Climate change impacts are felt in many sectors and across all Nepalese population. The Nepal National Adaptation Programme of Action (NAPA) to climate change has identified public health as one of the most vulnerable sectors to the negative effects of climate change. There are increasing evidences on the impacts of climate variability and change on health outcomes in Nepal. The health impacts of climate change are water-borne diseases, vector-borne diseases, air-borne diseases, food-borne diseases and nutrition related diseases such as malnutrition, injuries and mental illnesses . Though the effects of climate change on health are noticeable, there are limited etiological studies on the health impacts of climate change in Nepal. Several challenges for conducting climate change and health research in developing mountainous countries have been reported which include lack of trained human resources, financial resources, long-term data and information, and suitable methods that are applicable to the local context . Entomological and epidemiological studies carried out in Nepal show early effects of climate change on vector-borne diseases with clear shifting of vector-borne diseases and their vectors in the highlands of Nepal . The impacts of climate change could be seen or observed through the changes in average temperature, precipitation and extreme weather conditions over the past three decades. These changes bring about direct impacts on human health or indirectly on disease transmitting agents and thereby affecting human health.

Based on global evidences and scientific consensus, if climate change continues as projected across the RCPs scenarios, the major increase of ill-health will occur in Nepal compared to no climate change scenario through: 

1. the greater risk of injury, disease, and death due to more intense heat waves, cold waves and fires; 

2. the increased risk of under-nutrition resulting from diminished food production in resource poor regions; 

3. consequences on health of lost work capacity and reduced labour productivity in vulnerable populations; 

4. the increased risks of food- and water-borne diseases and vector-borne diseases especially in previously considered non-endemic mountain areas; 

5. modest reductions in cold-related mortality and morbidity in the highlands due to fewer cold extremes, 

6. increased morbidity and mortality related to cold waves in southern Terai; and 

7. the reduced capacity of disease-carrying vectors due to exceeding thermal thresholds especially in the lowland Terai regions. 

Management of these health effects of climate change will require inputs from all sectors of government and civil society, collaboration between many academic disciplines, and new ways of international cooperation. Involvement of local communities in discussing, advocating, assisting and monitoring of the process of adaptation will be crucial.

Constitution of Nepal 2015: The article 30(1) ensures that each person shall have the right to live in a healthy and clean environment and article 30(2) has provisioned that the victim of environmental pollution and degradation shall have the right to be compensated by the pollutants as provided for by law. Hence, Constitution of Nepal has clearly spelled out matter of loss or damage caused by emissions of global GHGs and right to get compensation as per national/international laws, negotiations and treaties. Similarly, the article 35 has stated about right to health care. The major provision of article 35 are: (1) Every citizen shall have the right to seek basic health care services from the state and no citizen shall be deprived of emergency health care, (2) Each person shall have the right to be informed about his/her health condition with regard to health care services, (3) Each person shall have equal access to health care, and (4) Each citizen shall have the right to access to clean water and hygiene.

Climate Change Policy 2011: The policy has been formulated mainly to inform parties of UNFCCC about the implementation of the convention, to promote climate adoption mitigation and restoration of the carbon level, and to make natural resource management climate-friendly for socio-economic development and climate-resilient infrastructure development. The Policy intends to integrate climate change aspects into plan and development programmes and their implementation, to establish climate change centre; to reduce GHG emissions, to promote renewable energy; to enhance adaptation in and climate resilient capacity and initiate community based local adaptation plan in line with NAPA; to enhance the capacity to estimate and forecast present and future impact of climate change; to promote climate friendly technologies and to manage solid waste as a resource. The policy is mainly for general strategy. The policy intends to form sector wide working group and integrate climate change policy in the sector policies. The policy has emphasized the implementation of preparedness programmes to fight against disaster and epidemics; regular implementation of public awareness and capacity building programmes; preparation of appropriate climate forecasting models for Nepal and regularly updating it based on regional climate models; introduction of agriculture and disaster insurance in climate change-affected areas; and allocation of at least 80 percent of total funds available for climate change-related programmes at the community level.

