Climate Change & Health Adaptation in Fiji

CLIMATE CHANGE & HEALTH ADAPTATION IN FIJI

A project proposal for climate change and health adaption for five years by the Ministry of Health & Medical Service, Fiji

Fiji Proposal for Climate Change & Health Adaptation

Preface

Fiji is among the vulnerable island nations that are facing the severe effects of climate change. Coastal communities are experiencing rising sea levels exacerbated by more devastating disasters such as cyclones, floods and drought through our island nations. Our facilities and infrastructure are suffering greater damage with the increasing intensities and frequencies of the natural disasters. Food security has been threatened as planting areas get inundated with sea water and the oceans become increasingly acidified. Access to safe water supply is compromised due to severe droughts, salt water intrusion and frequent flooding contaminating domestic water supplies.

Life itself is under threat in Fiji as a result of the impact of climate change. We must take action. We must continue the fight against the forces that led to climate change in the first place. We must also adapt to what has already happened and events we are currently experiencing.

Communicable diseases spread by vectors have increased. Current trends show increasing frequencies of endemic diseases such as dengue, diarrhoea and typhoid outbreaks. Emergence of new diseases is observed as our country experience first cases of chikungunya and Zika in the recent past. It is also noted that climate change and natural disasters have a direct impact on NCDs as our people are forced to resort to processed foods to survive. Increasing temperatures and extreme weathers discourage our populations from outdoor activities leading to sedentary lifestyles that promote NCDs.

There is evidence suggesting a close interdependence of marine ecosystems and climate. This is seen in the increases in ciguatera resulting from rising temperature as a result of the enhanced greenhouse effect. Our coral reefs are under increasing pressure from human activities in recent years and ciguatera may be a sensitive indicator of environmental disturbance in tropical marine environment.

We must ensure that we build resilience into our people, into our health system and services and also in our health facilities. We must ensure that we build resilience into our people, into our health system and services and also in our health facilities.

Fiji Proposal for Climate Change & Health Adaptation

CONTENTS

1 PROGRAM OUTLINE ...... 4

2 SITUATION ANALYSIS ...... 6

2.1 Current Situation ...... 6

2.1.1 Background...... 6

2.1.2 Map of Fiji ...... 8

2.1.3 Fiji Country Profile ...... 9

2.1.4 Health Status of Fiji ...... 10

2.1.5 Mission, vision, values and structure of Fiji MoHMS...... 11

2.2 Problem Analysis ...... 13

2.2.1 Problems of Climate Change in Health Sector ...... 13

2.2.2 Problems of Climate Change in Water & Sanitation ...... 14

2.3 Rationale of the climate change and health adaptation program ...... 14

2.3.1 Opportunities and Comparative Advantage for Health Adaptation ...... 14

2.3.2 Challenges in strengthening health systems to manage the health impacts of climate change ...... 15

2.3.3 Evidence for Action ...... 16

2.3.4 Climate Change and Health Strategic Action Plan (CCHSAP) 2016 - 2020 ...... 17

3 PROJECT DESCRIPTION ...... 19

3.1 Goal ...... 19

3.2 Expected Results ...... 20

3.3 Detail Activities ...... 21

3.4 Project Details ...... 23

3.4.1 Health Facility 1 ...... 25

3.4.2 Health Facility 2 ...... 26

3.4.3 Health Facility 3 ...... 27

3.4.4 Health Facility 4 ...... 28

3.4.5 Health Facility 5 ...... 29

Fiji Proposal for Climate Change & Health Adaptation

3.4.6 Health Facility 6 ...... 29

3.4.7 Health Facility 7 ...... 29

3.4.8 Health Facility 8 ...... 30

3.4.9 Health Facility 9 ...... 31

3.4.10 Health Facility 10 (Retrofitting & Rehab) ...... 32

4 PROGRAM IMPLEMENTATION ...... 41

4.1 Program implementation structure ...... 41

4.1.1 CC&HA Steering committee ...... 41

4.1.2 CC & HA Program Management Center (PMC) ...... 41

4.1.3 Project Implementing Organization ...... 42

4.1.4 Technical support organization ...... 42

4.2 Key stakeholders and cooperating organizations ...... 43

4.3 Partnership with other donors ...... 44

4.3.1 Climate change & health adaptation UN joint program ...... 44

4.4 Risk Management ...... 46

5 PROGRAM MONITORING AND EVALUATION ...... 47

5.1 Monitoring and Evaluation Plan ...... 47

5.2 Knowledge Management Plan ...... 49

5.3 Transition or Exit strategy ...... 49

6 BIBLIOGRAPHY ...... 50

7 ANNEXES ...... 51

Appendix 1: Logical Framework ...... 51

Appendix 2: Work Plan and Time Table ...... 53

Appendix 3: Annual Budget Allocation ...... 56

Appendix 4: Environmental Screening ...... 59

Fiji Proposal for Climate Change & Health Adaptation

1 PROGRAM OUTLINE

Title Climate change and health adaptation in Fiji Objectives Building climate-resilient health system in Fiji Total cost 6. 0 Millions US$ Program duration period 2018-2022 ( 5years ) Target country Fiji Host organization Ministry of health and Medical services Program Strengthening health system for health adaptation from climate Goal Change in Fiji. Main Strategy for program Strategy 1: Climate change resilient health infrastructure 1. Standard operating procedures (SOP) with specifications for siting following relocation guidelines 2. Construction of health facilities, and energy, water and sanitation provisions developed in line with identified or projected climate risks. 3. Model of a Green Health Facility (including a smart and safe facility) in Fiji

Strategy 2: Essential and skilled climate change & health workforce in place 1. To improve health care capacity of health personnel to cope with surges of climate health risks and climate sensitive diseases (typhoid, dengue, diarrheal diseases and leptospirosis); 2. Facilitate processes that support effective and efficient use of resources and information considering additional risks associated with climate change; 3. Facilitate better awareness about climate change and its effect and response on health to the public and all stakeholders (policy makers, senior officers, communities and the media). 4. Ensure there are sufficient number of health workers with the required technical capacity available to deal with the health risks posed by climate variability and change; 5. Research findings are used by policy makers and health leaders for decision making pertaining to climate change and health. 6. Enhance application of surveillance data for understanding of vulnerability of human health to climate change

Collaboration Fund WHO, UNFPA, UNICEF are preparing “climate change adaptation program in health sector in Fiji” program with about 50 M US$.

ADB & Fiji government also preparing proposal similar subject for GCF funding 4

Fiji Proposal for Climate Change & Health Adaptation

Alignment  Climate compatible development initiative With The project will contribute to the climate compatible initiative of Korea Korea government development strategy through Development  Adopting integrated water management for climate change Initiative  Developing water-related infrastructures which are resilient and disaster-resistant

 Safe life for all from infectious disease initiative The project will contribute to the safe life for all initiative of Korea government development strategy through  Supporting a nationwide laboratory system for conducting tests on identified outbreak specimens transported safely and securely to accredited laboratories serving as tight surveillance and effective modern point of care  Fostering health security workforce including physicians, veterinarians, biostatisticians, laboratory scientists, field epidemiologist for climate change provoked infectious disease adaptation.

Fiji Proposal for Climate Change & Health Adaptation

2 SITUATION ANALYSIS 2.1 Current Situation 2.1.1 Background The government of Fiji is committed to act on the impacts of climate change on health systems including human health via the National Climate Change Policy, the Roadmap for Democracy and Sustainable Socio-Economic Development, the People‟s Charter, the Green Growth Framework for Fiji and through its international commitments under the UN Framework Convention on Climate Change.

The Sixty-first World Health Assembly, 2008, mandated Member States to support the work on the protection of human health from risks related to climate change. Subsequent Health Assemblies built on the evidences and resolutions presented in 2008 to empower Member States in contextualizing the regional frameworks for action pertaining to climate change and health.

WHO‟s Operational framework for building climate resilient health systems considers the process of building resilience to occur in two principle ways namely the reduction of overall vulnerability, and the development of specific system capacities acknowledging that a healthier population and stronger health system will be more resilient to climate change. For reduction in overall vulnerability, WHO recommends continued investments to reduce poverty and inequity and universal access to essential services, such as health, education, clean water and adequate food. In addition, for health system strengthening it is recommended to have an adequate workforce and climate-proofed infrastructure in local facilities to control climate- sensitive diseases and improve response to local emergencies and surveillance systems to monitor population health and environmental exposure with good practices of health governance.

At the 2009 Pacific Health Ministers Meeting (PHMM) in Madang, the Ministers committed to action on climate change and health with recommendations that included each PIC to develop national strategies and action plans for health sector adaptation. These will form parts of national adaptation programmes and national communication reports to the United Nations Framework Convention on Climate Change (UNFCCC) and the Pacific Islands Framework for Action on Climate Change (noting that the national adaptation programmes should be part of national sustainable development strategies).

The 2015 Yanuca Island Declaration pursued this further, recognizing the real and potential impacts of climate variability on health and health systems as an emerging challenge in the Pacific. The identified high-priority, climate-sensitive health risks common throughout the region include vector-borne, water-borne and food-borne diseases; injuries and deaths from extreme weather events; compromised food security and malnutrition; and the mental health impacts of, among other things, loss of livelihoods and climate change-induced population displacement (World Health Organization, WHO, 2009). In October, 2015, the Pacific Health Ministers commitment to climate change agenda was reinforced with the signing of the „KAILA‟ Pacific Voice for Action on Agenda 2030 to strengthen Climate Change Resilience through Reproductive, Maternal, Newborn, Child and Adolescent Health.

Fiji Proposal for Climate Change & Health Adaptation

The health ministers of the Pacific noted with concern that the reports of the Intergovernmental Panel on Climate Change (IPCC) on the effects of climate change on human health are already being observed.

Further to international and regional health mandates, there are strong political mandates such as the UNFCCC Paris Agreement and Fiji‟s 2015 Suva Declaration, where the leaders of the Pacific Islands Development Forum called for increased support for adaptation measures that addresses all vulnerable sectors including health, water and sanitation.

The Paris Agreement notes the right to health and recognizes the social, economic and environmental value of voluntary mitigation actions and their co-benefits for adaptation, health and sustainable development. There is further requests for the Green Climate Fund (GCF) (established adaptation fund under climate agreements & protocols) to expedite support for the developing country Parties in formulation of their national adaptation plans and for subsequent implementation of countries‟ policies, projects and programmes.

