Climate–Health Governance in South and Southeast Asia

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Executive Summary

South and Southeast Asia are among the most climate-sensitive regions in the world, facing some of the greatest projected losses in health, lives, and livelihoods. Countries in the region experience a convergence of dense populations, rapid urbanisation, resource constraints, uneven governance capacity, and high exposure to extreme weather events. These factors make them central to the global climate–health conversation and highlight the need for coordinated, multisectoral responses.

This paper reviews climate–health governance across 10 countries—Bangladesh, India, Indonesia, Malaysia, Nepal, Philippines, Singapore, Sri Lanka, Thailand, and Vietnam—to understand how countries are responding to the complex and growing effects of climate change on health. It maps existing policy responses and actions, uses an analytical framework based on the World Health Organization’s (WHO) operational guidance to evaluate climate–health governance, systems, and capacities across the region, and identifies shared regional priorities and opportunities for knowledge exchange. The analytical framework consists of five core dimensions: governance and institutional arrangements; climate–health information systems; climate-resilient health infrastructure and service delivery; workforce capacity; and financing frameworks. Based on this analysis, the paper highlights opportunities for regional collaboration and knowledge exchange in five areas: intersectoral governance innovations, sustainable climate–health financing, integrated climate–health information systems, capacity building, and community accountability and social participation. The findings underscore the urgency of institutional reforms and sustained investment to enable equitable and climate-resilient health systems across Asia.

Climate Change as a Health Crisis

Climate change manifests through a wide array of health and socio-economic risks in the region. Countries across South and Southeast Asia are increasingly recognising the links between climate change and health. Health now appears more frequently in national adaptation plans (NAP), climate strategies, and sectoral policies. Some countries have developed health-focused adaptation plans, while others have incorporated health as a priority within broader climate frameworks. These shifts reflect a growing acknowledgment that climate change is fundamentally a health challenge.

Across the 10 countries reviewed, governments are gradually integrating health into climate adaptation and resilience planning. Coordination among ministries of environment, climate, disaster management, and health is becoming more common as cross-sectoral risks intensify. Many national strategies now identify health vulnerabilities or outline priority areas for action, though the depth and coherence of integration vary widely, as discussed in the paper. In several cases, policies articulate broad goals but lack sustained financing, institutionalised coordination mechanisms, or systems for monitoring and evaluation (M&E).

Development partners have played a catalytic role in supporting climate–health initiatives through technical assistance, pilot projects, and investments in early warning systems and resilience programmes. However, these efforts often remain project-based and time-limited, raising concerns about long-term sustainability and institutionalisation.

Systemic Challenges in Climate–Health Governance

While the integration of climate and health into national policy frameworks is a critical step forward, countries face substantial challenges in translating commitments into action. Several cross-cutting issues emerge consistently across the region.

1. Fragmented Governance and Coordination Challenges

Governance of climate and health is distributed across multiple ministries and agencies. In many cases, ministries responsible for environment or climate policy lead adaptation efforts, while health ministries play a secondary role. This limits health-sector ownership of climate adaptation measures and results in fragmented governance structures.

Coordination challenges are especially pronounced in decentralised governance systems. Subnational authorities often bear significant responsibility for implementation but lack adequate technical capacity, financing, or access to data. Weak horizontal and vertical coordination leads to duplication, gaps, and inconsistent execution of national strategies.

2. Inadequate and Ad Hoc Financing

A major obstacle to climate–health action is insufficient financing. Health systems in many countries already struggle with limited budgets, and climate adaptation requires additional investments across infrastructure, surveillance, workforce capacity, and emergency preparedness.

Most climate finance globally continues to prioritise mitigation, leaving adaptation under-resourced. Only a small share directly supports health-related adaptation. Many countries in the region rely heavily on external financing from development partners, creating a landscape dominated by short-term projects rather than long-term, systemic investments. Without dedicated domestic financing streams, it is difficult to establish durable climate–health programmes.

