Federal Democratic Republic of Ethiopia Ministry of Health - Africa ...

Federal Democratic Republic of Ethiopia
Ministry of Health
Climate Change Adaptation Programme Plan for Health
2011-2015
FMOH
2011
F M O H , A D D I S A B A B A , E T H I O P I A

Table of contents
Foreword ................................................................................................................................................... 5
Acknowledgment ........................................................................................................................................ 6
Executive Summary ................................................................................................................................... 7
Acronyms and Abbreviations ..................................................................................................................... 11
Definition of terms .................................................................................................................................... 13
1. Introduction ..................................................................................................................................... 14
2. Background ..................................................................................................................................... 16
2.1. Demographic Situation ................................................................................................................. 16
2.2. Administrative Structure ................................................................................................................ 17
2.3. Socio-economic Situation .............................................................................................................. 17
2.4. Educational Status ....................................................................................................................... 17
2.5. Health Status ............................................................................................................................... 18
3. Situational Analysis and Guiding Principles......................................................................................... 18
3.1. Situational analysis ...................................................................................................................... 18
3.2. SWOT Analysis ............................................................................................................................ 19
3.2.1. Strengths ................................................................................................................................ 20
3.2.2. Weaknesses ............................................................................................................................ 20
3.2.3. Opportunities ........................................................................................................................... 21
3.2.4. Threats ................................................................................................................................... 21
3.3. Impact of Climatic change on the human health .............................................................................. 22
3.3.1. Global context .......................................................................................................................... 22
3.3.2. National context ....................................................................................................................... 23
3.3.3. Vulnerability ............................................................................................................................. 24
3.3.4. Response Measures................................................................................................................. 26
3.3.5. Portfolio of good practices ......................................................................................................... 27
4. Vision .............................................................................................................................................. 29

5. Scope ............................................................................................................................................. 29
6. Goal ................................................................................................................................................ 30
7. Objective ......................................................................................................................................... 30
8. Guiding Principles ......................................................................................................................... 30
9. Adaptive Capacity of the Health Sector .............................................................................................. 31
9.1. Economy ..................................................................................................................................... 31
9.2. Technology .................................................................................................................................. 32
9.3. Information and Skills ................................................................................................................... 32
9.4. Institutions ................................................................................................................................... 32
9.5. Infrastructure ............................................................................................................................... 33
10. Strategic Approaches ................................................................................................................... 34
11. Major Activities: ............................................................................................................................ 34
11.1. Research and Surveillance / evidence based policy decision ............................................................ 34
11.2. Inter- and intra-Collaboration, coordination and partnership .............................................................. 35
11.3. Health Systems Strengthening (HSS)............................................................................................. 36
11.3.1. Mainstreaming and prioritizing climate sensitive diseases management ........................................ 36
11.3.2. Human Capacity Development/Training ..................................................................................... 36
11.3.3. Infrastructure Structure Development ......................................................................................... 36
11.3.4. Emergency Medical Services .................................................................................................... 37
11.4. Climate Change Adaptation Programme promotion and Communication ........................................... 37
11.5. Monitoring & Evaluation ....................................................................................................... 37
11.6. Control high population growth rate ................................................................................................ 42
11.7. Strengthen and utilize Climate-informed early warning and response system ..................................... 42
11.8. Indoor air pollution ............................................................................................................... 43
12. Program Sustainability .................................................................................................................. 43
13. Activity and Budget ...................................................................................................................... 44
14. Annexes ..................................................................................................................................... 47

15. References .................................................................................................................................. 47

Foreword
The impacts of climate change may be physical, ecological, social or economical. The adverse effects
of climate change have already set in, and it is clear that developing countries are particularly affected
as population growth exacerbates family’s vulnerability.
The impacts of climate change are magnified in poor countries where the population is rapidly growing,
the management of resources is poor, awareness is inadequate and household and national
economies are very feeble. Ethiopia is among such developing countries with annual population growth
rate of 2.6% with varying across regions from Gambella 4.1% to Amhara 1.7%.This high population
growth will have high pressure on the ecosystem.
Even though Ethiopia’s contribution to global greenhouse gas emissions is negligible, it is affected by
the adverse impacts of climate change brought by the carbon-intensive development paths of
developed countries over the past century.
The Health sector is among the sectors affected by climate change. It will share most of climate change
effects of human health directly through morbidity and mortality impacts of temperature extremes,
vectors of infectious diseases, proliferation of non-vector-borne infectious diseases, air quality, floods
and storms, and indirectly through impacts on food supply and water resources. Climate sensitive
diseases like malaria, trypanosomiasis, onchocerciasis, schistosomiasis, Leshmaniasis are common in
Ethiopia.
In order to protect the entire Ethiopian population from health impact hoisted from climatic change it is
the time to develop climate change adaptation program plan, and implement, follow up and evaluate
implementation of the program as stipulated in this document.
Therefore, it is anticipated that this strategic plan will help to overcome the health risks of climatic
change, which the population have been facing for many years while dealing with health problems
raised from climatic change.
Dr. Kebede Worku
Federal Ministry of Health, State Minister

Acknowledgment
The Federal Ministry of Health (FMoH) would like to extend its gratitude to the Federal Environmental
Protection Authority (FEPA) for the technical and financial support and for initiating the climate change
adaptation program (CCAP) exercises and for their continuous follow-up and guidance throughout the
process including country report preparation. Our sincere thanks also goes to Dr. Kebede Worku, the
State Minister of health, for his concerned follow up and leadership of this climate change adaptation
program (CCAP) plan. Similarly our gratitude goes to the Technical Working Group (TWG) members
from FMoH, FEPA, FMHACA,EHNRI, UNICEF, WHO and School of Public Health, Addis Ababa
University for their immense contribution in leading the whole process from the beginning up to the final
stages in the preparation of Climate Change and Adaptation Programme country strategic plan. The
Ministry would further extend its appreciation to Dr. Daddi Jima, Deputy Director General; EHNRI for his
in-depth review of the documents and forwarding valuable comments.
We also appreciated the involvement of eleven Regional Health Bureau representatives and comments
for further refining the Climate Change and Adaptation Programme country strategic plan. Furthermore,
FMoH would like to cherish its special thanks to the following individuals for their full time engagement
in preparation of the Strategic Plan in the present form:.
Mr. Abduljelil Reshad, Federal Ministry of Health, Resource Mobilization Directorate
Mr. Dereje Mamo, Federal Ministry of Health, Policy and Planning Directorate
Wr. Ejgayehu Yeshitela, Food, Medicine and Health Care Control Authority
Dr. Alemayhu Belaineh, Federal Ministry of Health, Policy and Planning Directorate
Dr. Daddi Jima, Deputy Director General, EHNRI
Dr. Frehiwot Berhane, TUTAPE, Country Office
Mr.Getachew Belaineh, UNICEF/FMOH, Pastoralist Health Promotion & Disease Prevention
Directorate
Mr. Legesse G/ Meskel, Federal Environmental Protection Authority (EPA)
Wr. Miheret Shelemew, Federal Ministry of Health, Resource Mobilization Directorate
Mr. Waltaji Terfe, WHO, Country Office
Mr. Worku Tefera, Addis Ababa University, School of Public Health

Executive Summary
The Intergovernmental Panel on Climate Change (IPCC) defines climate change as: any change in
climate over time, whether due to natural variability or as a result of human activity. The main
characteristics of climate change are increases in average global temperature (global
warming);changes in cloud cover and precipitation particularly over land; melting of ice caps and
glaciers and reduced snow cover; and increases in ocean temperatures and ocean acidity due to
seawater absorbing heat and carbon dioxide from the atmosphere. Evidence from around the world
also showed that the global warming is changing rainfall and storm patterns, and disrupting the balance
of natural systems that supply the necessities of life.
These resulted in changing of the existence of the eco system which supports life on earth. According
to environmental health perspectives and the national institute of environmental health sciences of
Centers for Diseases Control and Prevention (CDC , January 2009) , the categories of human health
consequences of climate change are: asthma, respiratory allergies, and airway diseases, cancer,
cardiovascular diseases and stroke, food born diseases and malnutrition, heat-related and stressrelated
disorders, neurological diseases and disorders, vector borne and zoonotic diseases, water born
diseases and weather-related morbidity and mortality. In the long run, however, the greatest health
impacts may not be from acute shocks such as natural disasters or epidemics, but from the gradual
build-up of pressure on the natural, economic and social systems that sustain health, and which are
already under stress in much of the developing world.
All populations are vulnerable but some are more vulnerable than others and all populations will be
affected by a changing climate, but the initial health risks vary greatly, depending on where and how
people live. Health effects are expected to be more severe for elderly people and people with infirmities
or pre-existing medical conditions. Furthermore, the groups who are likely to bear most of the resulting
disease burden are children and the poor, especially women.
Even though Ethiopia’s contribution to global greenhouse gas emissions is negligible, it is affected by
the adverse impacts of climate change brought by the carbon-intensive development paths of rich
countries over the past century. It is hit harder than most countries by drought and its devastating
consequences. Recurrent droughts have resulted in loss of life and property as well as the migration of
people.