The health impacts associated with changes in climatic conditions has three categories. The first category includes those direct impacts caused by weather or climate extremes, which entail injuries and illnesses during or after floods, droughts, windstorms and heat waves. The second category encompasses the impacts of environmental and ecological changes that occur in response to climate change. These include the alterations in the geographical distribution and intensity of communicable diseases that spreads by vectors, rodents, food and/or water. In addition, the capacity of climate change to alter ecological systems has been observed to have the potential in favouring disease transmission and the emergence of diseases in areas where they have been non-existent, for example, malaria in south and eastern Africa. The third category relates to the diverse health impacts like trauma and stress caused by social disruptions to communities, such as loss of homeland or important resources.

Fiji‟s climate is expected to encounter extremes, dry seasons to become drier, wet seasons becoming wetter and the intensity of tropical cyclones to increase. Together, these will cause health impacts to increase and threaten the wellness of Fiji‟s population. Climate variability and change in Fiji already cause disasters because of droughts, floods or tropical cyclones. A major impact from these disasters is seen in the health sector where there is an observed increase in hospital admissions and treatments from injuries and infectious diseases such as diarrhoea, typhoid, dengue and leptospirosis. There is also an increase in malnutrition and stress related ailments.

With support from WHO, Fiji‟s MOHMS implemented the “Piloting Climate Change Adaptation to Protect Human Health” (PCCAPHH) project, which aimed at enhancing the capacity of the health sector to respond effectively to climate-sensitive diseases (CSDs). The four-year project funded by the Global Environment Facility (GEF) was implemented in seven countries globally (Barbados, Bhutan, China, Fiji, Jordan,

Fiji Proposal for Climate Change & Health Adaptation

Kenya and Uzbekistan). Fiji was selected to be part of this project because of the sensitivity of communicable diseases, namely typhoid fever, leptospirosis, dengue fever and diarrhoeal illnesses, to periods of water stress during and following hydro- meteorological disasters.

2.1.2 Map of Fiji

[Source: http://www.mapsofworld.com]

Fiji Proposal for Climate Change & Health Adaptation

2.1.3 Fiji Country Profile

Fiji is considered the hub of the South West Pacific and is located midway between Vanuatu and Tonga. The island nation is located between 176° 53′ east and 178° 12′ west. The 180° meridian runs through Taveuni but the International Date Line is bent to give uniform time (UTC+12) to all of the Fiji group. With the exception of Rotuma, the Fiji group lies between 15° 42′ and 20° 02′ south.

Fiji is made up of over 300 islands, of which one third are inhabited by about 865,611 total population at the end of 2014 (FBS, 2015). Fiji is located in the South Pacific region with a total land area of approximately 18,700 square kilometres.

Fiji has an oceanic tropical marine climate, which varies through different timescales. The major features steering the variability of Fiji‟s climate include the El Niño Southern Oscillation (ENSO), the South Pacific Convergence Zone (SPCZ) and the trade winds. Fiji experiences very heavy rainfall during the wet season and heaviest rainfall occurs in the SPCZ. Moderate to strong El Niño events reduce rainfall by about 20-50% as experienced in 1982/83, 1986/87, 1992/93 and 1997/98 resulting in major droughts over most parts of Fiji. From a health protection perspective, it is noted that the 1997/98 severe drought period relating to the El Niño event occurred concurrently with the 1997/98 dengue epidemic, the worst in Fiji with about 24,000 cases, 17,000 hospital admissions and 13 deaths (GRF, 2012).

While the average temperature sits on 25°C, annual variation shows an average between 20-27°C. The summary of climate predictions for Fiji shows that temperature will continue to rise and by 2030, under a high emissions scenario, this increase in temperature is projected to be in the range of 0.4-1.0°C (annual mean temperature of 0.7°C). The projection for Fiji is more very hot days, warm nights, and a decline in cooler weather. However, drought projections are inconsistent for Fiji. It is generally suggested that there would be an increase in both the dry season and wet season rainfall and model projections show that extreme rainfall days are likely to occur more often in Fiji. In addition, sea level in Fiji will continue to rise and the acidity level of the seawater will follow a similar trend. Researchers explained that Fiji, a small island developing state, is vulnerable to the impact of climate change and is exposed to extreme events like floods and droughts (ABM & CSIRO, 2011; GRF, 2012).

In 2014, the Ministry of Strategic Planning, National Development and Statistics reported that the Fiji economy has been assessed to have the potential to sustainably grow by 5% per annum. On average, the economy has grown modestly in the past 8 years measured against a base in 2005. However, through the reforms implemented by Government and major investments in infrastructure, the pace of growth has increased by 4.7% in 2013, 5.3% in 2014 and by an estimated 4.2 % in 2015 (ROF 2016).This growth is attributed to the Sugar Development Programme, forestry sector, significant capital works and expansion in the mining sector, expected positive growth in manufacturing, construction, electricity, transport and storage, accommodation and food services to name a few.

Fiji Proposal for Climate Change & Health Adaptation

The level of investment over the past decade has been between 14-18% of GDP, which is well below the average levels of 22% recorded in the 1970s and 25% in the years before 1987. Inflation in the past 8 years averaged around 4.9%. A large proportion of Fiji‟s inflation is due to imports, representing around 60% of domestic inflation (ROF 2014).

Over the past two decades, national assessments on poverty have revealed a declining incidence. From a level of 37.5% in 1996, the incidence of poverty, as measured against a periodically reviewed basic needs poverty line, was assessed at 35% and 31% from the Household Income and Expenditure Surveys of 2002/03 and 2008/09 respectively. The distribution of poverty is higher with the rural population than the urban population. While employment provides the most appropriate way out of poverty, the economy has not been able to generate sufficient new jobs annually to accommodate the 20,000 school leavers (ROF 2014).

In early 2014, Fiji developed a „living document‟ known as the Green Growth Framework for Fiji: Restoring the Balance in Development that is Sustainable for Our Future. This Framework intend to support and complement the Peoples Charter for Change, Peace and Progress and the 2010-2014 Roadmap for Democracy and Sustainable Socio-Economic Development and its successor national development documents with a shared vision: A Better Fiji for All.

This Green Growth Framework for Fiji is a tool to accelerate integrated and inclusive sustainable development, which will inspire action at all levels, to strengthen environmental resilience, drive social improvement and reduce poverty, enhance economic growth and also build capacity to withstand and manage the anticipated adverse effects of climate change. Fiji‟s small size, vulnerability to climate change and climate variability is considered in the Framework, which is included as its first of the ten thematic areas on Building resilience to climate change and disaster.

2.1.4 Health Status of Fiji

Fiji‟s health system is divided into two main programs: primary and preventive health care services or the public health system and curative health care services or the hospital services. It provides health services throughout Fiji, either free or at minimal cost to Fiji citizens. There are 214 health facilities in Fiji of which 107 are nursing stations, 80 health centres, 19 sub divisional hospitals, 3 divisional hospitals, 2 specialized hospitals and 3 old people‟s home.

Fiji‟s life expectancy at birth increased from 66 in 1990 to almost 70 in 2014. Neonatal mortality (per 1000 live births) was reduced from 17 in 1990 to 10 in 2015. The under 5 mortality rate has decreased significantly over the last 5 years with general improvement noted in immunization status of one-year olds. The Maternal Mortality Rate target is still elusive with an increase in the number of maternal deaths noted for 2014. Maternal mortality ratio per 100,000 live births ranged from 27.5 in 2009, 22.6 in 2010, 39.8 in 2011, 59.47 in 2012, and 19.07 in 2013 and increased to 44.4 in 2014.

Fiji Proposal for Climate Change & Health Adaptation

MOHMS recognizes that the main crisis at the moment in terms of the health of this nation is the burden of NCDs with its high mortality and morbidity as reports show the top cause of mortality remains NCD related (79% of top ten causes of mortality) with disease of the circulatory system being the top cause of mortality. Fiji faces a triple burden of disease through NCDs, CDs and climate change. MOHMS continues the battle and notes that the best approach is the wider sector involvement or whole of government approach where all Fijians have the responsibility to advocate for Wellness throughout their lifetime whether individually or family, community or the population at large.

Table 1: Vital Statistics (source – MOHMS 2013/2014AR;* FIBOS 2014 projection)

Health Indicator 2012 2013 2014 Life Expectancy 68.02 68.11 68.4 Infant Mortality Rate/1000 live births 15.86 13.7 13.8 Maternal Mortality ratio/100,000 live births 59.47 19.07 44.4 Crude Death Rate/1000 population 7.52 7.6 8.0* Dengue Incidence/100,000 population 51.16 105.92(969) 1150.20 Leptospirosis Incidence/100,000 population 44.04 23.62 (216) 20.36 Typhoid 600 492 698 Diarrhoea 25,249 25,805 34,670 Prevalence rate of diabetes/1000 population 25.8 25.6 25.9 Prevalence rate of cancer/100,000 population 127.3 169.8 152.5

2.1.5 Mission, vision, values and structure of Fiji MoHMS

The Ministry of Health and Medical Services of Fiji has a mandate to support every citizen of the nation, irrespective of ethnicity, gender, creed, or socioeconomic status. All Fijians have access to a national health system providing quality health care with respect to accessibility, affordability, efficiency and a strengthened partnership with communities for which this health care is provisioned, to achieve the best possible health and wellbeing, in order to improve the quality of life of the citizens of the Republic of Fiji.

The Guiding Principles for Ministry of Health and Medical Services are: Vision: A Healthy population

Mission: To empower people to take ownership of their health; To assist people to achieve their full health potential by providing quality preventive, curative and rehabilitative services through a caring sustainable health system.

The values of the Ministry include;  Equity;  Integrity;  Respect for Human Dignity;  Responsiveness; and  Customer Focus.

Fiji Proposal for Climate Change & Health Adaptation

Figure 1: Ministry of Health and Medical Services Organizational Chart

Fiji Proposal for Climate Change & Health Adaptation

2.2 Problem Analysis 2.2.1 Problems of Climate Change in Health Sector

There are several conceptual frameworks for relating environment, health, environmental health and their indicators. The driving force–pressure–state– exposure–effect–action (DPSEEA) framework is one that is more suitable and relevant for climate change and health, as it describes the environmental determinants of health from the highest upstream factors to the eventual downstream health outcomes, and identifies key entry points for possible interventions by society.

