HEALTH ADAPTATION PLAN IN RESPECT TO

CLIMATE CHANGE IN MANIPUR

DR K RAJO
DIRECTOR HEALTH SERVICES
MANIPUR
SECTOR IDENTIFIED : HEALTH
MANIPUR
Trends in observed maximum summer Trends in observed minimum summer
temperature during 1985 to 2015 temperature during 1985 to 2015
Trends in observed maximum winter Trends in observed minimum winter
temperature during 1985 to 2015 temperature during 1985 to 2015
Frequency of occurrence of rainfall events of <50 mm, 51-100 mm and >100 mm per
day (units are in number of days in 30 years) in the districts of Manipur during 1987
to 2016
Climate Change projections
District-wise changes in summer maximum temperature (0C) projected for the short
term (2030s) and long term (2080s) under RCP 4.5 and RCP 8.5 scenarios relative to
1985 to 2015
District-wise changes in winter minimum temperature (0C) projected for the short
term (2030s) and the long term (2080s) under RCP 4.5 and RCP 8.5 scenarios
relative to 1985 to 2015
Number of rainy days in a 30-year period:
Historical and projected under RCP 4.5 and RCP
8.5 scenarios
 Climate change hotspot districts – based on percentage increase in the number of high
intensity rainfall events (>50 mm/day)
Tengnoupal is the most Climate stressed District – under both RCP 4.5
and 8.5 Scenarios

Percentage increase in
Category number of high rainfall
RCP 4.5 RCP 8.5
of hotspot intensity days/year (>50
mm/day)

Kangpokpi, Churachandpur,
Moderate Upto 25% Tamenglong, Bishnupur Imphal East, Imphal West,
Pherzawl, Thoubal
Severe 25-50% Chandel, Kangpokpi Ukhrul
Thoubal, Ukhrul, Kakching,
Tengnoupal, Jiribam, Noney, Imphal
Tengnoupal, Chandel,
Extreme >50% West, Pherzawl, Senapati,
Bishnupur
Churachandpur, Kamjong, Imphal
East
CHANGES OBSERVED AND PROJECTED
1. As OBSERVED DURING (1969-2011 there is Temperature variability
with INCREASE OF BOTH MINIMUM ( 13.8 to 15.3 degree C ) AND
MAXIMUM TEMPERATURE ( 26.5 to 27.3 degree C )

2. RELATIVE HUMIDITY IS INCREASING DURING NIGHT IN MANIPUR

IN JUNE TO DEC - RELATIVE HUMIDITY REACHED ABOVE 80 %
3. Frequent occurrence of flash floods and landslides :When heavy
precipitation takes place and the natural watercourses do not have
the capacity to convey excess water, flooding occurs. Other factors
which may contribute to flooding include: volume, spatial
distribution, intensity and duration of rainfall over a catchment
4. The four valley districts in Manipur, namely Imphal East, Imphal
West, Thoubal and Bishnupur are most vulnerable to floods.
IMPACTS
1. Changing of climate and its impact may link to health directly and
indirectly in many ways by propagation many diseases like
• increase in the number of vector borne (e.g. increase in incidence of Malaria ,
JE and Dengue and its related outbreaks),
• Escalation with respect to their virulence and spread to hitherto disease-free
areas.
2. water borne diseases like typhoid due to frequent flooding
3. Deterioration in nutritional health due to loss of food security and
reducing cereal yields, etc
4. Air pollution related health disease like COPD ,Asthma and lung
cancer
Vector borne diseases
• The increased current mean temperature and the relative humidity is
likely to favor the reduced sporogony of the vector mosquito.
• Moreover at increased temperature the rate of digestion of blood
meal increases this in turn accelerates the ovarian development, egg
laying, reduction in duration of genotrophic cycle and higher
frequency of feeding on host amongst the vectors, thus increasing the
probability of malarial transmission.
• District-wise distribution of percentage of malaria cases in the state
indicates increasing trends of incidence in Tamenglong and
Churachandpur
District wise contribution of Malaria to the
State 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Tamenglong 42 26 18 24 35 52 122 44 31 13 15