Health sector is one of the sectors affected by climate change. It will share most of climate change
effects of human health directly through morbidity and mortality impacts of temperature extremes,
vectors of infectious diseases, proliferation of non-vector-borne infectious diseases, air quality, floods
and storms, and indirectly through impacts on food supply and water resources. Climate sensitive
diseases like malaria, trypanosomiasis, onchocerciasis, schistosomiasis and Leshmaniasis are
common in Ethiopia.
Ethiopia has been part of all international initiatives to prevent environmental degradation both at local
and at global levels. International agreement on reducing greenhouse gas emissions to 6-8 percent
below 1990 levels between 2008 to 2012 is enshrined in the United Nations Framework Convention on
Climate Change, which led to the adoption of the Kyoto Protocol on Climate Change in 1997.The
country ratified these international legal instruments 1992- and 2005 respectively. In June 2009, the
National Adaptation Programme of Action for Ethiopia finalized the identification of priority activities for
adaptation to climate change.
Climate change also brings new challenges to the control of infectious diseases. Many of the major
killers are highly climate sensitive as regards temperature and rainfall, including cholera and the
diarrheal diseases, as well as diseases including malaria, dengue and other infections carried by
vectors. In sum, climate change threatens to slow, halt or reverses the progress that the global public
health community is now making against many of these diseases.
Rising temperatures and changing patterns of rainfall are projected to decrease crop yields in many
developing countries, stressing food supplies. For populations that depend on subsistence farming, or
do not have sufficient income to buy food, this situation is expected to translate directly into wider
prevalence of malnutrition. In turn, malnutrition increases the severity of many infectious diseases,
particularly among vulnerable groups.
In Ethiopia all population are at risk of climate change. However, the most vulnerable groups to the
impact of climate change are women, children, elderly, disabled and poor people. People living in arid,
semi arid, lowland and flood prone areas of the country which have high incidence of flood that
happens mainly due to climatic change and variability are also more vulnerable. The problems resulted
from climatic change are malaria, diarrhoea, infections associated with malnutrition, and non
communicable diseases. In general, factors that increase the vulnerability of health sector to climatic

change in Ethiopia include: poverty, lack of public awareness to climate sensitive diseases, harmful
traditional practices, inadequate health service and inadequate infrastructure and transportation facility.
Adaptive capacity encompasses coping ability (i.e. what could be implemented now to deal with current
climate and climate variability) and strategies, policies and measures that can expand future coping
ability. Adaptive capacity is a theoretical construct because it is not possible to know with certainty
whether a country will invest resources to expand its coping ability, how technology and other factors
will change, or what adaptations actually will be implemented, until a perturbation or stress occurs.
The Intergovernmental Panel on Climate Change (IPCC) identified the main features of countries that
seem to determine their adaptive capacities are: economic wealth, technology, information and skills,
infrastructure, institutions and equity.
Adaptation strategies frequently are described as risk management and public health programs can be
characterized as reducing climate change health risks, improved weather warning and preparedness
systems, buildings and infrastructure, all can be considered measures to reduce human health risks in
the event of a changed frequency of weather disasters.
Prior to the implementation of adaptation activities it is important to build a public understanding that
climate change is occurring and to persuade people of an immediate action to prevent future damage
from climate change impacts on human health. Best practices indicate that the adaptation activities
have been developed through a broad partnership with extensive consultation to a variety of
stakeholders and interest groups to guarantee that adjacent interests are not adversely affected. Prior
to the implementation of adaptation actions, it was learned that to carry out detailed studies, such as
explore potential climate change impacts and vulnerabilities, identify priority concerns, bench mark
others best practices, desk top study reviewing and all other relevant information, to help assess the
feasibility of adaptation plan.
The guiding principles for good practices in adaptation are intended to support planners and decision
makers when dealing with the challenges of adapting to climate change and provide a framework for
identifying good practice examples in adaptation. Adaptation is a cross-level and cross-sectoral activity
which brings together actors from different stakeholders including the government.
The objectives of the adaptation program plan are:
o
o
To identify and prioritize highly vulnerable areas and segments of the population to climate
change in the country
To identify climate change sensitive diseases and adverse public health events

o To develop evidence based preparedness, response and recovery plan
o To strengthen the health system in order to respond to climate change vulnerability with
special focus on the priority areas
o To strengthen advocacy, social mobilization, communication and education to facilitate the
climate change adaptation
Major activities identified for the adaptation program include:
o Research and Surveillance
o Inter- and intra-Collaboration, coordination and partnership
o Health Systems Strengthening (HSS)
o Climate Change Adaptation Programme promotion and Communication
o Monitoring & Evaluation
o Control high population growth rate
o Strengthen and utilize Climate-informed early warning and response system
o Reduce Indoor air pollution
Cognizant of the health effects of the climate change on citizens of Ethiopia, the Federal Ministry of
Health prepared this Climate Change Adaptation Programme plan to lay a foundation for systematic
response and implementation across all health systems at national, regional, zone, woreda and kebele
levels.

Acronyms and Abbreviations
ACTs
Arthemesinin Based Combination Therapy
ARM
Annual Review Meeting
CC
Climate Change
CCAP
Climate Change Adaptation Plan
CCAPP
Climate Change Adaptation Plan Program
CDC
Centers for Disease Control
CH4
Methane
CMH
Commission on Macroeconomics on Health
CO2
Carbon Dioxide
CSO’S
Civil Society Organizations
DHS Demographic Health Survey ( Ethiopia )
DSS
Demographic Surveillance Sites
EHNRI
Ethiopian Health and Nutrition Research Institute
EIA
Environmental Impact Assessment
EMP
Environmental Management Plan
EPI
Expanded Program on Immunization
EPRP
Emergency Preparedness and Responsiveness Plan
4AR
Fourth Assessment Report
FEPA
Federal Environmental Protection Authority
FMHACA
Food, Medicine, and Health care Administration and Control Authority
FMOH
Federal Ministry of Health
FP
Family Planning
GDP
Gross Domestic Product
GIS
Geographic Information System
GOs
Government Organizations
GTP
Growth and Transformation Plan
HCSS
Health Commodities Supply System
HEWs
Health Extension Workers
HEP
Health Extension Program
HEPs
Health Extension Packages
HIA
Health Impact Assessment

HIV/AIDS
HMIS
HPDP
HSDP
HSS
IDSR
IE/BCC
IHP+
IMR
IPCC
LLINS
MDGs
M&E
MMR
MOE
N20
NAPA
NCDs
NGOs
NTDs
PASDEP
RDTs
RVF
SOPs
TB
TOR
TWG
UK
UNICEF
UV
WB
WHO
Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome
Health Management Information System
Health Promotion and Disease Prevention Directorate (in federal ministry
of health)
Health Sector Development Plan
Health System Strengthening
Integrated Disease Surveillance and Response
Information, Education Communication/Behavioral Change Communication
International Health Partnership Plus
Infant Mortality Rate
Intergovernmental Panel on Climate Change
Long lasting Insecticide Nets
Millennium Development Goals
Monitoring and Evaluation
Maternal Mortality Rate
Ministry of Education
Nitrogen Dioxide
National Adaptation Plan of Action
Non- Communicable Diseases
Non Governmental Organizations
Neglected Tropical Diseases
Plan for Accelerated and Sustainable Development to End Poverty
Rapid Diagnostic Tests
Rift Valley Fever
Standard Operational Procedures
Tuberculosis
Terms of Reference
Technical Working Group
United Kingdom
United Nations Children’s Fund
Ultra Violent
World Bank
World Health Organization

Definition of terms
Adaptation: A process by which strategies and measures to moderate cope with and take advantage
of the consequences of climate events are enhanced developed, implemented and monitored
(UNDP,2003)
Adaptive capacity: is the general ability of individuals, communities, and institutions to effectively
prepare for and cope with consequences of climate variability and change
Climate: is the pattern or cycle of weather conditions such as temperature, wind, rain, snowfall,
humidity, clouds, including extreme or occasional ones over a large area averaged over many years
Climate Change refers to a statistically significant variation in either the mean state of the climate or in
is variability, persisting for an extended period (typically decades or longer) Climate change is due to
natural internal processes or external forcing, and to persistent anthropogenic changes in the
composition of the atmosphere.
Climate Variability describes variations in the mean state and other statistics (e.g. standard
deviations, the occurrence of extreme events, etc.) of climate on all temporal and spatial scales beyond
that of individual weather events. Variability may be due to natural internal processes within the climate
system or to variations in natural or anthropogenic external forcing.
Mal-adaptation: a business as usual development which by overlooking climate change impacts,
inadvertently increases exposure and/or vulnerability to climate change. Mal-adaptation also includes
actions undertaken to adapt to climate change impacts that do not succeed in reducing vulnerability but
increase it instead.
Mitigation refers to policies and measures to reduce greenhouse gas emissions and/or enhance sinks
Resilience is the ability of a natural or human system to absorb disturbances while retaining the same
basic structure and ways of functioning, the capacity for self-organization, and the capacity to adapt to
stress and change
Risk (i.e. climate-related risk) is a product of the likelihood of exposure and the consequence of that
exposure. It arises from the interaction of a physically defined hazard (i.e. floods and other extreme
weather events, increasing temperature) with the properties of the exposed system (its vulnerability)
(UNDP, 2003). System vulnerability is a critical determinant of the risk a region or subpopulation faces
when exposed to a particular hazard. This means that programmes to decrease vulnerability will
decrease risk.
Vulnerability: The degree to which a system is susceptible to, or unable to cope with, adverse effects
of climate change, including climate variability and extremes. Vulnerability is a function of the character,
magnitude, and rate of climate variation to which a system is exposed, its sensitivity, and its adaptive
capacity
Weather: is the state of the air at particular place and time-whether it is warm or cold, wet or dry and
how cloudy or windy it is, for example.