Figure 1 Health Impact from Climate Change

[Source: Human health and Climate change in Fiji, WHO WPRO, 2015]

The most upstream determinants of health originate in driving forces (D), leading to pressures on the environment (P). These pressures contribute to changes in the state (S) of the environment and hence human exposure (E), with potential health effects (E). The framework identifies feasible policy options and other actions (A), hence DPSEEA, at each stage in the causal chain to reduce the eventual adverse health effects. The framework is flexible and open to modification, as national situations differ and scientific knowledge is evolving constantly.

A suggested DPSEEA framework for climate change and health is given in Figure 2. It is important to note that this is a synthesizing diagram, not an alternative method of risk estimation or projection. The causal pathways of the framework provide health sector policy- makers with evidence-based policy options, necessary not only to lead the health sector adaptation at the downstream end but also to influence other sectors for primary prevention (upstream). It is important to use this framework in the context of health-in-all-policies, whole-of-government and whole-of-society approaches in order to maximize the health co-benefits of climate change adaptation. 13

Fiji Proposal for Climate Change & Health Adaptation

2.2.2 Problems of Climate Change in Water & Sanitation

Water insecurity, or water stress, is a major concern in the context of climate change in the Pacific, particularly with respect to altered rainfall patterns and more severe extreme weather events such as droughts and floods. Rapidly growing demand, land-use change leading to deforestation, urbanization and tourism are already placing significant strain on the limited freshwater reserves in small island environments. The atoll countries (Kiribati, the Marshall Islands, Nauru, Tuvalu and Tokelau) are particularly susceptible to water insecurity from climate change, being dependent on rainwater and, in some cases, freshwater aquifers. The potential for waterborne infectious diseases to increase with climate change has been described at length in the scientific literature. Water may transmit disease via contamination with bacteria, viruses and/or protozoa; the risk of contamination by these pathogens increases with temperature, extremes of rainfall (scarcity and abundance, manifested at worst by droughts and floods) and during natural disasters, including via the displacement, crowding and disordered behaviors of affected people and communities.

2.3 Rationale of the climate change and health adaptation program 2.3.1 Opportunities and Comparative Advantage for Health Adaptation

As far as adaptation is concerned, Fiji has a comparative advantage despite its high vulnerability to the impacts of climate change.

A movement that is already being admirably advanced by Fiji is that of international advocacy on mitigation and adaptation action, and influencing the international political agenda on these issues. The Alliance of Small Island States (AOSIS), of which Fiji is a member, is one of the loudest voices on the global climate change stage. This prominent advocacy role should invite, if not demand, increased support from developed countries. “The ability of small islands to undertake adaptation and mitigation programs, and their effectiveness, can be substantially strengthened through appropriate assistance from the international community,” according to the Intergovernmental Panel on Climate Change.

Another special opportunity for adaptation lies in the fact that Fiji‟s Ministry of Health and Medical Services has completed its NCCHAPs. This health sector-driven plan represent strong evidence-based contributions to national adaptation planning processes – the health component of National Adaptation Plans, or H-NAPs, which should attract financial and technical support for the health sector.

Fiji‟s small size enables a degree of familiarity and proximity between individuals and agencies, which would not be possible in more populous countries. A pertinent example of this is the unprecedented level of cooperation between the health and environment sector, and climate change division in the climate change and health vulnerability assessment and adaptation planning process in Fiji. This level of close multi-sectoral cooperation was often relatively easy and quick to achieve in Fiji due to the small populations and close family and community connections.

Fiji Proposal for Climate Change & Health Adaptation

This cross-sectoral collaboration also forged some novel institutional linkages, for example, between public and environmental health units and meteorology services in several countries. These evolving linkages may enable innovative adaptation strategies such as climate-based early warning systems for epidemics of CSDs. Unlike in countries with large populations, it is possible in Fiji and areas to adopt an integrated approach to climate change adaptation, disaster risk management and environmental health, effectively and efficiently.

The launch of a post-2015 development agenda and the Sustainable Development Goals (SDGs) within the United Nations framework may offer Fiji and areas a chance to strengthen both climate change adaptation and development processes in a sustainable and synergistic manner. As the IPCC AR5 chapter on small island states highlights: “Adaptation to climate change generates larger benefit to small islands when delivered in conjunction with other development activities, such as disaster risk reduction and community-based approaches to development”.

2.3.2 Challenges in strengthening health systems to manage the health impacts of climate change

It is important to note that, when discussing strategies to improve the ability of communities, civil society, government agencies, nongovernmental organizations, international organizations and the health sector to cope with the impacts of climate change, there is a substantial overlap between development (i.e. improvements that should take place as a matter of course regardless of climate change) and adaptation (i.e. additional measures taken specifically to address the threats posed by climate change, including slow-onset events). Health systems development aiming at improving resilience to climate change must be considered as an adaptation measure, going beyond “business as usual”. In reality, it is often impossible to differentiate development from adaptation measures and vice versa.

Human resources A constant challenge for the health sector (among others) in Fiji is the recruitment and retention of a health workforce capable of meeting the demands of a SIDS. With the majority of the workforce required to travel abroad to study and train at one or more times during their career, and with relatively low levels of remuneration for highly technical health-care related work in many Pacific islands, it is understandable, but unacceptable, that “brain drain” affects the health sector more than most other areas of public service. Fiji is not an exception in this area. Financial incentives and the local provision of education, training and continuing professional development are two obvious strategies that may attract health personnel, and enable them to remain in their own country for longer periods of time. Climate change adaptation funding provides an important extra avenue of potential resourcing to build a health workforce capable of addressing the health impacts of climate change.

Fiji Proposal for Climate Change & Health Adaptation

Technical capacity The risks posed by climate change to human health are still not well understood by either the public or the wider community of researchers. Not surprisingly, it has taken decades for the international health community to reach some broad consensus regarding the key issues and requirements for health protection related to climate change. It is both vital and now urgent that this technical expertise be passed on to health professionals in developing countries, in order to build the capacity of these health sectors to explore, understand, anticipate and minimize the health impacts of climate change in their communities. Specific areas of technical capacity-building required in Fiji for adaptation include disease surveillance, primary health care, applied environmental epidemiology (analytical techniques and synthesis of relevant information), public and environmental health services (including safe drinking- water supply, food safety and vector control), disaster risk management (preparedness, response and recovery) and the use of meteorological data in predicting risks of CSDs (climate-based early warning systems).

2.3.3 Evidence for Action

Sustained efforts need to be focused on the evaluation of current and future health vulnerability, in order to identify the interventions and adaptation strategies, which will contribute towards reducing the impacts of climate change. Early planning and preparation of the health system is essential for reducing and eliminating both short term and long-term effects of climate change on public health.

Further assistance will be required in the development of policies to ensure data sharing with relevant stakeholders such as the Water Authority of Fiji/Rural water supply and the Fiji Meteorology Services so as to support the health sectors early warning system.

Initial work under the PCCAPHH project provided a way forward in trialing a climate-based early warning system (EWS) for the four climate sensitive diseases (CSDs) in Fiji. Some correlations were observed between monthly temperature, rainfall, humidity and extreme weather events and monthly cases of leptospirosis, typhoid fever, dengue fever and diarrhoeal disease in several regions of Fiji (McIver et al, 2012). Progresses were made within the PCCAPHH project including training on data management tools, development of awareness and community advocacy materials, establishment of the baseline sensitivity of CSDs in Fiji and establishment of novel linkages and partnerships, for example, with the Fiji Meteorological Service and Fiji Red Cross. In addition, progress towards the future activities include strengthening CD data reporting and control mechanisms, supporting the emergency health programme and further development of climate-based early warning systems for health. The PCCAPHH project has also generated nation-wide momentum towards a more comprehensive strategy to address climate impacts on health, with the MOHMS as the lead agency.

Fiji Proposal for Climate Change & Health Adaptation

Climate sensitivity analysis with the four focal diseases is on-going to develop a competent and suitable early warning system for our health sector and vulnerable communities. Training and piloting of improved reporting systems are being implemented at the health facilities in the project sites as part of health system adaptation.

Support from higher levels of government and nongovernmental organizations are called to strategically oversee the protection of human health from climate variability and change impacts through appropriate adaptation processes.

The activities connected with raising public awareness and the preparation of promotional materials may represent a joint action on behalf of the government and nongovernment sector (Wellness unit, FRCS, WHO, UNICEF).

Regional frameworks and other country climate change and health work plans contributed to the Operational Framework for climate resilient health systems of the World Health Organisation (2015) on which Fiji‟s CCHSAP is built. This plan utilises the 10 components for building climate resilience considering both direct and indirect health impacts specific to Fiji.

2.3.4 Climate Change and Health Strategic Action Plan (CCHSAP) 2016 - 2020

The CCHSAP 2016 – 2020 is built on the identified six elements/building blocks of health system and follows the ten components used by WHO (2015) in its operational framework on building climate resilient health systems:

Component 1: Leadership and governance Component 2: Health workforce Component 3: Vulnerability, capacity and adaptation assessment Component 4: Integrated risk monitoring and early warning Component 5: Health and climate research Component 6: Climate resilient and sustainable technologies and infrastructure Component 7: Management of environmental determinants of health Component 8: Climate-informed health programs Component 9: Emergency preparedness and management Component 10: Climate and health financing

Fiji Proposal for Climate Change & Health Adaptation

Figure 3: The ten components from WHO’s operational framework for building climate resilient health systems showing connections to the building blocks of health systems

[Source: World Health Organization, 2015]

The ten components framework is used in this plan as a guide in the efforts to mainstream climate change health impacts into MOHMS structure. Since it is being used as a guide, a flexible approach should be practiced by the implementers of the plan, particularly in its initial phase of implementation.

The CCHSAP 2016 - 2020 supports Fiji‟s MOHMS efforts to operationalize the components of WHO‟s (2015) operational framework on building climate resilient health systems. It is the tool to ensure that the health risks from impacts of climate and natural disasters are adequately minimized to protect Fiji‟s population health in a changing climate. The plan recognizes that Fiji has identified four climate sensitive diseases that are considered in this plan. In addition, the plan calls for continued research into other health risks including NCDS and mental health. The use of „vulnerable‟ in this context mainly refers to vulnerability to the combination of climatic impacts and health risks, particularly diseases.

