maure and Waltaji Terfa KUTANE, WHO Mozambique Executive summary

Statistics from Inform's Risk Management Index 2018 indicate that among 191 countries, Mozambique is considered high risk and is ranked as the 19th highest risk country, 46th in terms of risk and exposure, 11th in terms of vulnerability and 31st in terms of lack of capacity to deal with impact. In this context of increased vulnerability, the possible impact of climate change on health can only be mitigated by preparing, adapting and strengthening health systems, based on knowledge of risk, through an assessment of vulnerability and adaptation of the sector to climate change1

This study presents an assessment of health sector vulnerability and adaptation to climate change with a national dimension. It is a pioneer in Mozambique as such an assessment is being carried out in this sector for the first time in the country. A further novelty of this study is that it was carried out taking the district as the unit of analysis, which is exceptional when compared to similar assessments in other countries and/or other sectors.

The study has developed a vulnerability assessment methodology that can and should serve as the basis for a sustainable model for assessing and monitoring health sector vulnerability to climate in Mozambique, which is regularly updated, in which vulnerability is determined and quantified through the Health Vulnerability Index (HVI), according to a methodology recommended by the World Health Organization (WHO). Thus, the HVI was calculated from the indexes of the three factors that determine vulnerability, namely: Exposure (E), Sensitivity (S) and Adaptive Capacity (AC), for each district in the country. Each of the index was calculated based on multiple indicators of climate, demographic, health and health resources, water and sanitation variables and health determinants. For this purpose, secondary data were collected from various sources, such as the Ministry of Health, the National Institute of Meteorology, the National Institute of Statistics, the National Institute of Health, the National Institute of Disaster Management, the Technical Secretariat for Food Security, the National Directorate of Water Supply and Sanitation, among other sources.

1 Thow, A., Vernaccini, L., Marin Ferrer, M., & Doherty, B. (2017). Inform Global Risk Index - Results 2018. Publications Office of the European Union (pp. 1–40). https://doi.org/10.2760/754353 In addition, an assessment of the impact of climate change on two climate-sensitive diseases in Mozambique was carried out, namely Malaria and acute diarrhea. For this purpose, the country was divided into four regions (north, coast, centre and south) and two districts in each region were selected. For each of these eight districts a statistical analysis of the trend and correlations between two climate variables, temperature and precipitation, and the incidence of Malaria and acute diarrhea were performed. Projections of the impact of climate change on the incidence of malaria and diarrhea in the short, medium and long term were also calculated considering three scenarios of low, medium and high emissions. Finally, a case study of two emerging diseases, dengue and chikungunya, in Mozambique was presented.

Main results

Vulnerability analysis:

● Mozambique is a country with high exposure to climate change (CC). The results showed that CC exposure is very high in the provinces of the southern regionof the country, especially in the districts of Chokwé, Xai-Xai, Guijá, Chinuto and Massingir, in ; and in the districts of Govuro, Massinga and Homoíne, in Province. The results also showed greater exposure to CCfor the districts in the coastal zone, with greater notoriety for the district of Marromeu in Sofala . The results showed that the sensitivity indices range from high to very high for 12 districts, namely Ka-Nhlamanculo, Ka-Mpfumo, Mleuco, Beira, Caia, , Kamaxakeni, Massingir, Quelimane, Mecufi, Tete and Ibo. The result for adaptive capacity showed that51 and 63 districts have low and very low adaptive capacity respectively. The results are consistent with other studies and information and reveal a large urban/rural inequality. Out of the 125 districts in the country, only 11 of them Fig1;Health Vulnerability Index (HVIs) by have high to very high AC and on all them are from district of Mozambique city except Kanyaka, and the urban districts of Matola, Quelimane, Beira, Xai-xai and Inhambane. None of provincial capitals appears in the group of districts with low to very low AC category. A north/south geographical pattern of AC distribution was also found, and in general AC is smaller in the northern half of the country than in the southern half..

Following analysis of exposure, sensitivity and adaptive capacity of the health sector to climate change the following Health Vulnerability Index has been developed for Mozambique (fig 1)

The detail result of vulnerability analysis is summarized below:

● Forty-two (42) districts, corresponding to 31.8% of the national territory and 24.1% of the population, have a high to very high HVIs. The districts with high or very high HVIs are in the provinces of Zambézia (9 districts), Nampula and Inhambane (8 districts each), Gaza (6) and Sofala (4), Tete (2) (1), Niassa (1) and Manica (2). Eight (08) of the 42 districts had a very high HVIs, namely: Govuro, Massingir, Marromeu, Machanga, Nacaroa, Mabote, Chibuto and Nicoadala. ● The HVIs of the country's districts with droughts floods) and cyclones indicate that: ○ Eleven (11) districts (9.3% of the national territory and 4.2% of the population) have a very high HVIs, namely, in decreasing order of IVS: Panda, Mabote, Funhalouro, Govuro, Marromeu, Massingir, , Homoíne, Chokwe, Nacaroa and Massinga. Additionally, 15 districts (13.2% of the territory and 5.3% of the population) have a high HVIs. The districts with the highest HVIs are mainly located in the south of the country, especially in the province of Inhambane. ○ Twelve (12) districts (8.2% of the territory and 7.2% of the population) have a very high HVIs namely, in decreasing order of HVIs: Nhamatanda, Mopeia, Caia, Mutarara, Morrumbala, Machanga, Maganja da Costa, Xai- xai, Cahora Bassa, Magoe, Buzi and Guijà. A total of 19 additional districts have a high HVIs (10.5% of the territory and 11.2% of the population). The geographical distribution of the most vulnerable districts to floods follows the main hydrographic basins in the country. ○ Four (04) districts have very high HVIs (2.2% of the territory and 3.5% of the population): Larde, Moma, Massinga and Nhamatanda. A total of 17 additional districts (9.7% of the territory and 11.9% of the population) have a high HVIs. The districts with the greatest vulnerability to cyclones are located along the coast between the provinces of Inhambane and Nampula.

Main Recommendations

Based on the results of this evaluation the following recommendations were identified to improve the health response and ensure climate resilient health system addressing weather variability and climate change:

• Use this study as a reference for the MoHM to develop and validate a model for monitoring vulnerability and impact of health sector climate change that can be regularly updated and ensure that vulnerability and adaptation are incorporated across health sector policies, strategies, plans, etc., such as the next Health Sector Strategic Plan (HSP). • Immediately develop the National Health Adaptation Plan, based on the findings of this study, with focus on the District. • Improve access and availability of Health data through integration of the SI-SMA Basic Module data; • Strengthen climate prediction, early warning and disaster response systems with the inclusion of sector contingency plans, including a manual of procedures of the MOH for preparing for, responding to and recovering from climate emergencies and/or calamities • To improve epidemiological surveillance throughout the country, especially of diarrhea and emerging diseases, and in situations of calamities caused by extreme weather events. • Train more health personnel from the most vulnerable areas for each type of event (droughts, cyclones, floods) and reduce inequity in human resource allocation by defining allocation criteria using HVIs. Integrate climate change and emerging diseases programmatic content into the training curricula of health technical staff. • To promote communication, education and awareness campaigns among citizens, individuals and communities for greater knowledge and a better response to the challenges of the CC. • Incorporate a gender perspective in the design of strategies, plans and actions designed to mitigate the impact of CC and improve adaptive capacity. • To improve access to safe water sources and safe sanitation in the most affected districts. • Strengthen cross-sectoral coordination and partnerships with other ongoing adaptation programmes in the country taking advantage of complimenting funding such as the Green Climate Fund and others. • Strengthen related research activities