1. Introduction
The Intergovernmental Panel on Climate Change (IPCC) defines climate change as: any change in
climate over time, whether due to natural variability or as a result of human activity. The main
characteristics of climate change are increases in average global temperature (global
warming);changes in cloud cover and precipitation particularly over land; melting of ice caps and
glaciers and reduced snow cover; and increases in ocean temperatures and ocean acidity due to
seawater absorbing heat and carbon dioxide from the atmosphere. Evidence from around the world
also showed that the global warming is changing rainfall and storm patterns, and disrupting the balance
of natural systems that supply the necessities of life. Similarly, rising fossil fuel burning and land use
changes have emitted, and are continuing to emit, increasing quantities of greenhouse gases into the
Earth’s atmosphere. These greenhouse gases include carbon dioxide (CO2), methane (CH4) and
nitrogen dioxide (N2O), and a rise in these gases has caused a rise in the amount of heat from the sun
withheld in the Earth’s atmosphere, heat that would normally be radiated back into space. This increase
in heat has led to the greenhouse effect, resulting in climate change.
These resulted in changing of the existence of the eco system which supports life on earth. According
to environmental health perspectives and the national institute of environmental health sciences of
Centers for Diseases Control and Prevention (CDC , January 2009) , the categories of human health
consequences of climate change are: asthma, respiratory allergies, and airway diseases, cancer,
cardiovascular diseases and stroke, food born diseases and nutrition, heat-related and stress-related
disorders, neurological diseases and disorders, vector borne and zoonotic diseases, water born
diseases and weather-related morbidity and mortality. In the long run, however, the greatest health
impacts may not be from acute shocks such as natural disasters or epidemics, but from the gradual
build-up of pressure on the natural, economic and social systems that sustain health, and which are
already under stress in much of the developing world. WHO reported that each year about 800, 000
people die from causes attributable to urban air pollution, 1.8 million from diarrhoea largely resulting
from lack of access to clean water supply and sanitation, and from poor hygiene, 3.5 million from
malnutrition and approximately 60, 000 in natural disasters. Climate change also brings new challenges
to the control of infectious diseases (WHO, world health day 2008).
The adverse effects of climate change have already set in, and it is clear that developing countries are
particularly affected as population growth exacerbates family’s vulnerability. All populations are

vulnerable but some are more vulnerable than others and all populations will be affected by a changing
climate, but the initial health risks vary greatly, depending on where and how people live. People living
in small island developing states and other coastal regions, megacities, and mountainous and polar
regions are all particularly vulnerable in different ways. Health effects are expected to be more severe
for elderly people and people with infirmities or pre-existing medical conditions. Furthermore, the
groups who are likely to bear most of the resulting disease burden are children and the poor, especially
women. This might be because they have less financial resources, lack alternative income
opportunities and they depend more directly on primary natural resources.
Even though Ethiopia’s contribution to global greenhouse gas emissions is negligible, it is affected by
the adverse impacts of climate change brought by the carbon-intensive development paths of rich
countries over the past century. It is hit harder than most countries by drought and its devastating
consequences. Recurrent droughts have resulted in loss of life and property as well as the migration of
people. Drought frequency is predicted to increase (Willenbockel, D et al. 2008), placing stress on
already vulnerable production systems.
The impacts of climate change are magnified in poor countries where the population is rapidly growing,
the management of resources is poor, awareness is inadequate and household and national
economies are very feeble. Ethiopia is among such developing countries with annual population growth
rate of 2.6% with varying across regions from Gambella 4.1% to Amhara 1.7%.This high population
growth will have high pressure on the ecosystem, low agricultural productivity due to poor varietals and
water source pollutions due to overcrowdings.
According to the IPCC Fourth Assessment Report (4AR) and national documents such as National
Adaptation Plan of Action (NAPA) and PASDEP have put the sectoral impacts of climate change on the
national development agenda. Health sector is one of the priority sectors affected by climate change. It
will share most of climate change effects of human health directly through morbidity and mortality
impacts of temperature extremes, vectors of infectious diseases, proliferation of non-vector-borne
infectious diseases, air quality, floods and storms, and indirectly through impacts on food supply and
water resources. Climate sensitive diseases like malaria, trypanosomiasis, onchocerciasis,
schistosomiasis and Leshmaniasis are the common in Ethiopia. Moreover, malaria vectors are coping
and expanding to be found on the highland of the country where malaria was not common before.
Ethiopia has been part of all international initiatives to prevent environmental degradation both at local
and at global levels. International agreement on reducing greenhouse gas emissions to 6-8 percent

elow 1990 levels between 2008 to 2012 is enshrined in the United Nations Framework Convention on
Climate Chang, which led to the adoption of the Kyoto Protocol on Climate Change in 1997.The country
ratified these international legal instruments 1992- and 2005 respectively. In June 2009, the National
Adaptation Programme of Action for Ethiopia finalized the identification of priority activities for
adaptation to climate change.
Cognizant of the health effects of the climate change on citizens of Ethiopia, the Federal Ministry of
Health prepared this Climate Change Adaptation Programme plan to lay a foundation for systematic
response and implementation across all health systems at national, regional, zone, woreda and kebele
to bring sustainable development in Ethiopia by integrating climate into health and overall development.
2. Background
Ethiopia is the tenth largest country in Africa, covering 1,104,300 square kilometers (with 1 million sq
km land area and 104,300 sq km water) and is the major constituent of the landmass known as the
Horn of Africa. It is bordered on the north and northeast by Eritrea, on the east by Djibouti and Somalia,
on the south by Kenya, and on the west and southwest by Sudan. It is a country with great
geographical diversity and its topography shows a variety of contrasts ranging from high peaks of
4,550m above sea level to a low depression of 110m below sea level. More than half of the country lies
above 1,500 meters. The predominant climate type is tropical monsoon, with temperate climate on the
plateau and hot in the lowlands. There are topographic-induced climatic variations broadly categorized
into three: the “Kolla”, or hot lowlands, below approximately 1,500 meters, the “Wayna Degas” at 1,500-
2,400 meters and the “Dega” or cool temperate highlands above 2,400 meters. The mean temperature
and rain fall 25-30degree centigrade and 800-1200mm respectively.
2.1. Demographic Situation
Projections from the 2007 population and housing census estimate the total population for the year
2010 to be 79.8 million out of which 50.3% were males and 49.7% were females. Similarly the 2007
Census results showed that the population of Ethiopia grew at an average annual rate of 2.6 percent
between 1994 and 2007—a decrease of 0.2% from the annual growth rate during the previous period
(1984-1994). The annual rates of population growth for Somali, Harari and Tigray Regions and Dire
Dawa City Administration are almost the same as the national rate. The annual growth rate for Amhara

Region (1.7) is the lowest in the country, while overall, annual growth rates in four other regions are
higher than the national average.
Accordingly, the country is among the least urbanized country in the world with 83.6% living in rural
areas whilst 16.4% of the total population living in urban areas. The largest city in the country is Addis
Ababa, the capital, with 2.7 million people accounting for nearly 4% of the total population. The average
size of house hold is 4.7, the natural rate of population growth is 2.6 and the ratio of male to female is
51 to 49.
2.2. Administrative Structure
The Federal Democratic Republic of Ethiopia is composed of nine Regional States and two City
Administrations councils. The regional states and city administrations are subdivided into 817
administrative Woredas. These are further divided into about 16,253 Kebeles which is the smallest
administrative unit in the governance system.
2.3. Socio-economic Situation
Agriculture is the main economic base for the country which accounts for 83.4% of the labour force,
about 43.2% of the Gross Domestic Product (GDP) and 80% of exports. The regular droughts
combined with poor cultivation practices, make Ethiopia's economy very vulnerable to climatic changes.
Despite these obvious challenges, Ethiopia has shown an impressive economic growth over the last
seven years, although the per capita of 235 USD remain below the Sub Saharan average. The
reduction in poverty has been more pronounced in rural than in urban areas. The overall economic
dependency ratio for the country is estimated at 93 dependents per 100 persons in the working age
group of 15-64 years.
2.4. Educational Status
Education is one of the most critical variables in epidemiological and health service provision in
Ethiopia and illiteracy is usually associated with high risk and low health seeking behavior. Despite
major progresses in Education, the literacy status of the population of Ethiopia is still low. The total
adult literacy rate (whose age is above 15 who can read and write) is 36% (62% for male and 39% for
female) (MOE, 2010)

2.5. Health Status
The major health problems of the country remain largely preventable communicable diseases and
nutritional disorders. Despite major progresses have been made to improve the health status of the
population in the last one and half decades, Ethiopia’s population still face a high rate of morbidity and
mortality and the health status remains relatively poor. Figures on vital health indicators from DHS
2005 show a life expectancy of 54 years (53.4 years for male and 55.4 for female), and an IMR of
77/1000. Under-five mortality rate has been reduced to 101/1000 in 2010 and more than 90% of child
deaths are due to pneumonia, diarrhea, malaria, neonatal problems, malnutrition and HIV/AIDS, and
often a combination of these conditions.
Since the development of HSDP I which also paved the way for the subsequent HSDP II and HSDP III,
the Federal Ministry of Health has formulated and implemented a number of policies and strategies that
afforded an effective framework for improving health in the country. The Health Sector Development
Programme (HSDP IV) of the Ministry which is the focus under the Growth and Transformation Plan
(GTP) of the Government of Ethiopia considered climate change issues as one of the critical
programmes given special attentions.
More importantly, the driving force for change is Ethiopia’s Health Services Extension program with its
emphasis on provision of preventive health care at household level and designed to bring about
production of health at a household level. Based on the concept and principles of PHC, it is designed to
improve the health status of families, with their full participation, using local technologies and the
community's skill and wisdom. The 16 Health Extension Packages (HEPs) are implemented at
community and household level. For these packages implementation, the government of Ethiopia
deployed 34,382 Female Health Extension Workers to more than 16,253 kebeles to the lowest
administrative levels in the country (FMOH, ARM REPORT, 2010).
3. Situational Analysis and Guiding Principles
3.1. Situational analysis
The major health problems of the country remain largely preventable communicable diseases and
malnutrition. Despite major progresses that have been made to improve the health status of the
population in the last one and half decades, Ethiopia’s population still face a high rate of morbidity and

mortality and the health status remains relatively poor. Figures on vital health indicators from DHS 2005
show a life expectancy of 54 years (53.4 years for male and 55.4 for female), and an IMR of
77/1000.According to WB estimate Under-five mortality rate has been reduced to 101/1000 in 2010 and
more than 90% of child deaths are due to pneumonia, diarrhea, malaria, neonatal problems,
malnutrition and HIV/AIDS, and often a combination of these conditions. These are very high levels,
though there has been a gradual decline in these rates during the past 15years.According to WHO
estimates MMR has declined from 673 to 470/100,000 though it still remains to be among the highest.
Climate sensitive diseases like malaria, trypanosomiasis, onchocerciasis, schistosomiasis and
Leshmaniasis are common in Ethiopia. The Ministry of Health has given great emphasis in preventing
and controlling the malaria through both vector control (LLINs, IRS, and environmental management)
and diagnosis and early treatment (multispecies RDT, microscopy and ACT). Currently the government
developed and embarked on elimination of malaria from the country by 2020. The financial support
from the Global Fund to Fight against HIV/AIDS, Tuberculosis and Malaria (GFATM) and other sources
is sought to meet the intended target.
Now a day’s non communicable disease such as cardiovascular diseases, diabetes mellitus and
cancers along with injuries are also became one of the major health burdens of the country which leads
to high level of mortality and morbidity.
The above mentioned health problems in the country will be more aggravated by the climate change
and climate variability. Moreover it will inevitably affect the basic requirements for maintaining and
improving the health status of the country. Thus, it will create additional burden on the existing health
care service delivery capacity which needs strengthening the adaptive capacity of the health sector
through capacity building and mainstreaming.
3.2. SWOT Analysis
Analysis of strengths, weaknesses, opportunities and threats will help to identify gaps and area of
intervention for climate change adaptation planning process. Prior identification of weaknesses and
threats help to identify relevant strategies for internal improvement and for the mitigation and adaptation
of factors that may have adverse impacts resulting beyond the control of the health sector. Recognition
of strengths and opportunities facilitate ripping of maximum benefits from internal and external
environments in order to achieve the goals and targets set in Climate Change Adaptation Plan Program
(CCAPP).