Fiji Proposal for Climate Change & Health Adaptation

3 PROJECT DESCRIPTION 3.1 Goal Strengthening health system for health adaptation from Climate Change in Fiji

The health systems of Fiji are vulnerable to climate variability and change. Therefore, it is important for the health sector of Fiji and areas to build the climate resilience of health systems by reducing vulnerability and improving the capacity of the health system. The resilience-building approach to health systems can improve the overall performance of the health system resulting in better protection and promotion of population health. Climate resilience should be built into all aspects of the health system – leadership and governance, human resources, information resources, essential medical products and technologies, financing and service delivery – in order to be effective and sustainable.

The climate resilience of the health system can be built through a continuing process of reducing vulnerability and strengthening capacity to meet the challenges of any type and severity of climate variability. It should be noted that effective and efficient protection and promotion of population health is not possible without adopting a whole-of-government approach to the social and environmental determinants of health, such as water and sanitation, energy, food and agriculture, environment, transport, education and urban planning. Therefore, collaboration and coordination between the health and non-health sectors is crucial for building climate-resilient health systems. In this context, the Ministry of Health should be empowered to take the leadership by adopting the health-in-all policies approach. At the same time, each community should be empowered to take timely and effective measures to protect and promote the health and well-being of the community members, considering the specific nature of community resilience and vulnerability.

Fiji Proposal for Climate Change & Health Adaptation

3.2 Expected Results

Outcome 1: Climate change resilient health infrastructure Standard operating procedures (SOP) with specifications for siting and construction of health facilities, and energy, water and sanitation provisions developed in line with identified or projected climate risks.

Objective: Building climate resilient health system, it is also vital to provide essential preventive and curative health products such as vaccines for the CSDs; provide climate resilient infrastructure and services; provide new technologies and approaches for efficient and effective interventions so as to reduce vulnerability to climate risks within and outside the health sector. The specific objectives of implementing climate resilient and sustainable technologies and infrastructure are to: i. Provide climate resilient health infrastructure and services considering siting of buildings and application of regulations account for climate risks (current and future), climate resilience of essential environmental services to health facilities, such as water and sanitation services which may be compromised by flood or drought; ii. Enhance use of new technology and approaches for improved health interventions particularly with the use of information technology; iii. Explore medical technologies and products with lower environment footprint.

Outcome 2: Essential and skilled climate change & health workforce in place The capabilities of health workforce are adequate to provide services to deal with the health impact of climate change. The public are well aware of health problems associated with climate change.

Objective: This component refers to strengthening of technical and professional capacity of health personnel and the organizational capacity to collaborate with other sectors. The specific objectives of implementing activities relating to health workers are to: i. Ensure there are sufficient number of health workers with the required technical capacity available to deal with the health risks posed by climate variability and change; ii. Facilitate processes that support effective and efficient use of resources and information considering additional risks associated with climate change; iii. To improve health care infrastructure and capacity of health personnel to cope with surges of climate sensitive diseases (typhoid, dengue, diarrheal diseases and leptospirosis); and iv. Facilitate better awareness about climate change and its effect and response on health to the public and all stakeholders (policy makers, senior officers, communities and the media). v. Enhance application of surveillance data for understanding of vulnerability of human health to climate change; vi. Research findings are used by policy makers and health leaders for decision making pertaining to climate change and health.

Fiji Proposal for Climate Change & Health Adaptation

3.3 Detail Activities

Outcome 1: Climate change resilient health infrastructure

Activities

i. Regular maintenance of health facilities, retrofitting or renovating to ensure back-up water supply, electricity, communication, supplies and medicines and equipment are available. ii. Ensuring strong commitments on Rainwater Harvesting System installation, waste management including 4 R‟s, Hospital Friendly Hospital Initiative and the good principles and component of sustainable development. iii. New health facilities to be located in areas not vulnerable to the impacts of climate change and are accessible to the public. iv. Explore prospects of developing Green Health Facilities and Safe and Smart hospitals.

Expected results

i. Standard operating procedures (SOP) with specifications for siting and construction of health facilities, and energy, water and sanitation provisions developed in line with identified or projected climate risks. ii. Model of a Green Health Facility (including a smart and safe facility) in Fiji

Fiji Proposal for Climate Change & Health Adaptation

Outcome 2 - Essential and skilled climate change & health workforce in place

Activities

i. Training for EH officers, laboratory technicians, record keepers and other health workers on identifying risks and response related to climate change. ii. Recruitment and training of additional EH officers to: implement and monitor community health adaptation; and focal persons in the implementation of objectives 2 to 5 of the Outcome 2 work plan matrix. iii. Preparation of climate change and health curriculum/programs at the Fiji National University. iv. Training for doctors, nurses, pharmacists and other practitioners on climate impacts on appropriate health and adaptation measures. v. Development and update of technical guidelines for diagnosis, detection, control, prevention and treatment of diseases (dengue, diarrhea, typhoid, leptospirosis), injuries and other food and fish poisoning (ciguatera) illness arising from climate change; vi. Development of short and long term additional action plan for improved health infrastructure, staffing and capacity to cope with vector-borne and water/food borne diseases in the context of climate change. vii. Preparation, printing and distribution of information brochures combined with TV and radio shows about the impact of climate change and appropriate response on health and protection measures during high/low temperatures, in conditions of flood/drought and other measures to prevent occurrence of CSDs with specific attention at vulnerable population groups (the elderly, children, in high risk areas to CD outbreaks). viii. Work with the disaster management unit ensuring contingency plans and protocols address health personnel deployment during extreme disasters. ix. Undertake on-going research with relevant experts to determine the sensitivity of health determinants including water, sanitation and hygiene (WASH); NCDs, including psycho-social illnesses to climate variability and change. x. Evaluative research of educational measures effectiveness.

Expected results

i. Trained people in institutions and champions identified to guide operational activities as it arises and are equipped with relevant resources. ii. Adequate trained EH officers implementing climate change and health adaptation activities. iii. Standard operating procedures and guidelines for health personnel involved in CSDs diagnosis, reporting and investigation. iv. Contingency plans and protocols that address health personnel deployment during extreme disasters. v. Introduction of climate-change and health-related modules into graduate and postgraduate curricula at FNU‟s CMNHS. vi. Plan of action to address climate-related health issues at vulnerable sites.

Fiji Proposal for Climate Change & Health Adaptation

3.4 Project Details

Outcome 1: Climate change resilient health infrastructure

From the 212 health facilities within Fiji, there are several health facilities that are considered vulnerable to climate change due to its location and siting. A tentative list of these sites was drawn up by divisional teams consisting of approximately thirty- three (33) facilities as listed below:

Table 1 List of Health Facilities Proposed for Relocation

EASTERN DIVISION (12 Facilities)

NO. HEALTH FACILITY SUB-DIVISION REMARKS 1. Nayau Nursing Station Lau Proposed for relocation to high ground due to rising sea level. 2. Totoya Health Centre Lau Proposed for relocation to high ground due to rising sea level. 3. Qarani Health Centre Gau Threat from landslide. 4. Naqara Nursing Station Kadavu Proposed for relocation to high ground due to rising sea level 5. Ravitaki Nursing Station Kadavu Proposed for relocation to high ground due to rising sea level 6. Gasele Nursing Station Kadavu Proposed for relocation to high ground due to rising sea level 7. Nalotu Nursing Station Kadavu Proposed for relocation to high ground due to rising sea level 8. Talaulia Nursing Station Kadavu Threat to rising sea level 9. Daviqele Health Centre Kadavu Proposed for relocation to high ground due to rising sea level 10. Lomaloma Hospital Lomaloma Proposed for relocation to high ground, recently affected by wave surge 11. Batiki Nuring Station Lomaiviti Proposed for relocation to high ground due to rising sea level 12. Nasoki Nursing Station Lomaiviti Proposed for relocation to high ground due to rising sea level

CENTRAL DIVISION (7 Facilities)

NO. HEALTH FACILITY SUB-DIVISION REMARKS 13. Beqa Health Centre Serua/Namosi Proposed for relocation to high ground due to rising sea level. 14. Galoa Nursing Station Serua/Namosi Proposed for relocation to high ground due to rising sea level. 15. Nasauvere Nursing Naitasiri Easy accessibility to the community because the Station current is on high ground. 16. Laselevu Health Centre Naitasiri Proposed to move to the other side of the river because most of the people within that community are now gain access to the health centre by road. 17. Nasoqo Nursing Station Naitasiri Access to Public 18. Nausori Hospital Rewa Relocate to high ground to avoid flood. 19. Nasoqo Nursing Station Access to Public

Fiji Proposal for Climate Change & Health Adaptation

WESTERN DIVISION (9 Facilities)

NO. HEALTH FACILITY SUB-DIVISION REMARKS 20. Nacula Health Centre Lautoka/Yasawa Relocation of the health facility currently taking place due to rising sea level. 21. Kese Health Centre Lautoka/Yasawa As above 22. Malolo Health Centre Lautoka/Yasawa Within the village boundary, need to be isolated from the village residential area. 23. Yanuya Nursing Station Lautoka/Yasawa Due to rise in sea level 24. Teci Nursing Station Lautoka/Yasawa Due to rise in sea level 25. Yaqeta Nursing Station Lautoka/Yasawa Due to rise in sea level 26. Somosomo Nursing Lautoka/Yasawa Due to rise in sea level Station 27. Tokaimalo Nursing Ra Access to Public station 28. Nausori Highland Nadi The current one within village boundary and was Nursing Station built through self-help, need to build one isolated from village residential area.

NORTHERN DIVISION (4 facilities)

NO. HEALTH FACILITY SUB-DIVISION REMARKS 29. Saqani Health Centre Cakaudrove Relocation of the health facility currently taking place due to rising sea level. 30. Tukavesi Health Centre Cakaudrove Relocation of the health facility currently taking place due to rising sea level. 32. Natewa Health Centre Cakaudrove Relocation of the health facility currently taking place due to rising sea level. 33. Yadua Nursing Station Bua Relocation of the health facility currently taking place due to rising sea level.

These facilities have been short-listed and further prioritized by the Asset Management Unit based on the urgency and planning needs of each site and for the purposes of this project proposal eight (8) health facilities have been identified for relocation.

