A playbook includes “process workflows, standard operating procedures, and cultural values that shape a consistent response—the play.” It borrows from some of the Aristotelian elements of the play and provides a directional “how” while reinforcing the “why” and “what”.
Plot: The arrangement of events or incidents on the stage. The plot is composed of “clearly defined problems for characters to solve.”
Character: The agents of the plot. The People.
Theme: The reason for the play. The Purpose.
This comprehensive integrated health and climate change response playbook is a set of guidelines designed to address the intersection of climate change and its impact on public health. There are several reasons why such a playbook is considered essential:
Interconnected Challenges: Climate change and health are intricately connected. Changes in climate patterns can lead to more frequent and severe weather events, altered disease patterns, and various environmental health risks. A playbook helps navigate these interconnected challenges.
Mitigation and Adaptation: The playbook outlines strategies for both mitigating the causes of climate change and adapting to its inevitable impacts. This may include reducing greenhouse gas emissions, developing resilient health infrastructure, and implementing policies to protect vulnerable populations.
Public Health Risks: Climate change poses direct threats to public health through increased heatwaves, extreme weather events, changes in infectious disease patterns, and the impact on air and water quality. A playbook helps identify and address these risks to safeguard public health.
Policy Guidance: Governments, organizations, and communities need clear guidance on how to formulate and implement policies that address the health impacts of climate change. A playbook provides a framework for developing and implementing effective policies at various levels.
International Cooperation: Climate change is a global challenge that requires international cooperation. A playbook can serve as a tool for collaboration, providing a common understanding of the health risks associated with climate change and facilitating joint efforts to address them.
Education and Awareness: A playbook serves as an educational resource, raising awareness about the links between climate change and health. It can inform healthcare professionals, policymakers, and the general public about the potential health impacts and the importance of taking action.
Emergency Preparedness: Climate change can lead to more frequent and severe emergencies, such as hurricanes, floods, and wildfires. A playbook helps communities prepare for and respond to these emergencies, ensuring that health systems are resilient and can effectively handle increased demands.
Long-Term Planning: Climate change is a long-term challenge, and a playbook provides a framework for sustained, adaptive planning. It helps communities develop strategies that consider the long-term health impacts of climate change and incorporate them into broader public health planning.
In summary, a comprehensive integrated health and climate change response playbook is essential for providing guidance, fostering collaboration, and ensuring a comprehensive approach to addressing the complex and interconnected challenges posed by climate change on public health.
The CPHC alliance underscores the indispensable need for a Comprehensive Integrated Health and Climate Change Response Playbook, recognizing the intricate link between them. Climate change, driven by human activities, profoundly impacts public health, necessitating a collaborative approach.
This Comprehensive Integrated Health and Climate Change Response Playbook - a pioneering effort in India, guides district stakeholders in tailoring solutions for health, climate, and governance challenges.
It promotes a multi-stakeholder action plan at the district level, emphasising the frontline role of districts in addressing climate impacts on communities.
The playbook adopts a systems approach, integrating fragmented health systems, disaster preparedness, and involving diverse stakeholders. It avoids a one-size-fits-all strategy, offering options based on local context, and aims to unite all stakeholders to improve health and resilience amid climate change challenges. The document provides critical insights, frameworks, exemplars, and working methods across various topics.
The playbook is a result of intense collaboration sprints amongst the authoring entities, learnings from lived realities of communities at the last mile and individuals drawing from decades of experience and expertise and divides the entire process of arriving at a comprehensive integrated health and climate change response into 3 Acts, which are as follows:
The severe impact of climate change in India demands an integrated approach to address its health consequences, especially for vulnerable groups. India, ranking seventh in countries affected by climate change1 , faces extreme weather events2 and record temperatures3 . Climate change intensifies health risks, affecting access to water, air, food, and shelter, particularly for marginalised populations. Strengthening our health systems aligns with the Paris Agreement goals, potentially saving a million lives annually by 20504.
Recognizing district-level dynamics and implementing integrated climate change and health plans across districts can yield effective, sustainable solutions, emphasising the urgency for immediate action and innovation in addressing the climate crisis.