Churachandpur 11 8 16 19 23 24 63 33 57 141 72

Imphal east 7 17 28 14 17 5 9 4 4 2 4

Ukhrul 14 10 8 9 3 8 2 1 2 10 3

Chandel 10 13 12 9 4 6 29 5 16 2 4

Other districts 7 23 16 23 18 7 4 8 12 11 18

Source : NVBDCB ,Manipur

Disease profile of malaria in 2010 reveals that Tamenglong district contributes 32% of total 947 malaria
cases in the state, followed by Churachandpur district (22%), Imphal East including Jiribam SD (16%) and
other remaining districts contributing in the range of 1% to 8% respectively
• As per the report of Health Department, incidence of the cases of
Japanese encephalitis & Dengue are on the rise in the state.
• Disease and epidemiological profile points towards the relationship
between the occurrence of Dengue and Japanese Encephalitis to
subtle change in climatic conditions that favor the breeding and
proliferation of their vectors.
• Adoption of preventive measures of Japanese Encephalitis and
Dengue are critical as these diseases have caused serious morbidity
and mortality in recent times across the state.
Number of cases and deaths due to vector
borne disease in Manipur
Year malaria Denque JE
Cases Death Cases Death Cases Death
2001 943 5 nil nil Nil nil
2002 1268 9 Nil Nil Nil Nil
2003 2589 17 Nil Nil 2 1
2004 2736 8 Nil Nil 1 Nil
2005 2071 0 Nil Nil Nil Nil
2006 2709 8 Nil Nil Nil Nil
2007 1194 4 5 1 65 Nil
2008 708 2 Nil Nil 4 Nil
2009 1069 1 Nil Nil 64 Nil
2010 947 4 7 Nil 118 15
2011 714 1 NA NA 9 1
2012 255 Nil 6 0 0 0
2013 120 Nil 9 0 0 0
2014 145 Nil 0 0 1 0
2015 216 Nil 50 0 6 0
2016 122 Nil 22 1 47 1
Vulnerable sections
• Poor and weaker sections
• Children and aged people
• Diasble persons
• Pregnant mothers
• People with already existing chronic disease
Housing and climate related health events
• Manipuris live in a wide range of housing types, including formal, freestanding dwellings,
apartments, formal and informal backyard dwellings.The prospect of increased climate
change variability poses problems in particular for those living in unsound, informal
housing, usually in settings of poverty in rural areas and urban informal settlements.
• The high concentration of people and infrastructure in urban areas pose a risk of
considerable economic losses, and health and safety risks in the event of extreme
weather events.
• In urban settings the heat island effect is also an important concern. Rural populations,
where support and response services may be limited or absent, are also potentially
vulnerable to intensified weather events and the associated infra-structural damage or
hazards.

• Vulnerable areas include access to safe drinking water, waste disposal services, road and
pedestrian infrastructure and access to safe fuels leading to exposure to high levels of
indoor air pollution.
Climate changes and Air borne / Respiratory
diseases
• Air pollution is closely associated with climate change, and an individual’s
response to air pollution depends on the source and components of air
pollutants, as well as on climatic agents. Epidemiological studies attribute
most severe respiratory health effects of air pollution to particulate matter
and ozone
• Changes in meteorological parameters substantially increase respiratory
morbidity and mortality in adult patients with common chronic lung
diseases, such as asthma and COPD, and other serious lung diseases .
Extreme heat and high humidity trigger asthma symptoms .

• Climate change will increase the frequency and intensity of floods and
cyclones and thus fungal spore production, a powerful asthma and rhinitis
trigger.
ADAPTATION STRATEGY
ADAPTATION STRATEGY AND ACTION PLAN : This is based on WHO’s
operational framework for building climate resilient health

-based on six
building blocks
common to
health system (
inner ring)

-With 10
components to
strenghthen
climate
resilience
(outer ring )
Sl no Climate related Vulnerablity key areas Adaptation
health events
1 Water & 1.Availability of safe water 1.Strengthen/ develop surveillance systems during
high risk seasons/ periods
Food borne supply to all especially 2. Strengthen food and water quality
during flood
disease control,surveillance on food handling units and local
vendors
2.Sanitation facility in 3. Emergency action plans, including early warning,
1. Diarrhea migrant workplaces and public communication, and
2. Typhoid rural areas public health preparedness especially for high risk
populations during high risk seasons / periods
3. Salmonel 3.Personal Hygiene and
4. Capacity Buiding of health care personnel and
losis hand Washing laboratories
5. Improved access to health care facilities by
4. Leptospir vulnerable population
osis 6. provide logistic support , drugs and adequate
5. Brucellos supplies to the affected region

is etc
Sl Vulnerablity key areas Adaptation
2
Vector borne 1.Weather Variability : 1.Expand the scope of diseases monitored, and
and zoonotic Temperature ,rainfall,humidity,flood, monitoring at the margins of current geographic
disease Drought,wind daylight duration distributions to detect spread
2. Strengthen National Control programmed for