The detail project sites for this proposal on Climate resilient and sustainable technologies and infrastructure are listed as follows:

Fiji Proposal for Climate Change & Health Adaptation

3.4.1 Health Facility 1

Item Title Details Name Nayau Nursing Station A Sub-Division Lakeba Sub-Division Division Eastern Division B Type of facility: Nursing Station Latitude -17.9767864916564 C Location Longitude -179.03160385852357 Elevation > 40 meters above seas level (+/-20m) Situation / reason Proposed for relocation to high ground due to rising D for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction of E Plan new facility with staff accommodation F Budget US$250,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.2 Health Facility 2

Item Title Details Name Gasele Nursing Station A Sub-Division Kadavu Sub-Division Division Eastern Division B Type of facility: Nursing Station Latitude -18.952646599272125 C Location Longitude 178.3004203025347 Elevation > 109 meters above seas level (+/-20m) Situation / Proposed for relocation to high ground due to rising D reason for sea level and climate change impacts intervention Identification of Alternative Site and Reconstruction of E Plan new facility with staff accommodation F Budget US$250,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.3 Health Facility 3

Item Title Details Name Batiki Nursing Station A Sub-Division Lomaitivi Sub-Division Division Eastern Division B Type of facility: Nursing Station Latitude -17.79124233071484 C Location Longitude 179.1480483851663 Elevation > 73 meters above seas level (+/-20m) Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction E Plan of new facility with staff accommodation F Budget US$250,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.4 Health Facility 4

Item Title Details Name Beqa Health Centre A Sub-Division Serua/Namosi Sub-Division Division Central Division B Type of facility: Health Centre Latitude -18.411270672510263 C Location Longitude 178.1337915857283 Elevation > 69 meters above seas level (+/-20m) Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction E Plan of new facility with staff accommodation F Budget US$765,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.5 Health Facility 5

Item Title Details Name 6 Facilities in Suva Suva, Raiwaqa, Makoi, Samabula, Lami, Valelevu A Sub-Division Suva Sub-Division Division Central Division B Type of facility: Health Centres C Map - D Situation / reason for intervention Building Resilient Health Systems and Facilities Provision of Backup Generators and Water Supply E Plan Tanks F Budget US$200,000.00

3.4.6 Health Facility 6

Item Title Details Name Nacula Health Centre A Sub-Division Lautoka/Yawasa Sub-Division Division Westernl Division B Type of facility: Health Centre C Location - Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction of E Plan new facility with staff accommodation F Budget US$765,000.00

3.4.7 Health Facility 7

Item Title Details Name Teci Nursing Station A Sub-Division Lautoka/Yasawa Sub-Division Division Western Division B Type of facility: Nursing Station C Location - Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction of E Plan new facility with staff accommodation F Budget US$250,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.8 Health Facility 8

Item Title Details Name Saqani Health Centre A Sub-Division Cakaudrove Sub-Division Division Northern Division B Type of facility: Health Centre Latitude -16.41248548 C Location Longitude 179.76070206 Elevation > 30 meters above seas level (+/-20m) Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction of E Plan new facility with staff accommodation F Budget US$765,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.9 Health Facility 9

Item Title Details Name Natewa Health Centre A Sub-Division Cakaudrove Sub-Division Division Northern Division B Type of facility: Health Centre Latitude -16.59145604 C Location Longitude 179.73818539 Elevation > 50 meters above seas level (+/-20m) Proposed for relocation to high ground due to rising D Situation / reason for intervention sea level and climate change impacts Identification of Alternative Site and Reconstruction E Plan of new facility with staff accommodation F Budget US$765,000.00

Fiji Proposal for Climate Change & Health Adaptation

3.4.10 Health Facility 10 (Retrofitting & Rehab)

Item Title Details Selected Sites in Northern & Western A Area Division B Type of facility: Health Centre, Nursing Stations As per assessment and identification within C Map the first year of project Retrofitting of Health Facilities with Green D Situation / reason for intervention Options Identification of suitable options and E Plan construction F Budget US$100,000.00

Fiji Proposal for Climate Change & Health Adaptation

Outcome 2: Essential and skilled climate change & health workforce in place Objectives/ Strategies/ Outputs Activities Timeline Responsible Units Budget Indicators Desired Outcome 1. Establish, 1.1 Strengthened 1.1.1 Q4 2016  PS HMS $1,000,000.00  climate change unit maintain and organizational capacity Formalise positions/unit ($200,000/yr established within sustain a within MOHMS to adopt with clear structures and  climate change 1 principal MOHMS/PH/ EH collaborative and operationalize/ roles and responsibilities officer/advisor of the advisor HW01; approach functions of the climate to progress strategies of MOHMS 1 senior between the change and health the Climate Change unit technical officer sectors within adaptation unit (refer also 3.3) HW 02 and 2 the MOHMS and technical relevant officers HW 04) stakeholders for 1.2 Functional 1.2.1 CCH Steering Continuously MOHMS, Climate $20,000.00  Meeting minute the effective and cooperation and committee (TOR) to hold for each quarter Change Division (meetings,  Number of MOUs efficient use of coordination in terms of regular meetings and (MOF), FNU, other collaborations - /MOAs signed the available effective and efficient keep stakeholders central Government $4,000.00/yr)  Number of active resources and use of the available informed. ministries, Local information participation in CCD resources through the Government –NCCCC events towards climate CCH Steering 1.2.2 CCH Steering agencies, WAF, FMS change Committee for climate Committee supports interventions change and health NCCCC through relating to CSDs adaptation UNIT (all meetings and updates relevant (Networking, stakeholders/partners) awareness, 1.3 Strengthened 1.3.1 Continuously $50,000  Numbers of coordination) partnership and Involve active ($10,000.00/yr) organised events

cooperation between the participation with  reports published educational institutions educational institution for for educational programs research and knowledge appraisal

2.0 Facilitate 2.1 Education of and 2.1.1 Preparation, Quarterly MOHMS (Health $60, 000.00  Brochures produced better provision of regular printing and distribution 2016 - 2018 Promotion, EH-CCH), ($20,000/yr) and distributed to awareness information to the public of information Fiji Red Cross, target population about climate on climate-change- brochures combined with UNDP, WHO,  Seasonal bulletins 33

Fiji Proposal for Climate Change & Health Adaptation change and its induced health problems. TV and radio shows UNICEF, FMS (FMS/MOH) effect and about the impact of  Number of TV response on climate change and shows health to the appropriate response on  Number of media public and all health with specific briefs stakeholders. attention at vulnerable population groups (the elderly, children, in high risk areas to CD outbreaks etc.)

2.2 Enhanced training 2. 2. 1 Training for health Quarterly MOHMS $30,000  Number of trained and research for workers on identifying 2016 - 2018 ($10,000/yr) people in institutions community awareness risks and response and champions and advocacy through related to climate identified human resource capacity change  Officers are building` equipped with 2.2.2 Evaluative relevant resources research of educational  Evaluation research measures effectiveness reports and recommendations accepted and complied 2.3 Pursue efforts for 2.3.1 Preparation of 2016 - 2018 MOHMS /FNU $10,000  Consultation and Introduction of climate- climate change and workshops change and health - health curriculum/  Course content related modules into Programmes at FNU completed for graduate and adoption and postgraduate curricula at commences at FNU FNU‟s CMNHS.

Fiji Proposal for Climate Change & Health Adaptation

3.0 Protection 3.1: 3.1.1: 2017 – 2019 FNU, Fiji Red Cross, $100,000  Number of from climate- Enhanced application of Undertake on-going on-going UNDP, WHO, researches change-related surveillance data research with relevant UNICEF, SPC undertaken diseases. understanding of experts to determine the relevant training  Outcome of (To reduce the vulnerability of human sensitivity of CSDs institutions and Govt research tabulated burden of health to climate change. including water, departments and climate-sensitive sanitation and hygiene according to recommendations diseases (CSDs) (WASH); NCDs, objectives implemented in Fiji). including psycho-social illnesses due to climate variability and change.

3.1.2: 2016-2018 MOHMS (CCH-EH) $40,000  Vulnerable Identification of USP, Fiji Red Cross, communities listed communities most UNDP, WHO, prioritised and vulnerable to climate UNICEF, SPC, DOE, mapped (GIS) variability and change MOF (CCD) and associated health risk exposures through profiling or use of existing data 3.2: 3.2.1 Data analysis of Quarterly MOHMS (EH-CCHU, $30,000  Number of Continuous monitoring of selected HIU, Wellness assessment reports the risks connected with Parameters Centre), FNU, climate change and their (max temperatures, international  Number of analysed influence on health, and rainfall, the state of the academic institutions data upgrading the health watercourses; morbidity FMS  Interpretations of system‟s capacities for and mortality from analysed data prevention and mitigation climate sensitive reporting for diseases) In relation to execution of CDs and vector indices decisions (EHIA) and other identified risk factors 35

Fiji Proposal for Climate Change & Health Adaptation

3.3: 3.3.1: Incorporate 2016 - 2019 MOHMS (EH-CCHU, $25,000  Number of health Build the institutional and climate information into HIU, PPDU), Fiji Red plans with climate human resource capacity health planning and Cross, UNDP, WHO, information to enable the MoHMS to information systems, FMS adapt to the impacts of especially WASH, climate change on emergencies, nutrition, human health. CDs. 3.3.2: Training for all 2016-2018 (2 FNU, WHO $90,000 • Number of trainings health practitioners on trainings/year) ($30,000/year) conducted climate impacts on  Number (%) of appropriate health and personnel trained adaptation measures. 2016 - 2019 MOHMS (EH-CCHU), Build into  Number of meetings 3.3.3: Include relevant WHO existing and workshops and legislative support structures resources given

3.4: 3.4.1: Developing and 2016 - 2019 MOHMS (CD, EH, $100,000  Number of CSDs Strengthened health piloting of a web based CCHU, HIU) reported weekly information systems for reporting system for  Number of CS-risks faster detection of clinical, laboratory, detected climate-sensitive environmental health  Number of timely diseases and risks and and decision making interventions early implementation of teams interventions.

3.5: 3.5.1 Epidemiological Continuous MOHMS (EH-CCHU), $50,000  Numbers of Controlling monitoring, sanitary WAF hygiene- communicable diseases hygiene and inspection epidemiological through adaptive actions surveillance of water inspection supply sources and systems pre, during and  Number of water post weather extreme samples events in identified vulnerable areas.