1 Global Climate Risk Index, 2021
2 https://www.cseindia.org/india-2023-extreme-weather-events-11973
Take the case of the Karnataka government, which is being proactive about preventing the unfavourable effects of a heatwave. While heat waves affect central and northwestern India the most, the eastern and southern coasts have also been affected. To tackle this, the Karnataka State Natural Disaster Monitoring Cell has created a heat wave action plan. A departure from normal temperature by more than 4.5° Celsius or an actual maximum temperature of 45° C is considered to be a heatwave. The action plan has also identified 15 districts in north Karnataka which are prone to heatwaves. It puts the district administration in the hot seat by listing out the responsibilities of various departments
This plan encompasses various aspects including health and medical care, drinking water, nutrition and employment, to reduce the adverse effects of a heatwave such as fatalities.
One of the main strategies is to take a break from all outdoor work, including all forms of labour, and classes in educational institutions from 11 a.m. to 3 p.m. Work and study hours will be rescheduled when a heatwave is declared in a particular district. Also, additional fans will be provided in schools and outdoor activities will be avoided.
Other than rescheduling work and study hours, it talks about setting up temporary “cooling centres” in public places for distributing water, buttermilk, medicines and for shelter.
While there have been numerous deaths in the bordering states of Telangana, Andhra Pradesh and Maharashtra due to heat waves, a study put the number of fatalities in Karnataka between 1978 and 2014 at six. Karnataka may be doing something right. How can other states and their different districts learn from it?
The development and implementation of successful models for delivering high-quality, scalable, and sustainable primary healthcare services face inherent difficulties. Striking the right balance between preventive measures and treatment, establishing sustainable funding mechanisms, and fostering active community participation are ongoing challenges in this context.
A pressing concern is the imperative for stronger linkages between climate change and primary healthcare. This connection underscores the environmental impact on respiratory health, food production, and the potential for societal disruptions, including migration and increased poverty. Recognizing and addressing these interconnections are crucial steps in anticipating and mitigating the adverse health
In the face of climate change, Indian women are experiencing a
growing concern related to infertility. As extreme weather events and
environmental degradation become more frequent, their adverse
effects on reproductive health have become evident. Deteriorating air
quality, rising temperatures, changing rainfall patterns, and increased
exposure to pollutants pose significant challenges to the fertility of
women here. These factors can disrupt hormonal balance, affect
menstrual cycles, and contribute to reproductive disorders. Additionally,
the socio-economic implications of climate change, such as food
insecurity and displacement, further exacerbate the fertility issues
faced by Indian women. Urgent measures are needed to address the
intersection of climate change and infertility, including comprehensive
healthcare interventions, public awareness campaigns, and sustainable
environmental practices, to safeguard the reproductive well-being of
women and ensure a healthier future for generations to come.
https://www.indiaspend.com/air-pollution-can-lead-to-infertility-birth-
complications-emerging-research
The Comprehensive Integrated Health and Climate Change Response Playbook explains how the response can be designed to be people focused and operationalized at a district level.
However, let us first discuss District Planning in India, Why District as a unit and Why People Focus?
Article 243 (ZD) establishes District Planning Committees to consolidate plans from PRIs and ULBs, drafting a comprehensive development plan for the district. These committees bridge the gap between Panchayats and Urban Local Bodies, ensuring district-level planning aligns with local needs, growth potential, and budgetary allocations.
Every district offers specific context (such as topography, climate risks, size), assets (natural resources, organisations, leaders) and challenges (epidemic, service delivery, and community participation)
Keeping this in mind, it is important to support each district to comprehend its challenges and opportunities and then evolve a plan that is localised for the district.
Supporting district planning can fast track the process of strengthening district response, based on both
Districts offer small enough geographic and demographic areas to effectively manage problems and solutions.
Centralised, developmental, intervention designs often struggle to address specific local contexts, whereas districts have proved to be a suitable unit for tailored interventions and learning opportunities. Capacities for contextualising interventions to meet local needs are more feasible at the district level.
The pandemic has highlighted the importance of resilient health systems, which can be effectively implemented and managed at the district level.
Policy shifts under the 15th Finance Commission empower decentralised management of health and nutrition, enabling districts to have more control over their healthcare systems.
NITI Aayog’s ‘Transformation of Aspirational Districts’ initiative, encompassing 112 districts, focuses on results-based governance through convergence, collaboration, and competition among districts.
There is a global push by philanthropists and donors to support localised programming, promoting a paradigm shift towards customised solutions rather than force-fitting interventions.
Districts represent the lowest unit where the highest level of administrative delegation and leadership exists.