3.2.1. Strengths
Availability of sound health policy and having long term HSDP
Accelerated health facilities construction expansion program
Innovative community based health service approach (Health Extension Program)
Strong leadership commitment
Successes in the prevention and control of malaria
Sustained High coverage of EPI
Accelerated training of Health professionals
Increased supply of medicines and medical equipments
Increased allocation and expenditure on health
Active International Health Partnership plus (IHP+)
3.2.2. Weaknesses
Current adaptive initiatives on climate change are limited in scope and scale, and their
impacts are neither cohesive nor sustainable;
Even though the current potential health service coverage is high; the existing institutional
and system capacities to assess and manage climate change risks are not developed
sufficiently to create an enabling environment;
Limited knowledge of appropriate adaptation policies and measures weakens the
development of the institutional capacities to support climate risk management;
Absence of comprehensive strategy with respect to climate change adaptation in health
sector, including preparedness, response and recovery plan.
Financial constraints to test and demonstrate possible solutions, develop technical
capacities, and scale-up and sustain the adaptive capacity.
Inability to transfer communities’ indigenous knowledge of adaptation on climate change to
one another
Low health services utilization and Inadequate attention to NCDs and NTDs
Inadequate water supply and sanitation facilities to Health facilities, schools, and
communities;
Lack of Health infrastructure maintenance capacity (Building, Medical equipment, IT)
Slow implementation of Health Commodities Supply System (HCSS)

Shortage and attrition of highly skilled professionals;
Weak M&E and use of information for evidence-based decision making
Improper and unsafe expired and damaged food and pharmaceuticals disposal methods.
The health infrastructures built do not take into consideration the harsh weather conditions that
might encounter
Less timely and incomplete climate sensitive infectious diseases data due to weak surveillance
system.
Little capacity to use climate information for prediction of health related hazards
3.2.3. Opportunities
Active International Health Partnership plus (IHP+) and increased external resources
Climate change adaptation is currently a global agenda and there is political will nationally and
internationally
The availability of increasing evidence on the effect of climate change on health including
Ethiopia
Initiation of different health related adaptation projects by different governmental and nongovernmental
organizations
Democratization and decentralization of the administrative/political system
Increased community participation
Expansion of higher learning institutions including human resource for health
Increased domestic manufacturing capacity of medicines including medical supplies;
Increased school enrolment including girls, which is over 90%;
Increased participation and collaboration of CSO’s and private sector
3.2.4. Threats
Poverty and high level of population growth
Illiteracy
Global Financial crisis
Lack of capacity and guideline to regulate the import new and disposal of used equipment
emitting greenhouse gases (e.g. electronics)
Expansion of desertification
Low coverage or shortage of clean water

3.3. Impact of Climatic change on the human health
3.3.1. Global context
There is now widespread agreement that the earth is warming, due to emissions of greenhouse gases
caused by human activity. It is also clear that current trends in energy use development and population
growth will lead to continuing and more severe climate change. The changing climate will inevitably
affect the basic requirements for maintaining health: clean air and water, sufficient food and adequate
shelter.
A warmer and more variable climate threatens to lead to higher levels of some air pollutants, increase
transmission of diseases through unclean water and through contaminated food, to compromise
agricultural production in some of the least developed countries, and to increase the hazards of
extreme weather. Climate change also brings new challenges to the control of infectious diseases.
Many of the major killers are highly climate sensitive as regards temperature and rainfall, including
cholera and the diarrheal diseases, as well as diseases including malaria, dengue and other infections
carried by vectors. In sum, climate change threatens to slow, halt or reverses the progress that the
global public health community is now making against many of these diseases.
Heat waves are a direct contributor to deaths from cardiovascular and respiratory disease, particularly
among elderly people. High temperatures also raise the levels of ozone and other air pollutants that
exacerbate cardiovascular and respiratory disease, and pollen and other aeroallergens that trigger
asthma.
More variable precipitation is occurring, with an increase in the frequency and intensity of both floods
and droughts. At the same time, higher temperatures are hastening rates of evaporation of surface
waters that provide fresh water for many populations. Lack of fresh water compromises hygiene, thus
increasing rates of diarrhoeal disease. Too much water, in the form of floods, causes contamination of
freshwater supplies and also creates opportunities for breeding of disease carrying insects such as
mosquitoes.
Rising temperatures and changing patterns of rainfall are projected to decrease crop yields in many
developing countries, stressing food supplies. For populations that depend on subsistence farming, or
do not have sufficient income to buy food, this situation is expected to translate directly into wider

prevalence of malnutrition. In turn, malnutrition and under nutrition increase the severity of many
infectious diseases, particularly among children.
Expected increases in the frequency and severity of flooding and storms will result in the destruction of
homes, medical facilities and other essential services, impacting particularly on people in slums and
other marginal living conditions. The consequent destruction of homes and communities will eventually
force unprotected populations to seek safer ground, often increasing environmental and social
pressures in their new locations.
A warmer climate is expected to bring benefits to some populations, including reduced mortality and
morbidity in winter and greater local food production, particularly in northern high latitudes. However,
projections by WHO and IPCC suggest that the negative effects of climate change on health are
greater and are more strongly supported by evidence than are the possible benefits. In addition, the
negative effects are concentrated on poor populations that already have compromised health
prospects, thus widening the inequality gap between the most and the least privileged.
3.3.2. National context
The global mean temperature has created conducive ecological conditions for vector breading and
spreading of vector-borne diseases like malaria. In Ethiopia, Malaria, Helminthes and Tuberculosis are
the three top causes of outpatient visits at the health institutions. The leading causes of disease and
death being malaria, bronchopneumonia and TB. Widespread poverty along with general low income
levels of the population, low education levels (especially among women), inadequate access to clean
water and sanitation facilities and poor access to health services have contributed to the high burden of
ill-health in the country. Malaria remains the most important public health concern since it covers about
three-quarters of the country are considered to be either malarious or potentially malarious with about
two-third of the population at risk of infection (FMoH, 2009). It accounts for up to 20 percent of underfive
deaths in Ethiopia. Out of an estimated nine million malaria cases annually, no more than five
million are being treated in a health facility. The disease accounts for seven percent of outpatient visits
and represents the largest single cause of morbidity. Taking this in to consideration the federal ministry
of health prepared and endorsed national strategic plan for malaria prevention and control and
elimination. There are other vector-borne diseases such as onchocerciasis, guinea worm and
trachoma, that the country is undertaking a control program to eliminate in the long term plan (FMoH,
2005). Ethiopia remains in a precarious situation as it relates to nutrition status with malnutrition

emaining the underlying cause of over half of the child deaths. Malnutrition is widespread across the
country. Health is one of the areas most affected by climate change. The following table shows the
summary of the major health impacts due to climate change.
Table 1: The climate changes and their impacts on human health
Climate Change
Health Impact
Direct impact of extreme heat and cold
Cardiovascular disease deaths, skin cancer
Temperature effects on food and water borne
diseases
Temperature, rainfall effects on vector borne
diseases
Risk of malnutrition via changing patterns of
agricultural yield
Effects of extreme rainfall and sea level rise on
flooding
Changes in air pollution aeroallergen levels
Diarrheal Diseases
Malaria, Leshmaniasis, dengue Fever, RVF, Filariasis,
RVF, Schistosomiasis
Malnutrition
Fatal and non fatal injuries and mental effects
Deaths and disease cases associated with air
pollution, allergies
3.3.3. Vulnerability
In Ethiopia all population are at risk of climate change. However, the most vulnerable groups to the
impact of climate change are women, children, elderly, disabled and poor people. This pertains, among
other things, to food and water use habits, choices between traditional and newer crop growing
techniques, the purchase of different livestock and location of settlements. People living in arid, semi
arid, lowland and flood prone areas of the country which have high incidence of flood that happens
mainly due to climatic change and variability are also more vulnerable. The problems resulted from
climatic change are malaria, diarrhoea, infections associated with malnutrition, and non communicable
diseases. In addition people who do not have access to safe water supply are vulnerable to other water
borne diseases. Community conflicts driven by competition for scarce water and pasture resources will
also increase risk of health and safety.
Morbidity and mortality related to poor sanitation, hygiene and unsafe water supply remain a major
source of environment related deaths in the country. Similarly, the proportion of population which has
access to sanitation in 2007/08 was 37% (FMoH, 2007/08). Inadequate water and sanitation services

affect women and girls more severely than other family members as they are the ones who spend much
of their time fetching water for the whole family and caring for ill family members.
The main effects of environmental degradation on the urban setting are existence of polluted water
ways, contaminated land, polluted indoor and outdoor air, contaminated food, poor housing and
crowding, and toxic/hazardous wastes biodiversity loss, radioactive substances, infectious wastes.
These will profoundly negatively impact on the coping capacity of the population to climate change.
The national burden of disease attributable to indoor air pollution from solid fuel use for the year 2002 is
estimated to be 4.9% (WHO, 2007). Another report, from the WHO has also estimated the number of
deaths attributable to indoor and outdoor air pollution from particulate matter in urban setting for the
year 2004. Accordingly, the estimated number of deaths associated to indoor and outdoor air pollution
for the year 2004 was 72,400 and 2,500 respectively (WHO, 2009).
The extent to which the health of human population is vulnerable or in danger depends on the direct
and indirect exposures of human population: (e.g through disturbance of ecosystems…..) to climate
change effects; the populations’ sensitivity to the exposure and the affected systems ability to adapt. In
general, factors that increase the vulnerability of health sector to climatic change include: poverty, lack
of public awareness to climate sensitive diseases, harmful traditional practices, inadequate health
service and inadequate infrastructure and transportation facility.
The wide spread pre-occurrence of infectious diseases such as the ones indicated in the table below,
Ethiopia is highly vulnerable to the frequent occurrence the epidemics of these diseases and/or
expansion of this diseases to the areas it did not occur before.
Table 2 Major infectious diseases and their inter-annual variability and sensitivity to climate changes
Diseases include Inter- annual variability Sensitivity to climate Climate variables
Cholera ****** ***** (>T)
Malaria ***** ***** (>R,T,H)
Meningitis **** *** (>T,R)
Dengue **** *** (>R,T,H)
R.V. Fever *** *** (>R, T,>R)
Influenza ***** ** (