Fiji Proposal for Climate Change & Health Adaptation

3.5.2 Reporting, $50,000 monitoring, analysis and Continuous MOHMS (HIU, EH- Weekly reports to active epidemiological CCHU) NNDSS surveillance of enteric diseases in identified vulnerable areas.

3.5.3 Epidemiological Continuous MOHMS (EH-CCHU) $50,000  Numbers of

monitoring, sanitary MLGUDHE hygiene-

hygiene and inspection epidemiological

surveillance of inspection

installations where food

is produced, stored,  Number of water distributed and circulated /food samples pre, during and post

weather extreme events

in identified vulnerable

areas particularly in

health, educational and

social institutions.

3.5.4 Safe disposal of Continuous MOHMS (EH-CCHU) Build into  Number of communal solid waste MLGUDHE existing inspection and waste waters in structures visits during the identified vulnerable vulnerable or high areas risk periods 3.5.5: Conducting Continuous MOHMS (EH-CCHU) Build into  Disinfection and regular disinfection (if (annually) existing extermination of necessary) and structures insects and rats extermination of rats and carried out in all insects in HRAs. (climate health, educational change vulnerable and social institutions communities) of HRAs

Fiji Proposal for Climate Change & Health Adaptation

3.5.6: Control of surface MOHMS (EH-CCHU) Build into  Number of surface waters (streams and MLGUDHE existing water samples from rivers). structures HRAreas (test 3.5.6.1 depends on the Increasing the number of priority CSD for the samples HRA) taken for analysing the quality of surface waters and for recommending measures in HRAs

3.6: 3.6.1 Epidemiological Continuous MOHMS (EH- VCU, Build into  Weekly reports to Controlling vector-borne surveillance, reporting, (from NNDSS) CCHU) existing NNDSS to advice communicable diseases monitoring and analysis structures proper control and of vector borne mitigation strategies intervention and mitigation efforts 3.6.2 Entomological Continuous MOHMS (EH- VCU, Build into  Monthly reports surveillance, reporting, (from NVCU) CCHU) existing from NVCU and monitoring and analysis structures FMS utilised to of mosquito vectors develop dengue 3.6.2.1 Pursue EWS for outbreak risk dengue outbreak with use of mosquito vector and climate data 3.6.3 Rat surveillance, Continuous Build into  Monthly reports reporting, monitoring and (from NVCU) existing from NVCU analysis structures 3.7: 3.7.1 Assessment of the 2017 MOHMS (EH, CCHU, $50,000.00  Laboratory report Introduction and need to upgrade the CD), FNU (quality manager) development of good diagnostic and treatment laboratory and clinical capacities for CSDs practice and (HRAs) environmental health diagnosis to improve the treatment of climate 3.7.2 Development and 2017 - 2018 MOHMS (EH- CCHU, $50,000.00  Laboratory report sensitive infectious realization of plan to AMU, CD) (quality manager) diseases upgrade and resource 38

Fiji Proposal for Climate Change & Health Adaptation

laboratory (esp in HRAs)

3.8: 3.8.1 Synthesis of 2016 MOHMS (EH- $100,000.00  Mapped Vulnerable PCCAPHH project climate, disease and CCHU)/USP/FNU communities with concept is replicated in other relevant adaptation all vulnerable data/parameters capacities (GIS) communities in Fiji (exposure, adaptive capacity) and Implementation of recommendations in the last PCCAPHH report 3.8.2 Build capacity 2018 MOHMS (EH- CCHU) $500,000.00  Reduced CSD through Intervention with incidence adaptive measures in identified vulnerable communities 3.9: 3.9.1 Evaluation of all Midterm (2018) MOHMS /WHO (EH- $10,000.00  Vulnerability Established Monitoring reports and End term CCHU) Reduction and Evaluation guideline recommendations of (2020) Index/score adaptive measures for  Number of improvement in recommendations resilience progressed for implementation

4.0 Climate- proof health 4.1: 4.1.1: Annual MOHMS (EH- CCHU, $500,000.00  Annual Assessment infrastructure to Improved resilience of Regular maintenance of assessments AMU, NHEDMO) reports maintain delivery health facilities to climate health facilities. of services at all change. times 4.1.2: During MOHMS (EH- CCHU, $250,000.00  EHIA reports from New health facilities to proposed sites AMU, NHEDMO) EHOs be located in areas not selection HIA to vulnerable to the impacts be conducted  Annual Assessment of climate change and prior to all new reports

Fiji Proposal for Climate Change & Health Adaptation

are accessible to the developments public. Annual assessments. 4.1.3: 2017 - 2020 MOHMS (EH- CCHU, $400,000.00  Assessment Retrofitting or renovating AMU, NHEDMO) Reports existing health facilities  Safe health facilities to ensure back-up water with back up supply, electricity, infrastructure and communication, supplies services and equipment is available. 4.1.4: $100,000.00  Assessment Explore prospects of Reports developing Green Health 2016 - 2019 MOHMS (EH- CCHU,  Project proposals Facilities and Safe and AMU) for developing GHF Smart hospitals. and SSH

5.0 5.1 5.1.1 2017 - 2019 MOHMS (EH- CCHU, Build into  Number of Resource Facilitation of greater Explore funding sources NHEDMO, CD, existing proposals prepared Mobilisation to contribution of funds through continued AMU) structures (new and disseminated support adaptive from donor agencies for preparation and CCH unit) measures climate change- and dissemination of health related innovative and programme appropriate adaptation implementation projects to potential donor agencies 5.1.2 2017 - 2019 MOHMS (EH- CCHU Build into  updated matrix of Maintain communication NHEDMO) existing donor agencies with potential donor structures (new distributed for health agencies CCH unit) adaptation projects

Total - $3,155,000.00 (FD)

Fiji Proposal for Climate Change & Health Adaptation

4 PROGRAM IMPLEMENTATION

4.1 Program implementation structure

4.1.1 CC&HA Steering committee

The CC&HA Steering Committee will consist of MoHMS, WHO DPS, and KOICA. The steering committee meeting is planned to be held in Fiji at the beginning of the project and thereafter annually until the end of the project.

The role of CC&HA steering committee is major decision for the CC&HA program, for example, approval of annual plan, approval of annual progress report, set the target of program outcome, audit the CC&HA PMC and the other major decision for program implementation.

Secretary of CC & HA steering committee will consist of WHO DPS and KOICA. The role of secretary is organizing the steering committee meeting annually, preparation of main agenda for meeting, communication among steering committee member states.

4.1.2 CC & HA Program Management Center (PMC)

The CC & HA program management center will be selected through grant & contract process of KOICA among international NGOs, universities, social enterprises and etc.

The role of CC & HA PMC will be implementing CC&HA program activities as a program implementer. In addition, they will report the progress of activities quarterly, the annual plan for steering committee approval, financial situation annually.

They will consist of 3 units. The 1st unit is responsible for CC&HA adaptation governance system technical support, policy making advocacy and research area defining and support. The 2nd unit is responsible for CC&HA assessment, information system establishment, Monitoring & evaluation of the program. The 3rd unit is responsible WASH program, infectious disease management system and community participation for CC&HA.

The establishment of this Center shall be embedded within the MoHMS governance system, which will be through partnership between Fiji MoHMS and KOICA.

Fiji Proposal for Climate Change & Health Adaptation

4.1.3 Project Implementing Organization

Ministry of Health and medical services

The Ministry of Health and Medical Services acknowledges that it is the right of every citizen to have access to a national health system that provides high quality health services, the principal function of which is to provide accessible, affordable, efficient and high quality health care and strengthen community development leading to improved quality of life.

The Ministry of Health and Medical Services overall Strategic Goals include; - Health systems strengthening are undertaken at all levels in the Ministry of Health and Medical Service; - Preventing, controlling or eliminating other communicable diseases; - Improved environmental health through safe water and sanitation.

4.1.4 Technical support organization

World Health Organization

The World Health Organization (WHO) is a specialized agency of the United Nations (UN) that is concerned with international public health. Established in 1948, its role is to act as a catalyst and advocate for action at all levels, from local to global, on health issues of public concern. WHO works together with a broad spectrum of partners from all sectors of society, and is involved in a host of closely related public health activities; including research, evaluation, awareness raising and resource mobilization.

WHO‟s mission is to lead the regional response to public health issues on all fronts - medical, technical, socio-economic, cultural, legal and political - towards the achievement of WHO's global health mission, which is to support all countries and people in their quest to achieve the highest attainable level of health. This is defined in the WHO Constitution as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity."

Fiji Proposal for Climate Change & Health Adaptation

4.2 Key stakeholders and cooperating organizations

The government of Fiji plays a key role in all stages of the project; policy and decision making, planning and guideline development, coordination of efforts and monitoring and evaluation of the project. WHO DPS and KOICA and other partners are supporting while the governments are the owner of the project.

WHO will be an technical support partner involved in providing technical support to MOHMS at a national level with regards to policy, guideline and standards development. WHO will also provide support with implementing activities at climate change and health adaptation where appropriate.

Ministry of Health and Medical services will be a partner leading the establishment of climate change and health adaptation systems to support: governance, administration and management capacity to implement national action plan & adaptation plan, essential and skilled climate change & health workforce in place, climate change based health early warning system, water & sanitation improvement, quality & efficient infectious disease management system and community participation. At a national level, CC&HA PMC will be collaborated with MoHMS.

The MOHMS will play key role in establishing CC&HA governance structure, recruiting the appropriate field site for WASH, suggesting appropriate health worker for climate change & health adaptation training, information collection, infectious disease prevention, detection and response, organize national wide survey.

WHO DPS will provide direct technical support to MOHMS as well as to the CC & HA PMC. This technical advice will include development of evidence-based guidelines, guidance on the self-assessment and planning, training the staffs, and development of assessment tools.

CC&HA PMC will be formed based on technical areas and will act as technical advisers for the CC&HA programme.

Fiji Proposal for Climate Change & Health Adaptation

4.3 Partnership with other donors

4.3.1 Climate change & health adaptation UN joint program

WHO, UNICEF, UNFPA are preparing the proposal to GCF for climate change and health adaptation program in Fiji. They will approach comprehensive health system resilience strengthening. The amount budget of the proposal will be about 50M US$ for 5years. If the proposal is successfully approved in GCF, it will be well cooperated with CC&HA program. For example, CC&HA program could be act as a pilot program for UN joint climate change & health adaptation program.

