Building climate-resilient and low-carbon health systems in Nepal: Insights from a policy document review and qualitative interviews with key stakeholders

OBJECTIVES: This study aimed to investigate the health sector's progress on building a climate-resilient and environmentally sustainable health system in Nepal. The objectives were to identify specific challenges related to the World Health Organisation's (WHO's) ten-component operational framework and provide actionable insights to inform evidence-based strategies for health policymakers. STUDY DESIGN: Mixed-method design involving policy analysis and qualitative interviews. METHODS: This study conducted a desk-based review of policies relevant to climate and health, and conducted qualitative interviews with 12 stakeholders (government policymakers, private sector and civil society). Participants were purposively selected based on their expertise in climate change and health, ensuring diverse perspectives. The findings were systematically organised and analysed using the ten components of the WHO operational framework for building climate-resilient and environmentally sustainable health systems. RESULTS: Integration of evidence from the policy document review and the qualitative interviews showed that, despite a strong policy foundation supporting the transition to low-carbon, climate-resilient health systems, implementation remained unsatisfactory, primarily due to poor data, weak intersectoral collaboration, insufficient capacity and inadequate funding allocated to climate resilience within the health sector. Issues related to the framing of climate change as either an environmental or a public health problem across ministries, demonstrated by divergent views on establishing early warning and monitoring systems, significantly affected ownership and responsibility for implementing existing policies. CONCLUSIONS: This study identified the need to strengthen inter-ministerial and cross-disciplinary collaboration in addressing climate change as a risk multiplier across many sectors. Such collaboration would enable international development partners and allow the state government to appropriately allocate resources to address topical challenges, including capacity building, infrastructure development and the establishment of integrated mechanisms to support transition to a climate-resilient health system in Nepal.