Federal Democratic Republic Of Ethiopia Ministry Of Health

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Federal Democratic Republic of EthiopiaMinistry of HealthReview of Policy DocumentsOn Climate Change, WASH and Public Health in EthiopiaSeptember 2015Addis Ababa, Ethiopia1

Executive SummaryMinistry of Health has commissioned a “Review of Policy Documents on Climate Change,WASH and Public Health in Ethiopia” with the technical and financial support of WHO throughfinancial support of WHO/ DFID project Building adaptation to climate change in health in leastdeveloped countries through resilient WASH from June to September, 2015. The purpose of thereview was to generate evidences of whether WASH and public health policy documents aresensitive to climate change; and whether climate change policies prioritize WASH and publichealth as sectors vulnerable to climate change events. Findings from this review are expected tosupport informed discussions among key stakeholders resulting in climate resilient WASH andPublic Health in Ethiopia.Climate change, WASH and public health policies, strategies and programs were collected fromrelevant ministries and reviewed on the basis of checklists prepared for the purpose. Findingsfrom the policy reviews were complemented by informative discussions conducted withrepresentatives selected from relevant ministries and other development partners.Key FindingsEthiopia, the fast growing economy with insignificant contribution to global green house gasesemission, has taken considerable steps towards adaptation to climate change because of theopportunity cost of investing otherwise could be high. If Ethiopia fails to move forward with therequired speed to adapt to or mitigate climate change, it is expected to loss significantpercentages of its economic growth. Hence, Ethiopia has formulated its first kind of ClimateResilient Green Economy Strategy in 2011 which aims to support the country in achievingmiddle income status by 2025 that is carbon neutral and climate resilient. It has also put newstructure to implement climate resilient green economy at national level as well as assignedCRGE implementing agencies. Ethiopia’s Prime Minister has been playing a leading role inregional and global responses to climate change. Ministry of Environment and Forest (supervisesand regulate implementation of the technical components of CRGE) in collaboration with theMinistry of Finance and Economic Development (the facility is responsible to solicit and managethe financial component of CRGE) and are responsible to coordinate implementation of CRGE.But, still there are huge assignments with sector ministries to fully own climate changeadaptation planning, implementation, monitoring and reporting within the framework indicatedin the CRGE vision and strategy. At the time of this review, the status of sectors in terms ofmainstreaming climate change within their respective development programs and operationalplans remain to be at its infancy. Only CRGE implementing sectors are currently developingii

climate resilient strategies and the Ministry of Environment and Forest is finalizing guidancenote to help sectors mainstream climate change adaptation in the second Growth andTransformation Plan which will be implemented during the coming five years.Since climate change policy documents focus on six sectors identified as CRGE implementingagencies, namely, agriculture, energy, industry, transport, construction, and forest, they are notfully prioritizing drinking water supplies, sanitation and hygiene (WASH) and health inadaptation plans being one of the sectors vulnerable to climate change. Even though notconsidered being as one of the CRGE implementing agency, climate change is identified amongother challenges, and adaptation measures are mainstreamed in to the HSTP and diseaseprevention and control strategies, and planned to be implemented by integrating in to existinghealth systems.Similarly, the water sector has recognized the effects of climate change on drinking watersupplies and recently has taken management actions including development of climate resilientwater safety plan strategic framework, implementation guidelines, climate risk screening forrural water supplies and training manuals. Though not adequate, the national one-WASHprogram also addresses to some extent adaptation to climate change through environmentalscreening and management. Both health and water sectors have adequate institutionalarrangement with right staffing which create opportunity for implementation of the climatesensitive interventions. Even though ESDP is silent to address issues of climate change, it ismainstreamed in to tertiary education training and intertwined in to biology, geography andgeneral science subjects. Climate change affects every sector and/or every society in the countrybut the scale and nature of the risks vary largely because of the difference in the shockabsorption capacities. If policies and programs are fully sensitive to climate change, it is possibleto minimize climate change risks and hence safeguard livelihoods of vulnerable segments of thesociety, which in turn has positive implications on their health.Climate change, if not sufficiently addressed, will continue to affect economic growth.Preliminary projections by UNDP indicated that climate change would have a sizable impact onthe economy, in a range of 7% to 8% GDP loss per year. Ethiopia is one of the African countriesmost vulnerable to the adverse impacts of climate change with limited response capacity to shortterm climatic shocks or adapt to long term trends (Conway et al., 2007). Its geographical locationas well as social and economic structures contributed to Ethiopia’s vulnerability to climatechange risks. More specifically, dependency of its population on climate sensitive sectors forlivelihoods, limited national response capacity, poor infrastructure as well as wide spreadenvironmental degradation and fragile ecosystem are reported to contribute towards country’svulnerability to climate change risks.Desert and drought prone areas are characterized by either erratic or shortage of rain fall, hightemperature, and flush flooding resulting in damage of Water supply and sanitationiii