T = Temperature R = rainfall H= Humidity
3.3.4. Response Measures
Adaptation strategies frequently are described as risk management and public health programs can be
characterized as reducing climate change, health risks improved weather warning and preparedness
systems, buildings and infrastructure, all can be considered measures to reduce human health risks in
the event of a changed frequency of weather disasters.
The following are response measures identified for the climate change adaptation program:
Due to the complexity of climate change and its potential impacts, particular attention needs to
be given to knowledge transfer and awareness raising. Decision makers, stakeholders and the
larger public should have access to reliable information about potential climate change impacts,
vulnerabilities, adaptation options and tools, good practice examples and advantages of
adaptation, potential trade‐offs, synergies and conflicts with mitigation and existing policies.
Initiate trainings to health professionals and researchers on the health effects of climate
change, ensure that systems are in place to detect and track climate change induced health
problems, make the necessary preparations to respond to, and manage climate change
associated risks.
Adaptive responses to health impacts of climate change are enhanced by infrastructures
specifically designed to reduce vulnerability to climate variability (e.g. flood control structures,
air conditioning, building insulation, stringent building codes, etc.) and general public health
infrastructures (e.g. sanitation facilities, waste water treatment, water supply systems,
laboratory buildings).
Building capacity is an essential step in preparing adaptation strategies. Education, awareness
raising and the creation of legal frameworks, institutions and an environment that enables
people to take well-informed, long-term, sustainable decisions, all are needed.
Building adaptive capacity in public health will require a forward-looking, strong and unifying
vision of health care as well as an understanding of the problems posed by climate change.
Effective adaptation will require individuals skilled at recognizing, reporting and responding to
health threats associated with climate change. Researchers trained in epidemiology and
laboratory research will be needed to provide a sound basis for surveillance and response.
Skilled public health managers, who understand surveillance and diagnostic information, will be
needed to mobilize the appropriate response.

People trained in the operation, quality control and maintenance of public health infrastructure,
including laboratory equipment, communications equipment, and sanitation, wastewater, and
water supply systems also are required.
The complex interaction of issues expected with climate change will require new arrangements
and collaborations between institutions to address risks effectively, thereby enhancing adaptive
capacity. Nations and international organizations, such as WHO, can cooperate in coordinating
surveillance and response activities to address disease threats more effectively.
Increased collaboration between the public and private sectors can enhance adaptive capacity.
It is important to improve understanding of the process of adaptation. This includes gaining
better knowledge of the processes of adaptation decision-making; roles and responsibilities in
adaptation of individuals, communities, nations, institutions and the private sector; conditions
that stimulate or act as a barrier to adaptation; and what level of certainty is needed for public
health decision-makers to act.
Research on barriers and opportunities for enhancing adaptive capacity in order to protect
human health
Focus and prioritize response measures to address the most vulnerable groups to climate
change during development and execution of policies, strategies and programs.
3.3.5. Portfolio of good practices
Prior to the implementation of adaptation activities it is important to build a public understanding that
climate change is occurring and to persuade people of an immediate action to prevent future damage
from climate change impacts on human health. Practices in some countries indicate that, the main
challenge was countering the general opinion to better delay taking action. However, the same study
confirms that with strong commitment, they succeeded to adopt a planned and managed approach to
climate change adaptation. Building knowledge and awareness of the public was a prerequisite for the
success.
Experiences from UK, on adaptation to climate change on sea level rise indicates that the adaptation
activities have been developed through a broad partnership with extensive consultation to a variety of
stakeholders and interest groups to guarantee that adjacent interests are not adversely affected.
Particularly good practice here was to not only have dialogues with powerful institutions to assure
official permits for the adaptation activities, but also to weaker parties such as recreational sailing

interest groups, commercial fisheries and agricultural interest groups. This indicates the dialogue has
been a major part of the adaptation activities.
Prior to the implementation of adaptation actions, it was learned that to carry out detailed studies,
such as explore potential climate change impacts and vulnerabilities, identify priority concerns, bench
mark others best practices, desk top study reviewing and all other relevant information, to help assess
the feasibility of adaptation plan.
When considering adaptation plan the following issues shall be taken into account:
Any adaptation needs to be sustainable. This means that our responses should not add to
climate change, or limit the ability of other parts of the natural environment, society or business
to carry out adaptation elsewhere. Our responses must avoid any detrimental impacts on other
parts of society, the economy or the natural environment.
Actions should be flexible. Although there is still uncertainty over the future climate, we should
consider options now and make decisions that maximize future flexibility – in many cases it is
failure to take decisions that locks us into inflexible pathways.
Action needs to be evidence based – making full use of the latest research, data and practical
experience so that decision making is well supported and informed.
Our response to climate impacts should be prioritized – for example, by focusing more
attention on policies, programs and activities that are most affected by the weather and climate,
those which have long term lifetimes or implications, where significant investment is involved or
high values are at stake, or where support for critical national infrastructure is involved.
Adaptation measures need to be effective (reducing the risks from climate change without
introducing perverse effects), efficient (the long term benefits of adaptation actions should
outweigh the costs), and equitable (the effects of the activity on different groups and where the
costs should fall should be taken into account)
Adaptation activities selected to serve as good practices:
• address as many guiding principles as possible
• have an applied focus
• are finished or in implementation phase
• can be transferred to all regions the country
• are well documented

• cover different horizontal levels
cover different vertical levels
Best practices in Ethiopia /Health Extension Program/
The Health Extension program was introduced with a fundamental philosophy that if the right
health knowledge and skill is transferred, households can take responsibility for producing and
maintaining their own health.
From the very start HEP was supported with the development of 16 different health intervention
packages to be delivered by HEWs at community level. These packages along with
implementation guidelines were made available to implementers as well as to technical and
vocational training institutions. The packages have been subjected to modification
commensurate to the life style of the pastoralist population. The training of all female HEWs
have been progressing well with encouraging sign and endorsement of community’s
acceptance and demand for HEP services.
The HEWS has assisted to create awareness at community level concerning sanitation issues
and indoor air pollution which have a direct impact on climatic change. Moreover the program
has also brought attitudinal change of the community especially on personal hygiene which is a
basic principle to achieve prevention capacity of the public. Such practices will assist in the
effective implementation of climate change adaptation program in the health sector.
Additionally documented indigenous knowledge and coping strategies of the community has to
be identified and used in the adaptation program.
4. Vision
To see healthy, productive, and prosperous Ethiopians
5. Scope
This document includes the vision, mandate, core values (guiding principles, situatational analysis,
goal, objectives and strategic approaches in relation to climate change and adaptation program for
health sector in Ethiopia 2011-2015. Further the document indicates the monitoring, evaluation and
indicators of the program, activities with budget implications and schedule for the implementation of the
strategic plan. The strategic plan provides a detailed account on the status and direction of the major
strategies of climate change and adaptation to health.

6. Goal
The goal of climate change and adaptation program of the health sector in Ethiopia is to achieve
reduction of vulnerability to health effects through adaptive mechanisms by 2015.
7. Objective
o To identify and prioritize highly vulnerable areas and segments of the population to health
hazards due to climate change
o To identify climate change sensitive diseases and adverse public health events and put in
place prediction and early detection mechanisms
o To promote operational research (information generation) related climate change and its
adaptation mechanisms
o
o
o
o
To develop evidence based preparedness, response and recovery plan
To strengthen the health system in order to respond to climate change vulnerability with
special focus on the priority areas
Strengthen human resource capacity building
To strengthen advocacy, social mobilization, communication and education to facilitate the
climate change adaptation
8. Guiding Principles
The guiding principles for good practices in adaptation are intended to support planners and decision
makers when dealing with the challenges of adapting to climate change and provide a framework for
identifying good practice examples in adaptation. Adaptation is a cross-level and cross-sectoral activity
which brings together actors from different stakeholders including the government. The following are
guiding principles for climate change adaptation program:
o Initiate adaptation, ensure commitment and management
o Build knowledge and awareness
o Identify and cooperate with relevant stakeholders
o Work with uncertainties
o Explore potential climate change, impacts and vulnerabilities and identify priority concerns
o Explore a wide spectrum of adaptation options
o Prioritize adaptation options

o
o
o
Modify existing policies structure and processes
Avoid mal-adaptation
Monitor and evaluate systematically
9. Adaptive Capacity of the Health Sector
Adaptive capacity encompasses coping ability (i.e. what could be implemented now to deal with current
climate and climate variability) and strategies, policies and measures that can expand future coping
ability. Adaptive capacity is a theoretical construct because it is not possible to know with certainty
whether a country will invest resources to expand its coping ability, how technology and other factors
will change, or what adaptations actually will be implemented, until a perturbation or stress occurs.
Uncertainties about future climate (especially how extremes may change), potential effects and
underlying determinants of adaptive capacity (i.e. how future institutions, technologies, skills,
knowledge will evolve). In addition, there are many unknowns with respect to costs, feasibility,
unintended consequences and effectiveness of adaptations
The Intergovernmental Panel on Climate Change (IPCC) identified the main features of countries that
seem to determine their adaptive capacity is: economic wealth, technology, information and skills,
infrastructure, institutions and equity. In addition, for public health, the current health status and preexisting
disease burdens must be considered.
9.1. Economy
The economic status of nations, described in terms of GDP, financial capital, wealth, or some other
economic measure, clearly is a determinant of adaptive capacity. It is widely accepted that wealthy
nations have a greater capacity to adapt because they have the economic resources to invest in
adaptive measures and to bear the costs of adaptation. It is also recognized that poverty is related
directly to vulnerability and that the poorest groups in the poorest countries are the most vulnerable to
health impacts of climate change. The government of Ethiopia is committed to meeting targets set by
global initiatives, notably the Millennium Development Goals (MDGs) and the recommendations of the
WHO Commission on Macroeconomics and Health (CMH) aimed at strengthening the link between
improved health and economic development. However, the existing low level of the economy
challenges the adaptive capacity of the country.

