Strengthening institutional coordination for climate resilient health systems
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Strengthening climate resilient health systems (CRHS) requires effective coordination across government sectors, federal and subnational levels and with stakeholders outside government. Coordination has often faced challenges in practice, hindering coherent actions and creating gaps and duplication in implementation.
This article examines coordination for CRHS in Bangladesh, Nepal and Pakistan, where already-fragile health systems face growing climate-related shocks and stressors. Findings are drawn from three separate country studies, each of which used document reviews and interviews.
This synthesis article draws on findings from each country to identify a range of factors affecting coordination for CRHS. Each country has – to varying degrees – incorporated CRHS in climate and health policy frameworks, and policies emphasise the importance of coordination. Policy implementation remains more nascent.
There has been some coordination across government environment, disaster management and health sectors, but siloes persist, and operational coordination remains inconsistent. Coordination between federal and subnational governments has encountered challenges such as unclear ownership and insufficient communication, hindering alignment and contributing to gaps in implementation.
Civil society engagement has sometimes been limited, with top-down government planning hindering stakeholder input. A range of organisational issues have affected coordination, including weak coordination mechanisms, unclear organisational mandates and roles, lack of units or focal points responsible for CRHS, capacity gaps, and political dynamics.
Overall, coordination mechanisms are necessary but insufficient, and their operationalisation and effectiveness depend on a wider enabling environment. Based on country experience, the article identifies lessons to support CRHS coordination in low-income countries, including fragile and shock-prone settings.
Read this Social Science and Medicine – Health Systems paper here. [opens new tab]
Suggested citation
Kate Gooding, Sushil Baral, Mahwish Hayee, Paul Kadetz, Sabrina Rasheed, Shehryar Khan, Mohammad Sameer Shahid, Sophie Witter. Strengthening institutional coordination for climate resilient health systems: Comparative experience from Bangladesh, Nepal and Pakistan, SSM – Health Systems, Volume 6, 2026, 100226, ISSN 2949-8562, https://doi.org/10.1016/j.ssmhs.2026.100226.
Further information
Read our policy brief – Strengthening climate-resilient health systems: opportunities and challenges
This paper is part of a Social Science and Medicine – Health Systems special edition Developing health systems resilience in fragile and shock-prone settings: Findings from the ReBUILD for Resilience Consortium [opens new tab]