Districts serve as self-contained health ecosystems, facilitating the coexistence of primary, secondary, and tertiary health systems. Also, district-level health indicators are available, not to mention the fact that one can achieve other SDGs such as providing clean water and ending hunger too.
Maintaining health requires individual practices, positive household and community norms, and a supportive ecosystem. Individual health involves proper nutrition, sleep, and avoiding risky behaviours. Positive community behaviours and mental health support are essential, along with an enabling environment for livelihoods and community assistance in times of distress. Lastly, a health-promoting ecosystem provides clean water, air, education, livelihood opportunities, and protective laws, preventing marginalisation and ensuring agency. Health-seeking behaviour is driven by understanding health loss, accessibility, affordability, and dignified care. Individuals value “quality” healthcare as accessible, compassionate, trustworthy, and attentive to their needs.
Integration of outcome to action: navigating interdependence, turning results into impactful actions, recognizing interconnected relationships for effective implementation and positive change.
Integrating assets enhances climate and health interventions, leveraging resources, expertise, and community engagement for comprehensive, sustainable solutions and positive impact.
Integration of AYUSH, medical, social, and management sciences forms a holistic approach, blending traditional healing, health, societal well-being, and administration. This extends to critical domains for climate and health planning, ensuring environmental resilience, public health, disaster preparedness, community engagement, and sustainable development strategies are seamlessly integrated for sustained progress and success.
Public health view transcends sectors, prioritising community well-being, prevention, and holistic approaches, fostering collaboration for collective health improvement.
People focus calls on human centricity and integrates well-being, awareness, and adaptive measures, ensuring a resilient healthcare approach for improved outcomes.
Data and surveillance provide vital insights, enabling informed decision-making, proactive interventions, and effective response strategies for public health challenges.
The inception of the CPHC Alliance began with recognizing the need for a collaborative platform to strengthen Comprehensive Primary Healthcare (CPHC). This idea took root through a series of strategic activities anchored by USAID and Swasti - starting with a brainstorming meeting involving key stakeholders in December 2020, followed by a “blue-sky thinking” session in February 2021. To ensure a well-rounded perspective, consultations with thought leaders were conducted through one-on-one interviews.
On the eve of World Health Day in April 2021, several organisations signed a Statement of Intent to form the Alliance for Comprehensive Primary Health Care (Alliance) in India.
By mid-2021, the Alliance extended invitations to over 30 potential members, forming a Core Group that included representatives from USAID, the Bill & Melinda Gates Foundation (BMGF), LetzDream Foundation (LGTVP), and the Asian Development Bank (ADB). One of the central themes identified by the members was the need to reimagine districts as units for healthcare delivery. This focus aimed to explore districtcentric models and develop a comprehensive, integrated approach to CPHC.
From 2022 to 2023, multiple in-person consultation meetings were organized to delve into critical aspects such as design, financing, and governance. These sessions sought inputs from Alliance members to shape actionable strategies. Additionally, a series of virtual “Meet the Expert” talks in 2023 provided members with diverse insights from subject matter experts.
The insights gathered from these activities culminated in the creation of the Comprehensive Integrated Health and Climate Change Response (CIHCCR) Playbook, enriched with climate considerations, and two documentary films that highlighted the voices of service users and frontline workers. These outputs, completed between 2023 and 2024, embody the Alliance’s collective learnings and vision for CPHC.
The CIHCCR empowers district-level stakeholders with actionable frameworks to address the intersecting challenges of health and climate change. This playbook was developed through a consultative approach and is designed to guide stakeholders in developing multi-stakeholder action plans that are both strategic and tailored to local needs, ensuring that solutions are practical and sustainable.
In its second phase, introduced in August 2024, the CPHC Alliance intends to expand its reach beyond India to encompass Asia, creating a broader platform to unite voices from across the continent. It aims to amplify visibility for impactful member initiatives, particularly those championing diversity, equity, and inclusion. By consolidating technical, technological, and financial resources, the Alliance supports crosssector collaboration, showcasing frugal innovations and driving sustainable healthcare improvements. With an infinite mindset and a commitment to unconventional perspectives, the Alliance is poised to scale its impact, attract investments, and stand as a unified voice for transformative primary healthcare solutions across Asia.
To know more about the alliance, follow us on LinkedIn at CPHC Alliance.
https://www.linkedin.com/showcase/cphc-alliance/