9.2. Technology
The availability and access to technology at the individual, local, and national levels, in health sector is
an important determinant of adaptive capacity. Many of the adaptive strategies that protect human
health involve technology (e.g. warning systems, air conditioning, pollution controls, housing, vector
control, vaccination, water treatment and sanitation).
In case of Ethiopia most of the above mentioned technologies are not well established. Moreover,
mobile laboratories, computer information and reporting systems which can support disease
surveillance are not yet available. In other cases there is a need for new technologies to develop new
vaccines that enhances the ability to cope with a changing climate.
9.3. Information and Skills
Countries with higher levels of “human capital” or knowledge are considered to have greater adaptive
capacity. As many adaptive measures involve implementation of effective health education programs, a
high level of illiteracy can seriously compromise their effectiveness. Some of the simple, low-cost, lowtechnology
measures to reduce health effects (e.g. using sari cloth to filter drinking water, removing
containers around dwellings that provide habitat for disease vectors) involve educating the public on the
feasibility and effectiveness of such measures.
Lack of trained and skilled personnel may restrict a nation’s ability to implement adaptation measures.
Health systems require qualified and experienced staff to function well. Health “human capital” can be
increased through investment in education and training. Human capital does not deteriorate with use,
but can depreciate as old skills become obsolete with the advent of new knowledge, methods, and
technologies.
Despite major progresses in education, the literacy status of the population of Ethiopia is still low.
Updating the knowledge level of health professionals on new knowledge and technologies that relate to
climate change is at its low level. These situations will be hindering the adaptive capacity of the country.
9.4. Institutions

Institutions are considered an important determinant of adaptive capacity. Those countries with lesseffective
institutional arrangements, commonly developing nations and those in transition, have a lower
capacity to adapt than countries with well-established and effective institutions. Inadequate institutional
support frequently is cited as a hindrance to adaptation. Institutional deficiencies and managerial
weaknesses are cited as contributing to vulnerability to climate change
Ethiopia’s ability to develop more sustainably depends on the capacity of its people and institutions to
understand complex and up-to-date health, environment and development issues so that they can
make the right development choices and perform with knowledge inputs, efficiently and effectively. In
this case institutions in the area of health including stakeholders need to have the expertise and
organizational capabilities to understand the potential and the limits of its impact on health.
Organizational capacity is required in health sector to achieve essential health related policy
interventions, international conventions, and the Millennium Development Goals. This will require
scientific, technological, organizational, institutional and other skills as well as overall organizational set
up. Hence, in the case of Ethiopia institutional arrangement and capacity needs further strengthening to
cope up with adaptive capacity of climate change.
9.5. Infrastructure
Adaptive capacity is likely to vary with the level of a country’s infrastructure such as health institutions,
roads, rails and bridges, water systems and drainage can reduce vulnerability to climate change. It also
has the potential to be adversely impacted (especially if immovable), which can increase vulnerability to
climate change. Flooding can overwhelm sanitation infrastructure and lead to water-related illnesses.
Severe damage to the transportation infrastructure can make more difficult to assist affected
populations.
Ethiopia is among sub Saharan Africa countries where the development of infrastructure is low
especially in emerging regions of the country which are prone to different climatic change problems
such as flooding, drought and air blow. This will create problems to access health care services to
affected areas. Thereby further aggravates the challenges of adaptive capacity of the country to climate
change.

10. Strategic Approaches
o
o
o
o
o
Strengthening the health system and mainstreaming climate change adaptation to health
care service delivery
Inter and intra Collaboration , coordination and partnership
Implementation of the adaptation mechanism /activities
Advocacy, communication , social mobilization and education
Monitoring and evaluation of the strategy action plan
11. Major Activities:
11.1. Research and Surveillance / evidence based policy
decision
Undertake extensive reviews to identify and prioritize highly vulnerable areas, population segments
and to identify climate change sensitive diseases and adverse events in the country by adapting
the standardized international methodologies and link with Metrological and GIS information
system.
o
o
o
Develop and implement Climate Change Adaptation Programme related to repeat
surveillance surveys research protocol to generate baseline data as well as to track the
changes over time.
Mainstreaming Climate Change to existing Demographic Surveillance Sites (DSS) and
establish new DSSs in lowland/pastoralist and other identified most vulnerable areas
Develop modeling and forecasting/ predicting climate change related health effects
o Develop evidence-based comprehensive early warning, preparedness, response and
recovery plan

11.2. Inter- and intra-Collaboration, coordination and
partnership
The ownership of health related Climate Change Adaptation Programme endeavors in the health
sector, responsible body for the coordination, technical support, information generation and
documentation and other relevant specific activities must be in place at all levels. Integration,
harmonization and alignment of Climate Change Adaptation Programme to health are crucial in the
over all health planning and service delivery. The overall national coordination of the issues related
to the health impact of climate and its adaptation mechanisms will be lead by FMOH by a high level
authority. The specific implementations at each level including FMOH and regional levels will be
lead by respective directorates or process owners. Partners will have a major stake in
implementation of this plan.
To facilitate the implementation of the CCAP, a CCAP Technical Working Group will be reestablished
both at Federal and Regional levels, which functions as per a clear and applicable
Terms of Reference (TOR) that will be developed / revised. The membership of the TWG will
include FMOH, FEPA, EHNRI, MOA, NMA, UNICEF, WHO and AAU-School of Public Health .......
If relevant other existing climate related forums will be members of the TWG. The previously
established climate and health working group (CHWG) will be absorbed into the bigger CCAP
TWG.
Some of the activities that will be accomplished by the TWG, based on its ToR, are;
o
o
o
o
Facilitate the establishment of Climate Change Adaptation Technical Working Groups at
different levels (Regional, zonal and woreda) which is comprised of health offices, health
institutions, Universities, Professional Associations, CSOs, NGOs, GOs and other relevant
organizations and develop clear TOR.
develop climate change adaptation programme to health
undertake and exercise inter- and intra collaboration, coordination and partnership
building for Climate Change Adaptation Programme to health at all levels
develop and implement health protection and response strategies ,manuals, guidelines,
SOPs, integrated work plans for adaptation to climate change at all levels

o
o
o
o
dissemination/training on the above documents
Develop climate change adaptation programme to health strategies, guidelines, integrated
work plans for adaptation to climate change and measures relating to climate change and
their effectiveness, including cost-effectiveness as appropriates.
Implementation manuals and guidelines with regards to each climate sensitive diseases
and extreme climate events at different levels
Training and dissemination of manuals and guideline
11.3. Health Systems Strengthening (HSS)
Strengthening health systems to enable them to deal with both gradual changes and sudden
shocks as fundamental priority in terms of addressing the direct and indirect effects of climate
change adaptation for health. The following could be some of the activities in health system
strengthening:
11.3.1. Mainstreaming and prioritizing climate sensitive diseases management
Mainstreaming and prioritizing climate sensitive diseases management in routine health service
delivery system at all levels
11.3.2. Human Capacity Development/Training
o Promote Health workforce as well as relevant others development to respond to the health
threats posed by climate change
o in-service training targeting all health workers
o short term trainings for school teachers and students and scouts, Fire brigade works,
police, community leaders, CSOs and relevant others
o pre- service training
o post graduate training
11.3.3. Infrastructure Structure Development
o Design, strengthen and enforce building codes and standards, roofs, roads, use of UV
resistant materials such as glasses/windows/ shades etc to be more climate change
resistant for existing and new facilities
o Provide air conditioned shelters and tents, blankets/, bed nets, public drinking
fountains, solar energy sources
o Develop public evacuation plans and avail travel clinics, emergency helicopters
ambulances/transport, boats and vehicles etc.
o Modernize and expand existing water and sewerage and avail emergency water and
sewerage systems in evacuation sites

11.3.4. Emergency Medical Services
o Prepare Emergency medical Srevice plan
o Avail emergency mobile and stationary medical center, equipment, medicine, feedings,
water and sanitation facilities
o Medical equipments and supplies including vaccines and therapeutic feedings,
o Mainstreaming and prioritizing climate sensitive diseases management in routine
health service delivery system
o Climate proof construction: rehabilitating existing facility structure that take into
consideration the extreme effect of climate change and on new building structure,
building materials, roof water harvesting and storage, etc.
11.4. Climate Change Adaptation Programme promotion and
Communication
o Develop communication strategy on CCHA
o Undertake systematic and planned evidence based advocacy for shaping policy and
programming for results using different medias at different levels
o Social mobilization and community capacity enhancement through community
conversations
o Education: incorporate CC adaptation and mitigation issues in High Educational
institutions as well as school curricula, IE/BCC interventions, Mass media
o Create experience sharing platforms at different levels from communities to
programmatic and scientific forums
11.5. Monitoring & Evaluation
The monitoring process will involve through out the programme period with the involvement of the
Health Promotion and Disease Prevention Directorates, Policy and Planning Directorate, Resource
Mobilization Directorate and Health and Nutrition Institute -Public Health Emergency Directorate-in the
Ministry of Health and other major Stakeholders. The Health Promotion and Disease Prevention
Directors in the Ministry will have an oversight during the implementation of the programme. The
program officers in the Health Promotion and Disease Prevention Directorates will directly provide
monitoring reports during the implementation to the donor organization for Climate Change Adaptation

