Public Health Impact and Health System Preparedness within a Changing Climate in Bangladesh: A Scoping Review

Abstract

Bangladesh, one of the most disaster-prone countries in the world is also severely exposed to climate change (CC) impacts with a multitude of health complexities. Health adaptation to CC is thus a serious issue in Bangladesh, but not explored properly from a health system and policy environment perspective. In order to address this gap and provide a holistic picture of the overall scenario, this scoping review explores CC impacts on the population health in Bangladesh and discusses the policy environment and health system preparedness against such climatic challenges. A total of 28 articles were reviewed following Arksey and O’Malley’s scoping review framework. A “5-point scale” was devised to assess CC integration in the health sector Operational Plans (OPs). Though the country made significant progress in different health indicators, poverty and income inequality have kept marginal communities out of many health provisions. There are four major stakeholders in the health system. The government sector is handicapped by poor governance, bureaucratic processes, and staff shortages; and primarily focuses on the public sector only. National Health Policy (NHP) governs the health system through 29 sectoral OPs, that put CC as a major cross-cutting issue. About 25% of the OPs have fully integrated CC and other OPs have significant CC co-benefits. In Bangladesh CC was linked to increased morbidity and mortality, diarrhea, cholera, skin problems, respiratory infections, malaria, dengue, kala azar, pre-eclampsia, and hypertension. Significant research gaps exist on child health, migrant health, and mental health. Integration of research evidence into policy, planning and program design is largely absent. However, prioritizing health for the National Adaptation Plan is an essential step towards establishing a climate-resilient health system.