A number of organization and Fund are available for climate change and health adaptation in Fiji. As growing the risk of climate change, the interest and funding is increasing for climate change and health adaptation in Fiji.

There are available fund or organization for collaboration for CC& HA as below;

Donor Area/scope of funding Type of funding Eligible countries GEF Special Adaptation Grants All Pacific Climate Change Disaster risk reduction (DRR), SCCF-A for SIDS Fund (SCCF) human health impacts, vector adaptation; control, infrastructure, water SCCF-B for resources management technology Mainstreaming, capacity transfer building, awareness raising GEF Least Adaptation Grants LDCs–Kiribati, Developed Support national Samoa, Countries Fund adaptation programme of Solomon (LDCF) action (NAPA) Islands, Tuvalu, implementation, if health Vanuatu GEF Adaptation Fund Adaptation (attributable to Grants Developing identified as priority, or via (AF) climate change, “concrete” countries that are other priority sectors projects) party to the Kyoto Health outcomes with Protocol and sufficient informational particularly links to climate change, vulnerable (SIDS monitoring of disease and LDCs) vectors, early warning systems, DRR, World Bank Pilot establishingAdaptation regional Grants and highly LDCs and SIDS Programme for centresMainstreaming for re sponse climate to- concessional Climate theseresilience events development in financing for Resilience all sectors investments (near 0% interest with up to 75% grant component) 44

Fiji Proposal for Climate Change & Health Adaptation

EU Global Adaptation plans in non- Grant, overseas LDCs, SIDS Climate Change LDCs, NAPA development (must be EU/ Alliance (EU implementation in LDCs, assistance World Bank GCCA) adaptation in water sector (ODA), technical member) DRR – improved climate assistance ADB Climate Climatemonitoring resilience, and Co-financing, Cook Islands, Fiji, Change Fund especiallyforecasting, preparednesswater and grant, technical Kiribati, the sanitationmeasures Climatebased on-proofing data assistance Marshall Islands, health projects Federated States of Mainstreaming climate Micronesia, Nauru, change into development Palau, Papua New plans Guinea, Samoa, World Bank Overall – reduce poverty, Grant, loan, SolomonCountries Islands, with International promote growth, reduce technical Tonga,gross national Tuvalu, Development inequalities, improve assistance incomeVanuatu (GNI)/ Association living conditions capital ≤US$ 1135, Adaptation and mitigation with some Climate programme (water exceptions Global Facility for andAdaptation energy); projects that Priority countries – Disaster tieDRR, adaptationrecovery, and risk the Marshall Reduction and mitigationfinancing and insurance, Islands, Papua New Recovery capacity building Guinea, Solomon New Zealand Sustainable economic FijiIslands, (75% ofVanuatu funds), (NZ) Partnerships development Improved but in partnership for International access to social and with New Zealand Development development registered Fund services – health, business, education, water, nongovernmental sanitation, organization, DRR, safe communities government, Priority to projects that academic promote gender equity, institution Australian Aid environmentalPriority adaptation protection Grants 14 Fiji Asia Pacific andmeasures human rights Community- based Adaptation Small Grants

Programme

Fiji Proposal for Climate Change & Health Adaptation

4.4 Risk Management

The following key risks with relevant mitigation measures may need to be addressed during the implementation of this project:

Adaptation Identified risk Potential Impact Likelihood Mitigating factors measures Ensuring common understanding and agreement with the CC&HA Steering Committee through Reiterate and follow Operational: regular approval and other Conflict between Ministry engagement Medium communication. oversight ministries of in hindered. Detailed minutes of processes of each health involved CC&HA steering Ministry of health. committee meetings are shared for comment prior to finalizing. Since climate change There may be and health adaptation Implement CC&HA political turmoil, issue are universal in as according to Political elections which may cause Low Fiji; this risk will agree upon plans at some issues trickling unlikely directly affect an operational down. the CC&HA level. programme. If we cannot find there is no We will maximize the appropriate appropriate quality capacity for implementing No available Fiji implementing advertisement of the partners, we will implementing partners among Medium program to INGO, consider UN partner(PMC) INGO, universities universities and social agency as an and social enterprises which is implementing enterprises available in Fiji. partner.

Fiji Proposal for Climate Change & Health Adaptation

5 PROGRAM MONITORING AND EVALUATION

5.1 Monitoring and Evaluation Plan

The implementation of the programmes within the project will be monitored and evaluated regularly in accordance with the specified indicators. The Ministry of Health and Medical Services and the other collaborating institutions will monitor the flow and dynamics of the implementation of the activities. There will be suggestions and recommendations for any necessary changes for achieving the defined goal and objectives.

Continuous monitoring and regular evaluation will be coordinated on an annual basis, by the responsible person from the Ministry of Health and Medical Services, through reports prepared by the relevant ministries and institutions, according to their jurisdiction. The Steering Committee will continue to be the decision making mechanism for matters pertaining to the climate change unit with quarterly reporting and meetings prepared by the unit. Table 2 contains the key indicators that will be utilized in the monitoring and evaluation processes.

Key Indicators to measure the operational achievements

Component Key indicators Verification source

Annual Assessment reports EH/DSPH//NHEDMO : :

1 EHIA reports from EHOs Copies of documents (EIA, Annual Assessment reports Annual Assessment reports for

Assessment Reports infrastructure, project and and

Climate Safe health facilities with back up proposals)

sustainable resilient resilient and

technologies infrastructure and services infrastructure Component Assessment Reports

Fiji Proposal for Climate Change & Health Adaptation

Number of trained people in institutions and Divisional offices/ MOHMS champions identified to guide operational training unit/ Wellness Centre activities as it arises (Media and graphics officers) Officers are equipped with relevant Training courses resources Training materials Consultation and workshops Training and workshop reports Course content completed for adoption by Media reports FNU Targeted populations FNU Program commences CCD - Ministry of Finance Number of trainings conducted Health Information Unit data Number (%) of personnel trained - Copy of inventories with lists of Brochures produced and distributed to identified vulnerable areas target population - FCCDC – Mataika House Seasonal bulletins (FMS/MOH) - NVCU – EH Number of TV shows and media briefs - Dengue and vector reports Inventory of Health system climate- Analysis report climate, vulnerable areas (listed and mapped) disease and vector data Number of proposals and plans prepared- NHEDMO for adaptation - National Health and Research Mapped Vulnerable communities with Office adaptation capacities (GIS) - Copies of research reports Reduced CSD incidence - EH//NHEDMO

Health workforce Vulnerability Reduction Index/score - - Number of analysed climate and disease data Number of CSDs reported weekly (reduction)

mponent2 Number of timely and effective

Co interventions Number of researches undertaken Outcome of research tabulated and recommendations implemented Multi-sectoral meetings and policies progress

Analysed reports of epidemiological data and CSDs or health risks Number of health plans with climate information Reduced CSDs Emergency and disaster protocols, policies, plans with mention of climate sensitive health risks SOPs are utilized effectively utilized during emergencies and disasters

The general goal of the project is to implement measures in adapting to climate change for the health system in order to prevent and overcome both existing and future risks. It is essential to pursue implementation of the activities in this project in the short and medium term to generate products and direction for the long termed impacts of climate change on health. In addition, the project, when implemented, will empower the health system to address climate change issues and protect public health in Fiji. The successes and lessons learnt from the PCCAPHH project strengthen the connectivity between the health systems adaptation strategies as it prepared public 48

Fiji Proposal for Climate Change & Health Adaptation

health infrastructure to adapt to climate change.

5.2 Knowledge Management Plan

The project will generate new knowledge at various levels of society in Fiji including national levels as well as among a broad range of stakeholders including managers in the implementing ministries, policy makers and other stakeholders involved in activities around climate change & health adaptation. The CC&HA concept will be integrated into national climate change policy and action plan in terms of changes to the health system. It is expected that these outputs will provide benefits to health staffs and the overall health sector in Fiji beyond the timeframe of this program.

5.3 Transition or Exit strategy

To ensure sustainability, the program will be implemented with close collaboration with the MOHMS of Fiji. The program will build capacities of the health system through organizing a consulting group and staff training, providing evidence-based, locally appropriated guidelines and supportive supervision. In the long-term, with the climate change compatible development, it is expected that Fiji government can sustain the CC&HA initiative through institutionalization of the interventions and capacity building provided through the project.

Fiji Proposal for Climate Change & Health Adaptation

6 BIBLIOGRAPHY

1. WHO WPRO, Human health and climate change in Fiji, 2015 2. Climate change and health strategic action plan(2016-2020), MoHMS, 2016 3. Australian Aid , Overview of Climate Change Impacts on Human Health in the Pacific Region, 2011 4. Lachlan McIver et al, Health Impacts of Climate Change in Fiji: A Regional Assessment of Vulnerabilities and Adaptation Priorities 5. Pacific islands development forum, Suva declaration, http://pacificidf.org/wp- content/uploads/2013/06/PACIFIC-ISLAND-DEVELOPMENT-FORUM-SUVA- DECLARATION-ON-CLIMATE-CHANGE.v2.pdf

Fiji Proposal for Climate Change & Health Adaptation

7 ANNEXES Appendix 1: Logical Framework

Means of Outcome Output Indicator Base line Target Responsibility verification

Climate change 1-1 Standard operating The Proportion of facility resilient health procedures (SOP) with that applying the SOP N/A 80% Annual report MoHMS infrastructure specifications for siting

1-2 construction of health The proportion of health facilities, and energy, facility that safe from water and sanitation climate risk N/A 40% Annual report MoHMS provisions developed in line with identified or projected climate risks. 1-3 Model of a Green Develop green healthy Health Facility (including a facility or not Not developed developed Annual report MoHMS smart and safe facility) in Fiji Essential and skilled 2-1 To improve health Number of trainings climate change & care capacity of health health workforce in personnel to cope with Number of person who 0 15 place surges of climate sensitive received training Training MoHMS (also refer to 3.4.3 diseases (typhoid, report 0 1500 pages 33 -43) dengue, diarrheal diseases and leptospirosis); 2-2 Facilitate processes Number of health action & that support effective and activities that in cooperate efficient use of resources with climate change and information 0 10 Annual report MoHMS considering additional risks associated with climate change;

Fiji Proposal for Climate Change & Health Adaptation

The proportion of 2-3 Facilitate better awareness about climate N/ 50% awareness about climate change risk among all change and its effect and stakeholders (policy response on health to the makers, senior officers, public and all stakeholders communities and the Survey MoHMS (policy makers, senior media). officers, communities and the media). The number of campaigns developed 0 5