Programme to health sector. Evaluation of the programme will explain and measure the level of
efficiency by comparing the expected project results with the real results.
Determining the benefits of health adaptations reduction in the effects of climate change on health is
likely to be complex. Information on Environmental Impacts Assessment (EIA) and Health Impact
Assessment (HIA) is likely to be important for decision-makers. Integrated frameworks will be needed to
review the impacts of proactive and anticipatory adaptation/response measures.
Climate change adaptation measures may pose environmental and health threats. Thus consideration
EIA and HIA when dealing with projects and activities, such as construction of health and sanitation
facilities, disposal of health institution /medical/ wastes, laboratory buildings, development of new
vaccines, etc. In general projects and activities that are undertaken to enhance the adaptive capacity of
the health sector require careful precautions and Environmental Management Plan (EMP).
Monitoring of the strategy will be part and parcel of the overall monitoring and evaluation frame of
HSDP IV. The Plan will be monitored throughout the implementation period using various means of
verifications as indicated in monitoring and Evaluation frame work. Annual plan will form the basis
platform for monitoring and evaluation of quarterly and annual outputs. Quarterly and annual monitoring
and evaluation will be conducted as part of the existing FMOH M&E/framework. Evaluation of the
programme will explain and measure the level of efficiency by comparing the expected project results
with the real results.
The following are some of the main activities to be considered under this thematic area:
o Conduct Environmental and Health Impact assessment for the climate change health
effects
o Establish/Strengthen the M&E (indicators, HMIS, supervision, researches/surveillances,
data warehouses and use) on CC related episodes and health interventions
o Integrate health, metrological, geophysical, GIS data to guide the predications and
actions
o Strengthening the IDSR, and early warning system to track climate sensitive diseases and
adverse events
For further descriptions, please see the following monitoring matrix below.

S
.
n
o
Objectives
To identify 1 and prioritize highly
vulnerable areas and
segments of the population to
health hazards due to climate
change
National Health Sector Climate Change Adaptation program Monitoring Framework
Strategies/Strategic
Approach
Strengthening the health
system and
mainstreaming climate
change adaptation to
health care service
delivery
Indicator Base line Target Means
of
verificat
ion/Data
Source
CCAP strategic Plan Document o Developed and Availability of written and
implemented CC SP implemented strategic
document
document
% or number of DSS sites
mainstreamed CCAP
Availability of adopted/adapted
forecasting modelling
0 8 assessment report
1 availability of written
manual
Early warning/preparedness
and recovery plan document
12 assessment report
To 2 identify climate change
sensitive diseases and
adverse public health events
and put in place prediction and
early detection mechanisms
Availability of functional TWG 12 minute of TWGs
assessment reports
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 39

Objectives
To 3 strengthen Coordination,
partnership and governance
with regards to CCAP
Strategies/Strategic
Approach
Strengthening inter and
intra collaboration and
partnership
Indicator Base line Target Means of
verification/Data
Source
Availability of written and
implemented TOR for TWG
0 12 assessment reports
CCAP Document(plan) 0 12 Assessment report
Number of meetings conducted
as per the TOR
Minute
assessment report
book
Number of manuals ,SOPS
guidelines prepared
4 written manuals/SOPs,
guidelines
To 4 strengthen the health
system in order to respond to
climate change vulnerability
with special focus on the
priority areas
Strengthening Human
Capacity Development
/Training
Number /proportion of inservice
trainees
Number /proportion of short
term trainees
Number /proportion of
postgraduate trainee on CC
35,000 training report
assessment report
administrative reports
15,000 training report
assessment report
administrative reports
4 assessment report
Strengthening
infrastructure
Development
Availability of endorsed and
implemented building code
Availability of comprehensive
public evacuation plan
1 assessment report
availability of written and
implemented code for HF
construction
12 assessment report
Strengthening
emergency
response
available and /or implemented
EPRP
12 assessment report
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 40

and recovery
Number /Proportion of Events
responded with written EPRP
100% assessment report
To 5 strengthen advocacy,
social
mobilization,
communication and education
to facilitate the climate change
adaptation
To 6 promote operational
research
(information
generation) and strengthening
M&E related to climate change
and its adaptation
mechanisms
Strengthening Climate
Change Adaptation
Programme promotion
and Communication:
Strengthening
operational research
and M&E
Availability of written strategy 1 written and implemented
strategy
Number/% of people
25000 Workshop
participated in advocacy
report/proceedings
workshops
Number/proportion
of
80 Workshop report
workshops organized on to
facilitate or build consensus on
in incorporating CC adaptation
in school curricula
number/% of environmental and
health impact assessments
Functional data base at national
level
Integrated and functional
prediction .forecast model at
national level
Number/% of strengthened
regional and regional public
health laboratories
10 Assessment reports
1
1 Written implantation
manual
20 Assessment report
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 41

11.6. Control high population growth rate
The Ministry of health clearly indicated in its HSDP IV document that targets the control of high
population growth rate by increase family planning service (CPR) from 32% to 66%.This can be
achieved through the following initiatives:
o
o
o
o
o
o
o
o
Reduce the high family planning unmet needs through increasing contraceptive commodities
supply and improve contraceptive logistics information system
Scale up family planning programme (community based FP services, social marketing, facility
based and outreach long acting and permanent FP service provision)
Provision of the family planning services following the expansion of health facilities
Increase awareness creation through social mobilization and community conversation
Improve availability of long acting contraceptives
Integrate FP service with other services
Empower women and encourage male involvement in family planning services
Coordinate the government and other partners efforts to the family planning services to control
the high population growth
11.7. Strengthen and utilize Climate-informed early warning
and response system
Many infections and chronic diseases are either directly or indirectly sensitive to the climate
changes. Managing this climate sensitivity more effectively requires new working relationships
between the health sector and the providers of climate data and information to facilitate networking
and to increase the return from the investment.
o
o
Build strong link between the Ministry of Health and the National Metrological Agency to avail
and utilize climate information for health interventions for climate-sensitive diseases such as
malaria
Create an enabling mechanism on the existing
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 42

11.8. Indoor air pollution
Climate change is exacerbated by ambient and indoor air pollution. The promotion on indoor air
pollution (housing) is one of the activities on which the health extension workers are engaged as
one package.
o
o
o
Promoting separation of kitchen from the main living quarter
Advise the rural public to arrange ventilation system in the house
Promote improving the stoves into energy saving and chimney
12. Program Sustainability
o Mainstream CCA for health issues in the national health strategic and annual planning process
at all levels
o Mainstream the coordination and collaborations with other sectors
o Strengthen proactive resource mobilization towards CCAP implementations continuously for
long years to come in collaboration with international partners
o Continues monitoring and evaluation and feedback system on performance policies, strategies,
guidelines and manuals
o Community empowerment for sustainable CCA and mitigation through continues hands on
training, education, availing required reference and other materials for practical demonstrations
and actions
o Encourage different individuals, organizations, communities etc for best performance in
responding towards CCA and mitigation efforts
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 43

13. Activity and Budget
Unit of
measurement
Unit
Price/Rate
Required Budget for implementing Key Interventions
Ser. No
Key Identified Activities
Quantity
2011 2012 2013 2014 2015 Total
10.1 Research and Surveillance
10.1.1 Develop and implement Climate Change Adaptation
Programme related to repeat surveillance surveys
research protocol to generate baseline data as well as to
track the changes over time. Number 1 100,000 100,000 - - - - 100,000
10.1.2 Mainstreaming Climate Change to existing Demographic
Surveillance Sites (DSS) and establish new DSSs in
lowland/pastoralist and other identified most vulnerable
areas Number 8 20,000 - 80,000 80,000 - - 160,000
10.1.3 Develop modeling and forecasting/ predicting climate
change related health effects Number 1 30,000 30,000 - - - - 30,000
10.1.4 Develop evidence-based comprehensive early
warning, preparedness, response and recovery plan Number 12 10,000 120,000 - - - - 120,000
10.1.5 Establish Climate Change Adaptation Technical Working
Groups at different levels (National, Regional, zonal and
woreda) which is comprised of Health institutions,
Universities, Professional Associations, CSOs, NGOs,
GOs and other relevant organizations Number 12 100 1,200 1,200 1,200 1,200 1,200 6,000
Sub Total 251,200 81,200 81,200 1,200 1,200 416,000
10.2 Inter- and intra-Collaboration, coordination and partnership
10.2.1 Develop clear and applicable Terms of Reference (TOR)
for CCAP Technical Working Group at Federal and
Regional levels Number 12 - - - - - - -
10.2.2 Develop National and Region specifice Climate Change
Adaptation Programme to health Number 12 - - - - - - -
10.2.3 Undertake and exercise inter- and intra collaboration,
coordination and partnership building for Climate Change
Adaptation Programme to health at all levels - -
10.2.4 Develop health protection and response strategies
,manuals, guidelines, SOPs, integrated work plans for
adaptation to climate change at all levels Number 4 3,000 6,000 6,000 - - - 12,000
10.2.5 Training and dissemination of manuals and guideline Number 60 262 31,440 31,440 - - 62,880
Sub Total 6000 37440 31440 0 0 74,880
10.3 Health Systems Strengthening (HSS)
10.3.1 Mainstreaming and prioritizing climate sensitive
diseases management Number 12 - - - - - - -
Sub Total - - - - - -
10.3.2 Human Resource Capacity Development
10.3.2.1 Provide in-service training targeting all health workers
on Climate Change Adaptation programme to health
impacts Number 35,000 262 3,668,000 3,668,000 3,668,000 3,668,000 3,668,000 18,340,000
10.3.2.2 Provide short term trainings for school teachers and
students and scouts, Fire brigade works, police,
community leaders, CSOs and other relevant
organizations on Climate Change effects on health Number 15,000 262 786,000 786,000 786,000 786,000 786,000 3,930,000
10.3.2.3 Provide pre- service training for newly graduated and
potential employees of health sector Number 5,000 262 262,000 262,000 262,000 262,000 262,000 1,310,000
10.3.2.4 Involve health professionals on post graduate trainings
related to Climate Change and Health Number 10 18,182 36,364 36,364 36,364 36,364 36,364 181,818
Sub Total 4,752,364 4,752,364 4,752,364 4,752,364 4,752,364 23,761,818
Responsible Body
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 44