1. Malaria 2.Change in vector/ animal population- various vector borne and Zoonotic diseases
2. Denque due to change in growth ,survival 3. Establish Early Warning System (EWS) and emergency
3. Japanese ,feeding habits,breeding sites etc action plans, including early warning, public
Encephalit communication, and public health preparedness especially
for high risk populations during high risk seasons /
is 3. Change in interaction of
Periods
4. Rabies vector/animal and pathogen due to
4. Integrated vector / pest control,
5. Scrub change in susceptibility /incubation
5. Enhance diagnostic and treatment options in high
typhus period or transmission
risk regions/periods by opening a state advanced
entomological and climate health lab .
4.Change in demography,migration
6. Plan for increased demand for treatment during
water projects/canal ,land usage
high risk seasons or weather conditions
practice
7. Ensure adequate animal and human vaccination
coverage
Sl no Climate related Vulnerablity key areas Adaptation
health events
Extreme heat and
3 Homeless / migrant workers 1. Heat-health action plans, including early warning,
thermal stress
public communication, and responses such as cooling-
1. Heat Stroke
Workers in the open field/ stone centres for high risk populations
2. Heat Fatique

crushers / factory / school

2. Improved health facility design, energy efficient
children etc cooling and heating system; Occupational health exposure
standards

3. Public education to promote behaviour change, e.g. in

relation to clothing,
ventilation etc

4. Develop an accurate and timely Alert System in

collaboration with Relevant department / organization etc
5. Incorporation of real time surveillance , evaluation and
monitoring the planning process
Sl no Climate related Vulnerablity key areas Adaptation
health events
4 Air Borne , Interaction of air pollution , -Strengthen surveillance system for respiratory
Cardio pollen and weather , illness and develop health forecasting for acute and
Pulmonary & chronic respiratory disease
respiratory Particulate matter and harmful - mapping and assessment of areas ,which have
Allergic Disease chemicals potential impact on respiratory disease through
production of pollen or other allergens
1. COPD Ambient Air quality
2. Asthma -establish air pollution monitoring system ,linkage
3. Lung cancer with Manipur pollution control board for Real time
4. Heart air quality started
Disease Sentinel surveillance of Air borne related illness
started
-linking with NPCDCS/cancer control program and
intensify /prioritize treatment .

Establish ICU in priority district hospitals

Sl no Climate related Vulnerablity key areas Adaptation
health events
5 Nutritional Changes in food availability Strengthen Maternal and child health health services and
disease ,accessibility,utilization promote implementation of IMNCI
involving under
Crop failure / yield decline Expand and promote fortified food consumption in
nutrition and
vulnerable population
malnutrition
Reduction in animal/aquatic
population Vit A supplemntaion , Anaemia screening to be intensified
in children and pregnant woman

Scale up integrated food security , nutrition and health

progrmme in vulnerable zone by strengthening Poshan
Abhiyan ,National nutrition mission
Other stake holders consultation / coordination

• Dept of Environment &State pollution control Board

• Ensure that SPCB set standards for industry specific emission and effluent
,monitor level of pollutants and enforce penalties .
• Enforces strict air quality standards for pollution
• Take strict measures for unregulated sector such as stone crushing ,trash burning
,brick kiln which contribute to ambient air pollution
• Minor Irrigation Dept
• Develop /encourage program for efficient use of irrigation water
• Management of safe water supply system ,rain harvesting

• Agriculture
• Promotion of climate resilent crops among farmers
• Prevent on-farm burning and promote multiple use of crop residues
•
• Education Dept
• Regular screening of school children for early detection of
disesase attributable to air pollution
• Inclusion of ill effects of environmental pollution and risk of
climate change in school and college curriculum
• Train teachers on proper first aid measures for heat waves
• Prevent outdoor activities during heat waves
• Improving indoor air quality of educational institutes
• Sensiting students and teachers about using Air quality index
in planning outdoor school activities
• Dept of Transport

• Provision of improved public transport like air conditioned buses , banning

outdated vehicles which are not in conformity with Motor Vehicles Act
• Ensure proper engine checks for vehicles to assess pollution