2-4 Ensure there are The proportion of sufficient number of health recruitment for climate workers with the required change & health technical capacity adaptation vacancy 0 80% Annual report MoHMS available to deal with the health risks posed by climate variability and change; 2-5 Research findings are The number of the used by policy makers research about climate and health leaders for change & health 0 5 publication MoHMS decision making adaptation pertaining to climate change and health. 2-6 Enhance application The vulnerability reduction of surveillance data for index score understanding of N/A Annual report MoHMS vulnerability of human health to climate change

Fiji Proposal for Climate Change & Health Adaptation

Appendix 2: Work Plan and Time Table

Output Activities 2018 2019 2020 2021 2022

1-1 Standard operating i. Assessment of health facilities for vulnerability of climate change procedures (SOP) with specifications for ii. Regular maintenance of health facilities, retrofitting or renovating to siting ensure back-up water supply, electricity, communication, supplies and medicines and equipment are available. 1-2 Construction of health facilities, and energy, water and iii. New health facilities to be located in areas not vulnerable to the sanitation provisions impacts of climate change and are accessible to the public. developed in line with identified or projected climate risks. i. Explore prospects of developing Green Health Facilities and Safe and 1-3 Model of a Green Smart hospitals. Health Facility (including a smart and Implementation of a Green Hospital/Health Facility Model within a safe facility) in Fiji ii. selected Setting in Fiji

2-1 To improve healthi. Training for EH officers, laboratory technicians, record keepers and care capacity of health other health workers on identifying risks and response related to personnel to cope with climate change.

Fiji Proposal for Climate Change & Health Adaptation surges of climate sensitive diseases Preparation of climate change and health curriculum/programs at the (typhoid, dengue, ii. diarrheal diseases and Fiji National University. leptospirosis);

Training for doctors, nurses, pharmacists and other practitioners on iii. climate impacts on appropriate health and adaptation measures.

Provide conference and training program for climate change & health iv. adaptation in pacific islands countries

2-2 Facilitate i. Development and update of technical guidelines for diagnosis, processes that detection, control, prevention and treatment of diseases (dengue, support effective and diarrhea, typhoid, leptospirosis), injuries and other food and fish efficient use of poisoning (ciguatera) illness arising from climate change; resources and information considering additionalii. Development of short and long term additional action plan for improved risks associated with health infrastructure, staffing and capacity to cope with vector-borne climate change; and water/food borne diseases in the context of climate change.

2-3 Facilitate better i. Preparation, printing and distribution of information brochures awareness about combined with TV and radio shows about the impact of climate change climate change and its and appropriate response on health and protection measures during effect and response high/low temperatures, in conditions of flood/drought and other on health to the public measures to prevent occurrence of CSDs with specific attention at and all stakeholders vulnerable population groups (the elderly, children, in high risk areas to (policy makers, senior CD outbreaks). officers, communitiesii. Work with the disaster management unit ensuring contingency plans and the media). and protocols address health personnel deployment during extreme disasters.

Fiji Proposal for Climate Change & Health Adaptation

2-4 Ensure there are sufficient number of iii. Organize the climate change & health department in MoHMS health workers with the required technical capacity available to deal with the health iv. Recruit the health staffs for climate change & health adaptation. risks posed by climate variability and change; 2-5 Research findingsi. Undertake on-going research with relevant experts to determine the sensitivity of health determinants including water, sanitation and are used by policy makers and health hygiene (WASH); NCDs, including psycho-social illnesses to climate leaders for decision variability and change. making pertaining to Evaluative research of educational measures effectiveness. climate change andii. health. 2-6 Enhance application of surveillance data for Conduct climate change & health adaptation surveillance in Fiji health understanding of i. system vulnerability of human health to climate change

Fiji Proposal for Climate Change & Health Adaptation

Appendix 3: Annual Budget Allocation

Output Activities 2018 2019 2020 2021 2022 Total 1-1 Standard operating Assessment of health facilities for procedures (SOP) with $50,000.00 $50,000.00 vulnerability of climate change specifications for siting Regular maintenance of health facilities, retrofitting or renovating

to ensure back-up water supply, Construction of health $950,000.00 $1,015,000.00 $1,015,000.00 $1,020,000.00 $4,000,000.00 electricity, communication, supplies facilities, and energy, water and medicines and equipment are and sanitation provisions available. developed in line with New health facilities to be located identified or projected in areas not vulnerable to the climate risks. $20,000.00 $20,000.00 $40,000.00 impacts of climate change and are accessible to the public. Explore prospects of developing 1-2 Model of a Green Green Health Facilities and Safe $10,000.00 $10,000.00 10,000.00 $30,000.00 Health Facility (including a and Smart hospitals. smart and safe facility) in Implementation of a Green Fiji Hospital/Health Facility Model $100,000.00 $100,000.00 $100,000.00 $300,000.00

within a selected Setting in Fiji Training for EH officers, laboratory 2-1 To improve health care technicians, record keepers and capacity of health other health workers on identifying $10,000.00 $10,000.00 $10,000.00 $10,000.00 $10,000.00 $50,000.00 personnel to cope with risks and response related to surges of climate sensitive climate change. diseases (typhoid, dengue, Preparation of climate change and diarrheal diseases and health curriculum/programs at the $25,000.00 $ 25,000.00 $50,000.00 leptospirosis); Fiji National University. Training for doctors, nurses, pharmacists and other practitioners $10,000.00 $ 10,000.00 $ 10,000.00 $30,000.00 on climate impacts on appropriate health and adaptation measures.

Fiji Proposal for Climate Change & Health Adaptation

Provide conference and training program for climate change & $100,000.00 $100,000.00 $ 100,000.00 $300,000.00 health adaptation in pacific islands countries Development and update of technical guidelines for diagnosis, detection, control, prevention and treatment of diseases (dengue, $10,000.00 $10,000.00 $10,000.00 $30,000.00 2-2 Facilitate processes diarrhea, typhoid, leptospirosis), that support effective and injuries and other food and fish efficient use of resources poisoning (ciguatera) illness arising and information considering from climate change; additional risks associated Development of short and long with climate change; term additional action plan for improved health infrastructure, staffing and capacity to cope with $10,000.00 $ 10,000.00 $ 10,000.00 $30,000.00

vector-borne and water/food borne diseases in the context of climate change. Preparation, printing and distribution of information brochures combined with TV and 2-3 Facilitate better radio shows about the impact of awareness about climate climate change and appropriate change and its effect and response on health and protection response on health to the measures during high/low public and all stakeholders $50,000.00 $50,000.00 $50,000.00 $150,000.00 temperatures, in conditions of (policy makers, senior flood/drought and other measures officers, communities and to prevent occurrence of CSDs with the media). specific attention at vulnerable

population groups (the elderly, children, in high risk areas to CD outbreaks).

Fiji Proposal for Climate Change & Health Adaptation

Work with the disaster management unit ensuring contingency plans and protocols $50,000.00 $50,000.00 $50,000.00 $50,000.00 $50,000.00 $250,000.00 address health personnel deployment during extreme disasters. 2-4 Ensure there are Organize the climate change & $50,000.00 $50,000.00 $100,000.00 sufficient number of health health department in MoHMS workers with the required technical capacity available Recruit the health staffs for climate to deal with the health risks $50,000.00 $50,000.00 $50,000.00 $50,000.00 $50,000.00 $250,000.00 posed by climate variability change & health adaptation. and change; Undertake on-going research with relevant experts to determine the 2-5 Research findings are sensitivity of health determinants used by policy makers and including water, sanitation and $20,000.00 $20,000.00 $20,000.00 $60,000.00 health leaders for decision hygiene (WASH); NCDs, including making pertaining to psycho-social illnesses to climate climate change and health. variability and change.

Evaluative research of educational $10,000.00 $10,000.00 $10,000.00 $30,000.00 measures effectiveness. 2-6 Enhance application of surveillance data for Conduct climate change & health understanding of adaptation surveillance in Fiji $50,000.00 $50,000.00 $50,000.00 $50,000.00 $50,000.00 $250,000.00 vulnerability of human health system health to climate change

TOTAL $350,000.00 $1,275,000.00 $1,545,000.00 $1,375,000.00 $1,455,000.00 $6,000,000.00

Fiji Proposal for Climate Change & Health Adaptation

Appendix 4: Environmental Screening

Question 1. Related environmental impacts

1-1 Will the project include new construction or enlargement or repair of building? ■ Yes □ No 1-2 Will the project change geographical features or land use? ■ Yes □ No 1-3 Will the project use or develop water resources? ■ Yes □ No 1-4 Will the project produce waste? □ Yes ■ No

Question 2. Requirement of EIA

2-1 Dose the host country have Environmental Impact Assessment (EIA) related laws or guidelines? ■ Yes □ No

2-2 Is EIA required for the project according to the laws or guidelines in the host country? □ Yes □ No ■ Unknown

2-3 If the EIA is required, please mark the corresponding item. □ Implemented □ On going ■ Planning

Question 3. Project's sensitive features

3-1 Does the project come under following sectors? ■ Yes □ No If yes, please mark the corresponding items. □ Hydropower, dams and reservoirs □ Urban development □ Roads, railroads and bridges □ Airports, ports and harbor ■ Water supply, sewage treatment □ Solid waste treatment □ River/Sand control □ Power transmission and distribution lines □ Mining development □ Industrial development □ Forestry □ Fishery □ Tourism □Agriculture (large-scale land-clearing or irrigation)

3-2 Are any of the following areas located on or around the project site? ■ Yes □ No

If yes, please mark corresponding items. □ National park □ Protected area designated by the government (cultural heritage) □ Protected area designated by the government (coastal zone, wetlands, reserved area for ethnic or indigenous people) □ Habitat of valuable species protected by domestic laws or international treaties □ Virgin forests, tropical forests □ Buffer zone of protected area □ Ecological important habitat areas (coral reef, mangrove wetland, tidal flats) □ Likely salts cumulus or soil erosion areas on a massive scale □ Remarkable decertification trend areas □ Archaeological, historical or cultural valuable areas ■ Living areas of ethnic, indigenous people or nomads who have a traditional lifestyle or special socially valuable areas

Fiji Proposal for Climate Change & Health Adaptation

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