How the World Bank is building climate-resilient health systems in India

Noklentula Sangtam has been working at the same hospital as a nurse for the last 31 years. This year, for the first time and just three years before her retirement, she witnessed the hospital get 24/7 electricity supply. Needless to say, the nurse in charge at the district hospital of Kiphire, a small town in India’s northeastern state of Nagaland, is relieved. “The next generation of nursing staff will not have to go through what we suffered when there were power cuts. In serious cases, we had to refer patients to Kohima or Dimapur [the largest cities in the state] at least 150 miles away.” Sangtam recalled. The remote region in one of India’s least populated states faces long power cuts both due to low electricity generation and extreme weather conditions. In 2021 alone, the state witnessed over 800 water- and climate-related incidents. Between 2018 and 2021, the state saw a whopping 200% increase in climate-related incidents. Forcing patients and health workers at the 75-bed district hospital to deal with various health crises amid blackouts which would sometimes stretch for six to seven hours. “With 75 beds, we are the biggest hospital in the district. Our staff would work under emergency lights or ask patients to hold candles, while they administered medicines or injections,” Dr. Holiba Anar, medical officer at the Kiphire district hospital, said. The situation was worse 25 miles away, at the 18-bed community health center in Pungro town of Kiphire. The center did not have its own electric generator and had to stop all services whenever there was a power cut. “We could not run the oxygen concentrator without electricity or provide warmers to newborns in this cold hilly region,” said Dr. Sikukhiumew Torechu, medical officer at the community health center in Pungro. But things started to improve after the Nagaland State Department of Health and Family Welfare reached out to several global institutions, seeking help for the state’s health care systems. The result was the implementation of the $60 million Nagaland Health Project, funded by the World Bank, in 2018. Light at the end of the tunnel In the last six years, the Nagaland Health Project has helped over 175 small and big health care centers install solar power panels with a total capacity of 1504 kilowatts peak. The move has also helped cut the dependency on fuel-run combustion generators, reducing their carbon footprint. As part of the project, solar streetlights, solar water pumps and solar water heaters were also installed in targeted health facilities. The carbon offset of the project was equivalent to saving 55,792 trees, a World Bank spokesperson said. “Since Nagaland has a small population, missing out on providing health care to even a few people made a huge difference in our health statistics. Electricity is crucial for everything, whether it’s administering vaccines or providing health care to pregnant women. I have seen staff struggle helplessly in power cut situations,” said Dr. ImkongTemsu Longchar, state immunization officer and acting project manager of Nagaland Health Project. “Most areas in the state are difficult to reach, and some are completely cut off from the cities due to deplorable condition of the roads. Nagaland is a landslide-prone region, which severely disrupts connectivity. Transporting combustion generators would not only add heavily to the carbon footprint, it is also very expensive,” added Longchar. In a written response, the World Bank spokesperson said, “Climate change is identified as the biggest global public health threat of the 21st century. Conservative estimates suggest 250,000 additional deaths per year due to climate change between 2030 and 2050. India ranks as one of the countries most vulnerable to climate change, owing to its peculiar topography, climatic conditions, and socio-economic vulnerabilities.” Initially, the project experienced some challenges The COVID-19 pandemic and several climate-related incidents delayed the project. Installation of the solar panels was to conclude in 2022 but was eventually finished in June 2023. But, according to Longchar, the project was a success and inspired the neighboring states of Meghalaya and Mizoram to duplicate some of the work. ‘Climate crisis is a health crisis’ In a special report released ahead of the United Nation Climate Change Conference, or COP29, the World Health Organization stressed the need to see the climate crisis as a health crisis. “Health is the argument for climate action,” it stated. “Extreme weather events, record-breaking temperatures, storms and floods are causing disruption to health systems, water and sanitation infrastructure and supply chains, fuelling outbreaks of infectious diseases and contributing to higher rates of noncommunicable diseases … Many of the tools to meet these challenges are already at hand, including sources of clean, efficient, cheap, renewable energy. Now is the time to utilize them on a grand scale, to make them the norm rather than the exception,” the report further said. Consequently, the discussion of integrating health care in climate negotiations was one of the top priorities of global health organizations at COP29, though it did not receive as much attention as it did at prior COPs. “As climate change worsens, so does its impact on health. From a rise in infectious diseases to increasing strain on already fragile health systems, the challenges are mounting. Investing in country-tailored solutions [and] investing in strengthening health systems is important. While we’re adapting to the climate crisis, it’s extremely important to be moving to low-carbon systems, thus working on energy efficiency,” said Tamer Rabie, global program lead for climate and health at the World Bank, during his interview at COP29. He added that it was crucial to transform health systems so that they become more resilient and climate-responsive. In India, the central government launched the National Programme on Climate Change and Human Health in 2019 to address the impact of climate change on health and enhance the adaptive capacity of the health system to climate-induced health risks. Meanwhile, the district hospital in Kiphire now has 180 solar panels installed, generating 60 kilowatts of electricity, more than sufficient to meet its daily needs. And health care workers like Sangtam are hopeful for the future. Editor’s note: This story was produced as part of the 2024 Climate Change Media Partnership, a journalism fellowship organized by Internews' Earth Journalism Network and the Stanley Center for Peace and Security. Devex maintains full editorial independence.