10.3.3 Infrastructure Development
10.3.3.1 Enforce building codes and standards, roofs, roads, use
of UV resistant materials such as glasses/windows/
shades etc to be more climate change resistant for
existing and new facilities Number 1 20,000 20,000 - - - - 20,000
10.3.3.2 Provide air conditioned shelters and tents, blankets/,
bed nets, public drinking fountains, solar energy
sources for CC vulnerable areas (pastoralist woredas) Packs 200 10,000 500,000 1,000,000 500,000 - - 2,000,000
10.3.3.3 Develop public evacuation plans and avail mobile
clinics, emergency helicopters, ambulances/transport,
boats and vehicles, etc. (per region) Number 11 300,000 1,200,000 2,100,000 - - - 3,300,000
10.3.3.4 Modernize and expand existing water and sewerage and
avail emergency water and sewerage systems in
evacuation sites Number 11 100,000 400,000 300,000 200,000 200,000 - 1,100,000
Sub Total 2,120,000 3,400,000 700,000 200,000 - 6,420,000
10.3.4 Emergency Medical Services
10.3.4.1 Prepare Emergency Preparedness and Response plan
(EPRP) Number 11 10,000 110,000 - - - - 110,000
10.3.4.2 Avail emergency mobile and stationary medical center,
equipment, medicine, feedings, water and sanitation
facilities Number 100 20,000 1,000,000 - 1,000,000 - - 2,000,000
10.3.4.3 Medical equipments and supplies including vaccines
and therapeutic feedings, Packs 100 10,000 500,000 - 500,000 - - 1,000,000
10.3.4.4 Mainstreaming and prioritizing climate sensitive diseases
management in routine health service delivery system Number 817 - - - - - - -
10.3.4.5 Climate proof construction: rehabilitating existing facility
structure that take into consideration the extreme effect of
climate change and on new building structure, building
materials, roof water harvesting and storage, etc. Number 200 50,000 2,500,000 5,000,000 2,500,000 - - 10,000,000
10.3.4.6 Procure and distribute Long Lasting Insecticide Nets
(LLINs) to prevent and control malaria in more vulnerable
areas and population segments Number 4,000,000 6 4,800,000 4,800,000 4,800,000 4,800,000 4,800,000 24,000,000
10.3.4.7 Procure and distribute Rapid Diagnostic Tests (RDTs)
and Arthemesinin Based Combination Therapy (ACTs) to Tests and
diagnose and treat malaria cases in more vulnerable doses
population segments
1,000,000 2 400,000 400,000 400,000 400,000 400,000 2,000,000
Sub Total 9,310,000 10,200,000 9,200,000 5,200,000 5,200,000 39,110,000
10.4 Climate Change Adaptation Programme promotion and Communication
10.4.1 Develop communication strategy on Climate Change
Adaptive mechanisms to health,produce,print and
distribute IE/BCC materials Number 1 50,000 50,000 - - - - 50,000
10.4.2 Undertake systematic and planned evidence based
advocacy for shaping policy and programming for results
using different medias at different levels (1 Federal,11
regional and 817 woredas) Number 25,170 262 94,320 6,421,620 - - - 6,515,940
10.4.3 Social mobilization and community capacity
enhancement through community conversations Session 195,036 - - - - - - -
10.4.4 Education: Organize workshop to advocate and reach
on consensus in incorporating CC adaptation and
mitigation issues in school curricula Number 80 262 10,480 10,480 - - - 20,960
10.4.5 Create experience sharing platforms at different levels
from communities to programmatic and scientific forums
(in country and abroad) Number 10 20,000 40,000 40,000 40,000 40,000 40,000 200,000
Sub Total 194,800 6,472,100 40,000 40,000 40,000 6,786,900
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 45

10.5 Monitoring & Evaluation
10.5.1 Conduct Environmental and Health Impact assessment
for the climate change health effects Number 2 100,000 100,000 - - - 100,000 200,000
10.5.2 Establish/Strengthen the M&E ( indicators, HMIS,
supervision, researches/surveillances, data warehouses
and use) on CC related episodes and health
interventions Number 1 10,000 - 10,000 - - - 10,000
10.5.3 Integrate health, metrological, geophysical, GIS data to
guide the predications and actions Number 1 20,000 - 20,000 - - - 20,000
10.5.4 Strengthening theNational,Regional and sub regional
Public Health Laboratories for early warning system and
IDSR to track climate sensitive diseases and adverse
events Number 20 30,000 180,000 180,000 120,000 120,000 - 600,000
Sub Total 280,000 210,000 120,000 120,000 100,000 830,000
10.6 Control high population growth rate
10.6.1 Increase and improve contraceptive commodities supply and
contraceptive logistics information system to fill the gaps of
high family planning unmet needs Per CYP 5,000,000 3.80 3,800,000 3,800,000 3,800,000 3,800,000 3,800,000 19,000,000
10.6.2 Scale up family planning programme (community based FP
services, social marketing, facility based and outreach long
acting and permanent FP service provision)
10.6.3 Provision of the family planning services following the
expansion of health facilities Per CYP 5,000,000 - - - - - - -
10.6.4 Increase awareness through social mobilization and
community conversation Session 195,036 - - - - - - -
10.6.5 Improve availability of long acting contraceptives
10.6.6 Integrate FP service with other services
10.6.7 Empower women and encourage male involvement in family
planning services
10.6.8 Coordinate the government and other partners efforts to the
family planning services to control the high population growth
Sub Total 3,800,000 3,800,000 3,800,000 3,800,000 3,800,000 19,000,000
10.7 Strengthen and utilize Climate-informed early warning and response system
10.7.1 Build strong link between the Ministry of Health and the
National Metrological Agency to avail and utilize climate
information for health interventions for climate-sensitive
diseases such as malaria
10.7.2 Create an enabling mechanism on the existing
Sub Total - - - - - -
10.8 Indoor air pollution
10.8.1 Promoting separation of kitchen from the main living
quarter
Woreda Health Offices
10.8.2 Advise the rural public to arrange ventilation system in
the house
Woreda Health Offices
10.8.3 Distribute energy saving stoves and into saving and
Woreda Health,water
promote households to secure chimney in their
&energy, Women,Children
houses/kitchens Number 1,000,000 5 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 5,000,000 and Youth Affairs
10.8.4 Construct high temperature incinerators for reduction and
disposal of hazardous health care wastes and expired
Food,Medicine and Health
Care Adiministartion and
medical supplies Number 7 121,212 242,424 242,424 121,212 121,212 121,212 848,485 Control Authority (FMHACA)
Sub Total 1,242,424 1,242,424 1,121,212 1,121,212 1,121,212 5,848,485
Gross Total 21,956,788 30,195,528 19,846,216 15,234,776 15,014,776 102,248,083
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 46

14. Annexes
1. Major health impacts due to climate change
2. Wide spread pre-occurrence of infectious diseases with inter-annual variability
and sensitivity to climate change
3. Monitoring and Evaluation matrix
15. References
1. Daze, A. kaia And E. Charles. (2009) climate vulnerability and capacity analysis hand book
a. Prutsch. et al, (2010) Guiding principles for adaptation to climate change in Europe
2. Africa Adaptation Program [AAP-E], (March,2008) Supporting climate resilient sustainable
development in Ethiopia Addis Ababa, Ethiopia
3. Afar Regional State[ARS], (October,2010) program of plan on adaptation to climate change
Grambisch and B.Menne, adaptation and adaptive capacity in the public health context
4. Federal democratic republic of Ethiopia ministry of health [FMOH], (March, 2009) National strategic
plan for malaria prevention , control and elimination in Ethiopia 2010-2015
5. Federal Democratic Republic of Ethiopia Ministry of Health [FMOH], (September 2010), Health
Sector Development Program(HSDPIV) 2010/11 – 2014/15 final draft document
6. Federal democratic republic of Ethiopia Ministry of Health[FMOH], (October, 2010), Annual
Performance Report (ARM) of HSDP III
7. Federal democratic republic of Ethiopia Ministry of Education [FMOE], (2010), Annual
Performance Report (ARM) of ESDP III
8. Federal democratic republic of Ethiopia situation analysis and needs assessment [SANA],
(April,2010) on the Libreville declaration on health and environment interlinkage country report,
Ethiopia
9. Intergovernmental Panel on Climate Change [IPCC 20016], (2001) Climate change: impacts,
adaptation, and vulnerability. Working group II to the third assessment report Cambridge, UK,
Cambridge university press.
10. Participatory learning and action 60 community based adaptation to climate change
11. United Nations Framework Convention on Climate Change [UNFCCC], (2007) climate change :
impacts, vulnerabilities and adaptation in developing countries
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 47

12. United nation development program [UNDP], (July,2007) Monitoring and Evaluation frame work for
adaptation to climate change
13. World health organization [WHO], (1999) sustainable development and healthy environments.
Environmental health indicators frame work and methodologies protection of the human
environment occupational and environmental health series, Geneva
14. World health organization [WHO], (2003), health and global environmental change methods of
assessing human health vulnerability and public health adaptation to climate change
15. World health organization [WHO], (2008) climate change and health (executive board 122nd and
124th session
16. World health organization [WHO], (2008) Protecting Health from climate change world health day
17. World health organization [WHO], Global change on climate, retrieved On
Jannuary12,2011,fromhttp://www.who.int/globalchange/publications/cchhsummary/en/
18. WHO websitehttp://www.who.int/globalchange/publications/cchhsummary/en/
Federal Ministry of Health Climate Change Adaptation Programme Plan [2011-2015] Page 48