infrastructures and creation of favorable environment for vector and water borne diseases. Inaddition, nine percent of the topographic feature of Ethiopian highland terrain is characterizedwith slope greater than 16% and one-third of this land area is with slope greater than 30% whererain can result in flush flooding which is the main cause for massive soil erosion, productivityloss and ground water scarcity. MoWIE took affirmative policy actions and developed riskassessment and management tools such as climate resilient water safety plans strategicframework and implementation guidelines so as to adapt to impacts of climate change.Where sector policy documents recognize climate change as one of the development challenges,the theories of changes are not well articulated, and hence how climate change affectperformance of the sector or sustainability of the services are not sufficiently addressed. Thismeans that interventions are not targeting climate change risks, but are running as business asusual.Climate change prone areas are not well known across the country by most of the sectors visitedduring this review. This is mainly because of the underdeveloped research and knowledgemanagement in the areas of climate change in Ethiopia. Where there is mapping of climatechange related risks, they are not being updated. For example, there is no update on malariatransmission mapping in light of current changes in urbanization, expansion of large scaleagricultural and industrial development, improvement in economic growth and climate change.NTD control master plan (FE) component of trachoma control strategy did not consider thenational hygiene and sanitation strategy being one of the opportunities for its successfulimplementation program. Therefore, there are grey areas that need integration and alignment ofprevention and control program interventions and resources for diseases that share commonenvironmental and climatic risk factorsRecommended policy optionsThe following recommendations have been made to facilitate discussions among keystakeholders leading to the establishment of climate resilient WASH and Public Health inEthiopia.Option 1: Provides Proposals for Policy Options in the Areas of Strategic Directions.In the long run WASH Sector Policies, being vulnerable to climate change risks, shall takeclimate resilience as their respective sector direction by reflecting it in the overall policy goals,objectives, strategies and targets. While revising their respective policies and strategies, sectorministries shall consider climate change as part of water, health and education sector policygoals, objectives, strategies, and targets. In the short run, climate change adaptation shall bemade part of water and education sectors’ GTP 2 targets.iv

Similarly climate change policy documents shall prioritize WASH and Public Health in thenational adaptation and/or mitigation action plans. Policy documents should also identify socialsectors including health, and education sectors as CRGE implementing sectors so that they arecapacitated to address climate change adaptationsHealth program strategies shall identify infectious diseases that have common environmental andclimatic risk factors and design high impact intervention that simultaneously addresses theburden and reduce vulnerability of the population to climate change.Sector policy documents (policy, strategy, programs) should have theories of change to fullyaddress climate change risks within their respective contexts. They should have clear path onhow climate change events affect the performance of WASH and public health, and hence haveclear measurable indicators.Option 2: Provides Recommendations with Regard to Management of Climate ChangeRisks on WASH and Public HealthThis review process agrees with recommendations given by previous researchers in those futurewater supply technology choices that need to focus on reliable sources including boreholes ordeep wells with productive aquifers, and large springs.In case there is no option but to use vulnerable sources, more focus should be placed on propersitting of the source (shallow wells, hand dug wells, on spot springs) and/or developingvulnerable sources along with more resilient technologies to spread climate related risks.At this point in time, it is clear that sectors lack required capacity to draw accurate plan to adaptto or mitigate climate change risks. Therefore, increasing adaptation and mitigation capacities ofall sectors susceptible to climate change would be of great importance. This might include inservice capacity building training or pre-service training.It is also important to capacitate sectors to analyze, interpret and use climate data or informationin planning process (for example: if temperature is projected to increase by 1degree Celsius,what does it mean for water supply planners? Health service planners? Education planners?). It iscritical to fully understand the scientific associations between increase or decrease in temperatureor precipitation and WASH and/or public health.MoEF is supporting development of climate resilient green economy through providing training,preparing guidelines to mainstream climate change adaptations or mitigations in sector programs.Sector ministries should be aware of such support and should utilize the opportunity in theprocess to establish climate resilient WASH and public health.v

Option 3: Provides Alternative Recommendations to Improve Research and KnowledgeManagement for Laying Ground in Establishing Climate Resilient WASH and PublicHealthFindings from this review indicated that there are limited scientific understanding on the linkbetween WASH and climate change, WASH and public health as well as climate change andspecific components of public health interventions in Ethiopia. CRGE coordinating body (MoEFand MoFED) in collaboration with relevant sectors should commission research to generateevidences on the scientific links between WASH and climate change, WASH and public healthas well as climate change and public health.Besides, CRGE coordinating bodies in collaboration with relevant sectors should map thecountry in terms of different variables including climate prone areas, people’s livelihoodpractices, hydrological and geological formations. This helps sectors to align their respectiveclimate change adaptation plans.vi