3. Weak Climate–Health Information Systems

Robust data systems are essential for monitoring climate-sensitive health risks, forecasting outbreaks, and planning targeted interventions. However, climate and health data systems, often managed by different ministries, tend to operate in silos. Limited data sharing, incompatible systems, and unclear mandates impede the development of integrated early warning systems.

Several countries have piloted climate-informed disease surveillance or early warning tools with support from international partners, but these remain fragmented and rarely scale nationally. The absence of standardised climate–health indicators and limited institutionalisation of data systems undermine evidence-based policymaking.

4. Vulnerabilities in Health Infrastructure and Service Delivery

Many health facilities across the region are not designed to withstand climate extremes. Flooding, storms, heatwaves, and power disruptions frequently affect hospitals and primary care facilities. Investments in climate-resilient infrastructure, such as solar power or flood-proofing, are increasing but often focus on tertiary facilities, leaving primary care systems comparatively under-resourced.

Climate impacts also exacerbate existing service delivery challenges, such as workforce shortages, overcrowding, and uneven access. During heatwaves or outbreaks, health systems face surges in demand that exceed capacity. Similarly, supply chains for essential medicines and equipments are also vulnerable to climate-related disruptions.

5. Limited Workforce Capacity for Climate–Health Action

Health workers play a central role in recognising and responding to climate-sensitive health risks, yet workforce training on climate–health issues remains limited. Existing training efforts tend to be short-term and ad hoc, lacking a comprehensive approach to building climate-resilience competencies.

There is a critical need to strengthen health workforce skills in surveillance, risk communication, disaster preparedness, and interdisciplinary collaboration. Integration of climate–health content into formal medical, nursing, and public health education is still nascent across the region.

Opportunities for Regional Collaboration and Collective Action

The challenges described above are shared across South and Southeast Asia, making regional cooperation both necessary and advantageous. Climate impacts and health risks frequently cross borders—vector-borne diseases spread regionally, natural disasters affect migrant populations, and supply chain disruptions ripple across countries. As such, a regional approach can strengthen national strategies and enable more effective and equitable responses.

1. Supporting Financing and Investment for Climate–Health Adaptation

Regional collaboration can enhance countries’ ability to mobilise resources by generating shared evidence on adaptation needs, highlighting economic costs, and advocating for increased global financing. A regional financing mechanism could support cross-border initiatives, including regional surveillance networks, joint procurement, and collaborative infrastructure projects.

2. Advancing Interoperable Climate–Health Data Systems

A regional initiative to harmonise climate–health indicators and facilitate data sharing can significantly improve risk forecasting and policy design. A regional observatory or shared analytics platform could support coordinated action on heatwaves, disease outbreaks, and other climate-sensitive health risks.

3. Building a Regional Climate–Health Workforce

Regional training hubs and standardised curricula can build workforce capacity across countries. Cross-country exchanges, mentorship, and collaborative capacity-building programmes can help address gaps in climate–health competencies.

4. Promoting Collaborative Research and Innovation

Joint research initiatives can generate regionally relevant evidence on climate-sensitive diseases, health system vulnerabilities, and cost-effective adaptation measures. Sharing successful pilot models—such as heat action plans, early warning systems, or climate-resilient health facility designs—can accelerate scaling across the region.

5. Enhancing Community Engagement and Accountability

Regional cooperation can help countries integrate community-based approaches into climate–health governance. Civil society organisations, local governments, and community networks play a central role in adaptation, and sharing participatory models can strengthen implementation and accountability.

Conclusion and Way Forward

The intersection of climate change and health represents one of the most urgent challenges facing South and Southeast Asia. While the region has begun to recognise and incorporate health into climate strategies, systemic gaps in governance, financing, data systems, infrastructure, and workforce capacity continue to impede comprehensive action.

