Strengthening institutional coordination for climate resilient health systems: Comparative experience from Bangladesh, Nepal and Pakistan

Strengthening climate resilient health systems (CRHS) requires effective coordination across government sectors, federal and subnational levels and with stakeholders outside government. Coordination has often faced challenges in practice, hindering coherent actions and creating gaps and duplication in implementation. This article examines coordination for CRHS in Bangladesh, Nepal and Pakistan, where already-fragile health systems face growing climate-related shocks and stressors. Findings are drawn from three separate country studies, each of which used document reviews and interviews. This synthesis article draws on findings from each country to identify a range of factors affecting coordination for CRHS. Each country has – to varying degrees – incorporated CRHS in climate and health policy frameworks, and policies emphasise the importance of coordination. Policy implementation remains more nascent. There has been some coordination across government environment, disaster management and health sectors, but siloes persist, and operational coordination remains inconsistent. Coordination between federal and subnational governments has encountered challenges such as unclear ownership and insufficient communication, hindering alignment and contributing to gaps in implementation. Civil society engagement has sometimes been limited, with top-down government planning hindering stakeholder input. A range of organisational issues have affected coordination, including weak coordination mechanisms, unclear organisational mandates and roles, lack of units or focal points responsible for CRHS, capacity gaps, and political dynamics. Overall, coordination mechanisms are necessary but insufficient, and their operationalisation and effectiveness depend on a wider enabling environment. Based on country experience, the article identifies lessons to support CRHS coordination in low-income countries, including fragile and shock-prone settings. • Health system resilience to climate change needs strong coordination • We explore links among climate and health actors in Bangladesh, Nepal and Pakistan • There is some collaboration, but gaps persist across sectors, levels and actors • Some coordination bodies meet rarely, exclude key actors, or only address disasters • Unclear roles, low capacity and political dynamics hinder coordination • Efforts to strengthen coordination need to address technical and political factors