AcknowledgementThe Federal Ministry of Health (MoH) would like to thank World Health Organization (WHO),for continuous financial and technical support to make the WASH and Health Sectors’ effort toadapt to current and future climate change in general and to conduct review of the Ethiopia’spolicy documents on climate change, WASH and health in particular.Furthermore, the Ministry would like to appreciate contributions of different Ministries andpartner organizations including National WASH Coordination Office, MoA, NMSA, MoE, andMoEF, MoH/EPHI, CO-WASH, MWA, and CRS, in providing documents and their valuableopinion on the strengths and gaps of their policies, strategies, programs and projects and for theirexplanations to the consulting team to have basic understanding on the challenges associatedsensitiveness of national policies, strategies and programs in light of climate change.MOH would like to thank and appreciate Mr. Girma Aboma (Senior Economist, Policy Analyst)and Mr. Yared Legesse (Environment and Public Health Specialist), WHO consultants for theirefforts to review policy documents and production of analysis report that could inform futureactions.vii

Table of ContentsExecutive Summary . iiAcknowledgement . viiTable of Contents . viiiList of Tables . ixList of Figures . xAcronyms . xi1. INTRODUCTION . 11.1. Socio-economic status. 11.2. Brief Summary of Health and WASH Sectors’ Profile . 21.2.1.Health sector profile . 21.2.2.WASH sector profile . 31.3. Climate Change Trends in Ethiopian . 52. METHODOLOGY AND APPROACHES USED. 63.1. Stakeholders analysis . 83.1.1.Key stakeholders for climate change adaptations . 83.1.2.Power and Interest Analysis . 93.2. Impacts of Climate Change on WASH and Public Health. 103.2.1.Nature and scale of climate change on public health . 103.2.2.Impacts of climate change events on WASH . 113.3. Analysis of Policy Environment and Governance . 133.3.1.Ethiopia’s Policy Responses of Climate Change . 133.3.2.Governance: Institutional Arrangement for Adaptation to Climate Change. 213.3.3.Gaps / Limitations with Existing Policies . 233.3.4.Scoring policy documents . 283.3.5.Potential areas for policy or program/strategy revisions. 314. CONCLUSIONS AND PROPOSED POLICY OPTIONS . 324.1. Conclusions . 324.2. Proposed Policy Options for Climate Resilience . 325. REFERENCES . 356. ANNEXES . 37viii

List of TablesTableTitle of the TablesPageTable 1Criteria for scoring policies for climate resilience7Table 2Lists of stakeholders for climate change, WASH and Public Health8Table 3Stakeholder analysis using power-interest grid (consultant perspectives)9Table 4Overview of climate change policy responses14Table 5Gaps with climate change policy documents in terms of prioritizing WASH and Health23Table 6Limitations with WASH policy documents in light of climate sensitiveness25Table 7Gaps with education and health policy documents in terms of addressing climate27change risksTable 8Results of scoring climate change policies in light of WASH and Public Health28Table 9Results of scoring sector policies in light of adaptations to climate change risks29Table 10Potential areas for policy/strategy/program revisions31ix

List of FiguresFiguresTitle of the FiguresPageFigure 1Figure 2Effects of climate change on water supplyNew structure for CRGE governance1222x

AcronymsAfDBAfrican Development BankAWDAcute Watery DiarrheaCCClimate ChangeCRSCatholic relief ServiceCRGEClimate Resilient Green EconomyCSACentral Statistic AgencyCSOCivil Society OrganizationDFIDUnited Kingdom, Department of International DevelopmentDHSDemographic and Health SurveyEPHIEthiopian Public Health InstituteESDPEducation Sector Development ProgramDPPRADisaster Prevention Preparedness and Response AgencyDRMDisaster Risk ManagementGDPGross Domestic ProductGTPGrowth and Transformation PlanHDWHand Dug WellHMISHealth Management Information SystemHSDPHealth Sector Development ProgramHSTPHealth Sector Transformation PlanITNInsecticide Treated NetsIRSIndoor Residual SprayJMPJoint Monitoring ProgramMDGMillennium Development GoalMWAMillennium Water AllianceMoEMinistry of EducationMoFEMinistry of Forest and EnvironmentMoFEDMinistry of Finance and Economic DevelopmentMoHMinistry of HealthMoWIEMinistry of Water, Irrigation and Energyxi

NAPANational climate change Adaptation Program ActionNGONon-Governmental OrganizationNHS-SAPnational Hygiene and Sanitation Strategic Action PlanNMANation Meteorological AgencyNTDNeglected Tropical DiseaseNWINational WASH InventoryODFOpen Defecation FreePHEMPublic Health Emergency Mana

Federal Democratic Republic of Ethiopia Ministry of Health Review of Policy Documents On Climate Change, WASH and Public Health in Ethiopia September 2015 . Addis Ababa, Ethiopia. ii . Executive Summary . Ministry of Health has commissioned a “Review of Policy Documents on Climate Change,

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