A mixed-method evaluation of climate change-health action plans and health expenditures for four Indian states

Human health is being gradually brought to the fore in international discussions on climate change. While developed countries have taken concerted measures to deal with the health implications of climate change, developing countries, such as India, have only recently begun systematic efforts in this regard. In order to strengthen health systems against the adverse impact of climate change, the Union Government of India launched the National Programme on Climate Change and Human Health (NAPCCHH) in 2019 and also mandated states to create State Action Plans for Climate Change and Human Health (SAPCCHH). Applying a concurrent mixed-method research design, this paper undertakes an assessment of SAPCCHH for four Indian states – Himachal Pradesh (HP), Assam, Gujarat and Kerala. Thematic analysis of SAPCCHH is triangulated by conducting Key Informant Interviews (KIIs) with stakeholders from a variety of professional backgrounds. In addition, we analyze state health budget data to understand the levels and trends of public health and climate-sensitive disease (CSD) spending. Our findings suggest that developing SAPCCHH requires more consultative and decentralized planning, with local bodies playing a more fundamental role in strategizing responses and strengthening preventive and public health programs. Our analysis reveals that public health and CSD spending across states is severely inadequate, which calls for exploring additional financing sources and strengthening technical capacity to enhance the utilization of approved budgets.