• Rural Development and Panchayati Raj

• Include health promotion guideline in the village assessment for awards
• To address social determinants of health for reducing air pollution like lack of
education , un employment, poverty, poor housing conditions etc .
• Municipal councils and Autonomous district Hill councils
• Elimination and reduction of vector breeding sites
• Develop building designs and other infrastructures to reduce the impact of climate change on
health
• Undertake actions of planting green trees ,ensure nonburning of garbage,buid shades at
public places
• Renewable Energy Department /MANIREDA
• Develop / strengthen policies for truly clean cookstoves
• Create action plan for replacing biomass fuel with alternate clean fuel \
• Support and strengthen integrated rural energy programe with emphasis on indoor air
pollution
• Town Planning
• Relief and Disaster management :Coordination with the Emergency
Health Response Team
• Labour
• Frame guidelines and conduct workshops for health promoting workplaces
• Ensure regular health check up and treatment of workers /laborer regarding
respiratory diseases and NCD by establishing special clinics
• Support companies which employ environment healthy workplace policy
that can reduce
• vehicular travel such as telecommuting or official AC bus transport
• MAHUD
• Formulate /revise urban transport policy which reducevehicular pollution
• Enforcement of ban on burning garbage or biomass especially during einter
months
• Help cities develop air pollution aletts and emergency plans based on Air
Quality index and SPCB continous air monitoring data.
• Finance Department
• Analysis of the economic and financial implications of the health and other
impacts of air pollution
• Budget
Identification of 5 adaptation options
1. Surveillance system and Early warning signals
2. Enhancement of health infrastructure and access to health facility
3. Capacity building of health staffs and public
4. Strengthening of national health programs to cover climate
sensitive diseases
5. Improvement of socio economic conditions including sanitation &
housing condition
Scoring of options
Sl options Cost Scalabi Feasibilit Gender Total priority
no factor lity y impact
1 Surveillance system and Early 8 8 8 9 33 III
warning signals

2 Enhancement of health 6 6 7 9 28 IV
infrastructure and access to health
facility

3 Capacity building of health staffs 9 9 10 8 37 II

and public

4 Strengthening of national health 9 9 10 10 38 I

programs to cover climate sensitive
diseases

5 Improvement of socio economic 5 5 6 8 22 V

conditions including sanitation &
housing condition
Summary of key adaptation strategies
• Facilitate better awareness about impact of climate change on health of public
,health care providers and all stake holders
• Design and production of educational material on Climate sensitive illness to
increase community awareness
• Development of Climate resilent health system to maintain delivery of health
system
• Capacity building of health care professional in context of climate change
• Strengthening Health System to assess vulnerabilities of climate sensitive
diseases and risks and early implementation of intervention
• Situational Analysis to strengthen preparedness and response of state / district
and below district level to cope with adverse health impacts of climate change
• Strengthening the epidemic preparedness and response teams through scaled up
training initiatives.
• Early Warning System / Alerts and response to state , district and below district
• Improving surveillance and reporting of cases toward early detection and case
management of key diseases.
• This includes the development and distribution of case management guidelines;
conduct of health education
• programmes; collaboration with stakeholders such as the NCDC,WHO,ICMR
• Collaborative work with stake holders
• Finalization of a monitoring and evaluation plan.
• Promoting health effective partnerships with stakeholders in the private
sector/civil society / NGO and government departments to create synergy with
other missions on Climate change
Activities so far
• The State Level Governing Body and State level task force on climate
chamge and health formed under the support of dept of Environment
, Govt of Manipur and national Action plan on climate change and
health
• State environment health cell established and state Nodal officer
identified
• Sentinel surveillance of air pollution related illness started in 5 health
institute in Manipur Manipur
• Ist version of action plan on climate change and health drafted
,second version will be completed after inputs of Directorate of
environment and addition of chapter on heat plan
Key proposed projects
• Establishment of Vector borne diseases diagnostic laboratory in 4 districts for
early diagnosis and treatment of fatal disease like JE

• Air borne quality monitoring and specialised ARI clinics for diagnosis and
management of COPD & asthma in 5 districts

• One Nutrition and food quality monitoring lab in state to study the impact of
climate change on crop quality ,and food value to plan for fortification and
supplementation

• To convert 5 health institute staying in climate vunerable areas to climate

resilient so as to treat the Climate sensitive diseases
• Thank you