Moving forward requires:

Stronger integration of health into climate policies.
Clear governance mandates and coordinated inter-ministerial action.
Sustained financing for long-term climate–health adaptation.
Investment in resilient health systems and infrastructure.
Strengthened climate–health information and surveillance systems.
Enhanced workforce training and institutional capacity.
Regional cooperation to leverage shared knowledge, financing, and innovation.

Additionally, authors have identified some research questions for guiding future regional work:

What governance and coordination mechanisms are most effective in sustaining intersectoral climate–health action?
What resources and financing models are needed to support long-term, equitable climate–health adaptation?
How can climate variables be systematically integrated into health information and surveillance systems?
What approaches are most effective for building climate–health capacities across all levels of the health system?
How can community participation strengthen accountability and inclusiveness in climate–health planning?

By addressing these priorities, South and Southeast Asian countries can better protect their populations, strengthen health systems, and advance a more equitable and resilient regional future. Regional platforms offer an important opportunity to unify national efforts, accelerate progress, and position the region as a leader in climate–health governance globally. By convening policymakers, researchers, civil society organisations, and multilateral institutions, regional networks can foster knowledge exchange, develop shared frameworks, and promote coordinated advocacy.

Q&A with authors

What is the core message conveyed in the paper?

Based on a review of climate–health governance across ten countries in South and Southeast Asia, the paper finds that climate–health risks are now widely recognised in national policies, marking an important normative shift. However, this recognition has not yet been translated into strong, institutionalised action within health systems.

The paper finds that climate–health responses remain fragmented, under-financed, and largely project-based. Key gaps persist in predictable financing, integration of climate data into health surveillance, climate-resilient primary health care, and governance arrangements that link health, environment, finance and development sectors. Many promising initiatives are led outside ministries of health and are not embedded in routine health system functions, limiting their sustainability and scale.

The core message is that climate change must be treated as a structural health system issue, not an add-on. This requires institutionalising climate–health action through clear mandates, sustained financing, integrated data systems, and appropriate workforce capacity. Regional cooperation can support this transition by enabling shared learning, pooled resources, and coordinated responses to cross-border climate-related health risks.

What presents the biggest opportunity?

Across the ten countries reviewed, the biggest opportunity lies in institutionalising climate–health action within existing health systems. In practical terms, this opportunity lies in moving from recognition to routine practice, for instance embedding climate considerations into core health system functions such as surveillance, primary health care delivery, infrastructure planning, workforce training, and budgeting. Many countries already have policies, pilot projects, and technical tools in place; the opportunity is to scale and sustain these by anchoring them within ministries of health, regular financing streams, and established governance mechanisms.

At the regional level, the opportunity is amplified through collective action. Shared climate risks, similar system constraints, and existing regional experience in disaster management and pandemic preparedness create a strong foundation for cooperation. By sharing data standards, training approaches, financing strategies, and tested models, countries can reduce duplication, lower costs, and accelerate implementation.

In short, the biggest opportunity is to convert widespread policy recognition and scattered innovations into durable, system-wide climate–health institutions which are supported by regional collaboration.

What is the biggest challenge?

The biggest challenge is that climate–health action is being layered onto health systems that are already stretched. Across South and Southeast Asia, many health systems are grappling with workforce shortages, uneven service coverage, financing constraints, and persistent demands from infectious and non-communicable diseases. Climate-related risks such as heatwaves, air pollution, disease outbreaks, and disasters are intensifying these pressures by increasing demand at precisely the moments when systems are least able to respond.

This strain is particularly visible at the level of primary health care and subnational systems, where climate impacts are felt most directly but institutional capacity is weakest. Health facilities and supply chains are vulnerable to climate shocks, health workers often lack training on climate-related risks, and surveillance systems are not designed to anticipate climate-driven surges in illness.

The challenge, therefore, is not only about coordination or policy alignment, but about building climate resilience into the everyday functioning of health systems. Without addressing these underlying capacity constraints, climate–health initiatives risk remaining reactive and episodic, rather than strengthening systems to manage growing and sustained climate pressures.