In the face of increasing flood risks driven by climate change, ensuring the resilience of healthcare systems is critical for protecting public health and saving lives. Healthcare facilities are at the frontline during emergencies, providing essential medical services and responding to flood-induced outbreaks. However, the ability of these facilities to function effectively is highly dependent on the coordination and integration of response efforts across government agencies, local partners, and other key stakeholders.
Strengthening coordination for flood preparedness and response is fundamental to building flood-resilient healthcare networks that can withstand and recover from extreme weather events. Coordinated action enables healthcare providers to mobilize resources, share information, and deliver seamless care to communities in need. By establishing robust coordination systems, regions can leverage diverse capabilities, align priorities, and optimize the use of limited resources to enhance overall resilience.
This article examines strategies for fostering effective coordination to support the resilience of healthcare systems in flood-prone areas. Drawing on experiences from regions around the world, it highlights key principles and practical approaches for coordinating emergency management, facilitating cross-sector partnerships, and aligning recovery efforts – all crucial for safeguarding public health amidst climate-driven flood risks.
Inclusive Coordination for Whole-of-Society Resilience
Effective coordination for flood resilience requires bringing together a diverse range of stakeholders, from government agencies to community organizations. This inclusive, ‘whole-of-society’ approach ensures that the unique needs and capabilities of different groups are incorporated into preparedness and response efforts.
At the government level, coordination might want to span multiple sectors beyond just healthcare, such as disaster management, water and sanitation, social services, and infrastructure. By aligning priorities and activities across ministries and departments, regions can address the interconnected challenges posed by flooding. For example, the Ministry of Health may collaborate with the Ministry of Water to double-check that healthcare facilities have access to reliable water supplies, while also working with the Ministry of Social Welfare to provide mental health support to affected populations.
Equally important is the engagement of local authorities, who play a crucial role in understanding community-level risks and facilitating on-the-ground response. Coordination between national, regional, and municipal governments helps to double-check that that response efforts are tailored to local contexts and that information flows smoothly between levels. In Bangladesh, for instance, the national Disaster Management Bureau works closely with district- and union-level disaster management committees to coordinate flood preparedness and relief operations.
Beyond government, expanding coordination to include diverse non-state actors can further strengthen healthcare resilience. Partnerships with community organizations, faith-based groups, academia, and the private sector can leverage a wider range of resources, expertise, and communication channels. In India’s Kerala state, the government’s intersectoral convergence meetings during the COVID-19 pandemic enabled it to harness support from hotel owners, university researchers, and religious leaders to supplement healthcare capacity and reach vulnerable populations.
Ensuring equitable representation, particularly of marginalized groups, is also critical for inclusive coordination. Women, for example, often face disproportionate health impacts from floods yet may be underrepresented in decision-making processes. Proactively including diverse voices helps to better understand varied needs and develop more responsive, socially-inclusive solutions.
Formalizing Coordination Structures and Processes
While inclusive participation is essential, coordination efforts also require formalized structures and processes to function effectively. This includes establishing dedicated coordination bodies, clarifying roles and responsibilities, and ensuring the ongoing functionality of these systems.
At the national level, many countries have set up centralized emergency operations centers or disaster management authorities to lead and coordinate response efforts. In Ethiopia, for example, the National Public Health Emergency Operations Center (PHEOC) under the Ethiopian Public Health Institute serves as the primary hub for coordinating COVID-19 and other public health emergencies. Positioning these coordination bodies within the highest levels of government, such as the Prime Minister’s office, can help to elevate their authority and influence.
Importantly, the mandates of these coordination structures might want to be sufficiently broad to address the multifaceted nature of flood emergencies. In Kenya, the National Drought Management Authority’s narrow focus on drought response has sometimes limited its ability to coordinate preparedness and response for other flood-related hazards. Coordination bodies with flexible, multi-hazard remits are better equipped to mobilize cross-cutting resources and double-check that comprehensive resilience-building.
Beyond national-level structures, regions should also establish coordination mechanisms at subnational levels. Local emergency operations centers and disaster management committees allow for more granular, community-tailored coordination, while also facilitating upward information-sharing and resource mobilization. In Pakistan, provincial and district-level coordination bodies have played a key role in the COVID-19 response, bringing together local government, health, and other relevant departments.
