ZAMBIA HEALTH NATIONAL ADAPTATION PLAN 2017 HEALTH NATIONAL ADAPTATION PLAN ii HNAP REPORT PREPARE BY MOH iii TABLE OF CONTENTS List of tables ................................................................................................................................ vi List of figures .............................................................................................................................. vi ABBREVIATIONS ................................................................................................................... vii DEFINITIONS ............................................................................................................................ ix EXECUTIVE SUMMARY ..........................................................................................................x 1 INTRODUCTION .................................................................................................................1 2 METHODOLOGY ................................................................................................................3 3 BACKGROUND INFORMATION ......................................................................................7 4 SITUATION ANALYSIS ...................................................................................................10 4.1 Key Health Indicators.................................................................................................. 10 4.2 Burden of climate sensitive diseases ........................................................................... 11 4.2.1 Infectious/communicable diseases ....................................................................... 11 4.3 Non communicable diseases ....................................................................................... 17 4.4 Determinants of health impacting on disease burden .................................................. 17 4.4.1 Poverty ................................................................................................................. 18 4.4.2 Nutrition ............................................................................................................... 18 4.4.3 Water, Sanitation and hygiene ............................................................................. 18 4.4.4 Housing ................................................................................................................ 19 4.4.5 Energy sources ..................................................................................................... 19 4.4.6 Education and literacy.......................................................................................... 19 4.4.7 Population structure and growth .......................................................................... 20 4.4.8 Health systems and access to health services ...................................................... 20 4.4.9 Policy environment .............................................................................................. 23 5 OBSERVED CLIMATE VARIABILITY AND HEALTH IMPACTS .............................25 5.1 Observed climate variability ....................................................................................... 25 5.1.1 Variability in precipitation patterns ..................................................................... 25 5.1.2 Temperature variability ........................................................................................ 27 5.1.3 Community perception of climate variability ...................................................... 27 5.2 Influence of observed climatic conditions on selected diseases ................................. 27 5.3 Health impacts from observed climate risks ............................................................... 31 5.3.1 Floods or excessive rainfall: ................................................................................ 31 5.3.2 Droughts ............................................................................................................... 34 5.3.3 Temperature: ........................................................................................................ 34 6 PROJECTED CLIMATE CHANGE AND HEALTH IMPACTS .....................................38 6.1 Projected climate change for Zambia .......................................................................... 38 6.1.1 Temperature ......................................................................................................... 38 6.1.2 Rainfall ................................................................................................................. 38 iv 6.2 Health impacts from projected climate variability ...................................................... 38 6.2.1 Diarrhoea: ............................................................................................................ 39 6.2.2 Cholera ................................................................................................................. 39 6.2.3 Under-nutrition .................................................................................................... 40 6.2.4 Malaria: ................................................................................................................ 41 7 VULNERABILITY TO CLIMATE CHANGE ..................................................................42 7.1 Geographical ............................................................................................................... 42 7.2 Current disease burden ................................................................................................ 43 7.2.1 Malaria ................................................................................................................. 43 7.2.2 Diarrhoeal diseases .............................................................................................. 44 7.2.3 Respiratory diseases ............................................................................................. 45 7.2.4 Under-nutrition .................................................................................................... 46 7.2.5 HIV and AIDS ..................................................................................................... 46 7.3 Socioeconomic status .................................................................................................. 46 7.4 Education and literacy ................................................................................................. 47 7.5 Access to health services ............................................................................................. 47 7.6 Population growth and urbanization ........................................................................... 48 8 ADAPTATION ...................................................................................................................51 8.1 Evaluation of adaptation options ................................................................................. 51 8.2 Selection of proposed adaptation measures ................................................................ 57 8.3 Mainstreaming climate change into the public health ................................................. 61 9 APPENDICES .....................................................................................................................62 9.1 ADAPTATION OPTIONS AND IMPLEMENTATION PLAN: 2018 - 2021 .......... 62 9.2 Sources of information ................................................................................................ 67 9.3 STAKEHOLDERS IN THE IMPLEMENTATION OF H-NAP ............................... 68 9.4 Questionnaires ............................................................................................................. 71 10 REFERENCES ....................................................................................................................73 v List of tables Table 1: Framework for climate proofing Zambia and chapters where details are provided in this document ............................................................................................................................... 5 Table 2: Climatic characteristics of the country based on agro-ecological zones ....................... 7 Table 3: Health system performance and attainment of MDG targets ...................................... 10 Table 4: Malaria epidemiological zones in Zambia ................................................................... 13 Table 5: Summary of extreme climate events and impact on health and livelihoods................ 36 Table 6: Summary of selected of drivers of vulnerability for Zambia ...................................... 50 Table 7: Health conditions/diseases vulnerable to climate change and rating for need to adapt.. .................................................................................................................................................... 52 Table 8: Public health principles applicable to climate change response for Zambia ............... 59 List of figures Figure 1: Top 7 causes of visitation to health facilities 2003 -2013 .......................................... 11 Figure 2: Malaria incidence 2003 - 2013 ................................................................................... 12 Figure 3: Incidence of respiratory tract infections (non-pneumonia) 2003 - 2013 .................... 14 Figure 4: Incidence of non-bloody diarrhoea 2003 -2013 ......................................................... 15 Figure 5: Annual cholera cases by province 2009 - 2013 .........................................................