National Adaptation Programmes of Actions (NAPA) to Climate Change, 2010: The NAPA, through a consultative process, has been prepared as strategic tools to assess climate vulnerability and systemic responses by climate change adaptation measures. The NAPA document has been summarized into six thematic groups: Agriculture and food; Climate induced disasters; Urban settlement and infrastructures; Public health; Forest and diversity; and Water resources and energy. Vulnerability analysis and work of TWG came out with a long list of adaptation options under each theme. Prioritization exercise was done for inclusion in the NAPA. Among nine areas of project profile, one is adapting to climate challenges in public health. The NAPA has analyzed public health as a separate theme and has prioritized following activities for adapting to climate challenges in public health:

1. Reducing public health impacts of climate change through evidence based research and piloting;

2. Empowering communities through education for responding to the adverse effects of climate change in public health;

3. Investing in disease outbreak and emergency response;

4. Scaling up programmes on vector-borne, water and food-borne diseases and disasters;

5. Strengthening forecasting/early warning and surveillance systems on climate change and health.

The adaptation strategies that have been identified in the NAPA, has largely focused on awareness raising and health care system strengthening at community level including urgency of research and studies to understand the scale and epidemiology of health problems induced by climate change and variability and formulation of evidence informed adaptation strategies. The adaptation options identified in other thematic groups such as water & energy, forest & biodiversity, agriculture, climate induced disasters etc. are also relevant for protecting health from climate change indicating the need of inter-sector collaboration.

National Framework on Local Adaptation Plans of Action (LAPA) 2011: The LAPA was formulated in line with the NAPA as a national framework to provide the effective delivery of adaptation services to the most climate vulnerable areas and people. The LAPA Framework ensures the process of integrating climate adaptation and resilience into the local and national planning. The LAPA actions include: identifying the most climate vulnerable communities; identifying and prioritize adaptation; preparing the LAPA and integrate it into the local and national plans in accordance with the LSGA; identifying and mobilising appropriate service delivery agents; adopting and/or implementing adaptation actions sequentially; and conducting monitoring and evaluation by ensuring effective implementation of the plan. The LAPA requires that all sectors integrate the local adaptation plan of action for climate change adaptation into the sector development plan at the local level. The LAPA mainly provides the process.

National Health Policy 2014: The new Policy has been developed as an improvement to the National Health policy of 1991 for ensuring quality health services to the people of Nepal without any discrimination. This aims to ensure the rights of people to quality services. The main objective of the new policy is the universal coverage of health services to all. The policy has one objective to gradually mainstream health in all policies by further strengthening collaboration with multi-sector stakeholders in health. In order to achieve this objective of health in all policies, it has adopted following strategies:

1. Health agenda will be included in all concerned policies;

2. For the overall management of the negative effects of climate change on health, a multi-sector plan will be developed in collaboration with all stakeholders and by properly utilizing the national networks and mechanisms or opportunities;

3. The muiti-sector action plan will be prepared and implemented in such a way that there will be multi-sector coordination on various aspects such as safe drinking water, sanitation, energy, food security, climate, environment, education, accommodation, infrastructure development including roads which affect in availing the health service.

National Population Policy 2014

This policy has given emphasis on carrying out research studies on inter-relationship between climate change, environmental degradation and different aspects of population for managerial works which maintain intimate relationship between population and sustainable development.

Nepal Health Sector Programme -Implementation Plan (NHSP IP-II): This is a continuation of NHSP IP-I (2004-10) extending plan for 2011-15. The plan has been prepared with the vision to improve health and nutritional status of Nepali population, especially the poor and excluded people. It has the objective to improve the health system to achieve universal coverage of essential health services including communicable disease control. The NHSP IP-II has added sanitation and hygiene for community as one of the health promotion activities and environmental health (water, air quality, sanitation, hygiene, waste disposal,) as one of the components of essential health services for piloting and scaling up with inter-sector partnership. The Action also includes establishing a knowledge network with academia and practitioners on climate change; and a public health response team for climate change. But environmental health or climate change activities have not been incorporated into the institutional framework explicitly.

Nepal Health Sector Strategy 2015-2020

The Nepal Health Sector Strategy 2015-2020 (NHSS) is recognized as the strategy that will guide the sector, taking into account multi-sector collaboration to address the social determinants of health over the next five-year period (2015-2020). It responds to the existing socio-political environment and the changes that have taken place both in the local and global health agenda. This strategy is developed following the overarching planning and monitoring frameworks of the National Planning Commission and is guided by the National Health Policy 2014. It articulates nation’s commitment towards achieving Universal Health Coverage (UHC). This strategy has given emphasis to establishing multi-sectoral response to climate change.