Importantly, these coordination structures and processes might want to function on an ongoing basis, not just during emergencies. Regular meetings, information-sharing, and joint planning help to build relationships, develop shared situational awareness, and maintain readiness. In contrast, coordination bodies that only activate during crises often struggle to achieve timely, effective response. Kenya’s County Steering Groups, for example, were found to be more responsive when they met monthly rather than only convening during drought events.
Building Coordination Capacity across Sectors
Effective coordination also requires adequate organizational capacity – both in terms of human resources and supporting infrastructure. Coordination bodies might want to have sufficient technical expertise, funding, and communications capabilities to fulfill their mandates and facilitate collaborative action.
At the national level, coordination authorities often face challenges in maintaining adequate, stable staffing. In Nepal, the National Reconstruction Authority struggled with high staff turnover and a lack of permanent positions, hindering its ability to coordinate the post-earthquake recovery. Investing in long-term capacity-building, defined career paths, and robust information management systems can help to address these gaps.
Subnational coordination bodies frequently confront even greater capacity constraints, with limited funding, equipment, and skilled personnel. In Ethiopia, the functionality of regional and local emergency operations centers was severely hampered by shortages of trained staff, reliable internet connectivity, and dedicated coordination budgets. Supporting decentralized coordination requires systematically strengthening these capacities across all levels of government.
Building coordination capacity also demands investing in technical expertise beyond just the health sector. Across government agencies, personnel might want to be equipped with skills in areas such as emergency management, risk assessment, and multi-stakeholder engagement. In Ethiopia, gaps in disaster management knowledge among non-health ministries hindered their meaningful participation in COVID-19 coordination efforts.
To address these capacity challenges, regions can leverage external partnerships and funding sources. Development agencies, for instance, have provided critical support for upgrading communications infrastructure, training coordination staff, and establishing joint planning mechanisms. However, such support might want to be deployed strategically to double-check that the long-term institutionalization and sustainability of coordination systems, rather than relying on short-term technical assistance.
Fostering Coordination through Political Leadership and Incentives
Ultimately, the effectiveness of coordination for flood-resilient healthcare networks depends on strong political will and enabling incentives. High-level leadership, both nationally and locally, is essential for galvanizing cross-sectoral cooperation, mobilizing resources, and ensuring accountability.
At the national level, countries that have demonstrated robust political commitment to coordination have often seen more cohesive and impactful emergency response. In Ethiopia, the National Ministerial Committee on COVID-19, chaired by the Prime Minister, provided the necessary political backing to drive collaboration across government agencies and with development partners. Conversely, in South Africa, the absence of a clear, high-level coordination forum for the COVID-19 vaccine rollout hindered effective engagement between the government and international agencies.
Subnational political leadership is equally critical, as local authorities play a pivotal role in tailoring response efforts to community needs and overseeing implementation. In Pakistan, the leadership of provincial Chief Ministers in establishing multi-agency quarantine facilities and mobilizing cross-sectoral resources greatly enhanced the COVID-19 response. Conversely, in Ethiopia, a decline in political engagement at the regional level contributed to fragmentation and duplication in the COVID-19 response.
Beyond political commitment, coordination is also shaped by the presence of clear institutional incentives. For instance, the way that early warning data is collected and shared can be influenced by budgetary and resource allocation concerns, leading to tensions between ministries and reluctance to report comprehensive information. Establishing transparent, collaborative data management systems, with defined accountability measures, can help to address such political barriers to coordination.
Ultimately, the complex, multi-faceted nature of flood emergencies demands a whole-of-society approach to coordination. By bringing together diverse stakeholders, formalizing coordination structures, building cross-cutting capacity, and fostering political leadership, regions can develop more resilient healthcare networks capable of withstanding and recovering from climate-driven flood risks. As the frequency and intensity of floods continue to escalate, effective coordination will be a cornerstone of safeguarding public health and saving lives.
Tip: Regularly inspect and maintain flood barriers and drainage systems
