Climate-resilient health facilities: a practical checklist for water, sanitation and power

A health facility that cannot keep its taps running, its toilets usable or its vaccine fridge cold during a flood or a heatwave fails people at exactly the moment they need it. Climate shocks are no longer rare events to be handled by emergency appeals alone. Pakistan's 2022 floods showed how quickly water, sanitation and power failures can take facilities out of service across whole districts. Resilience is therefore a routine planning question, and much of it comes down to unglamorous basics: water, sanitation, hygiene, waste and energy.

Start with the hazards the facility actually faces

Resilience plans often begin with a generic template. A better starting point is a short, site-specific hazard review. A facility on a river plain faces different risks from one in an arid district or a dense urban settlement.

Ask staff and the community what has happened before: how high the water came, how long the power was out, which road was cut, when the borehole ran dry. Local memory is often more precise than available maps, and combining the two gives a realistic picture of what the facility must withstand.

A checklist for the basics

A facility assessment does not need to be elaborate. The following questions cover most of what matters and can be answered in a single visit.

• Water: is there a reliable source on the premises, and a second source or storage if the first fails? Is storage raised above likely flood levels and protected from contamination?
• Water quality: is water tested and treated routinely, and are supplies for treatment kept in stock for emergencies?
• Sanitation: are toilets usable, separated for women and men, accessible to people with disabilities, and built so that they do not overflow or contaminate the water source during floods?
• Hygiene: are there functioning handwashing points with soap or hand rub at points of care and near toilets?
• Waste: is health care waste segregated, stored safely and treated or removed in a way that still works when roads are cut or storage areas are flooded?
• Energy: is there dependable power for lighting, the cold chain and essential equipment, with a backup that staff know how to operate and maintain?
• Building: are drainage, roofing, ventilation and shade adequate for heavy rain and extreme heat? Are electrical fittings, medicines and records kept above floor level?

Budget for operation, not only construction

Many facilities have water tanks that leak, solar panels that no longer charge and incinerators that have never been lit. The common cause is that capital investment was funded while operation and maintenance were not.

Every upgrade should come with a costed maintenance plan: who inspects it, how often, what spare parts are needed and which budget line pays for them. Where facility-level budgets exist, a small, flexible allocation for minor repairs often does more for resilience than a large one-off project. Where they do not, the district should hold a clear and funded responsibility.

Make responsibility clear

Water, sanitation and energy at health facilities sit between departments. Health, public health engineering, local government and energy agencies may each assume another is responsible. Unclear ownership is one of the most frequent reasons that a broken hand pump stays broken.

Name a focal person at each facility and at district level, set out who repairs what, and agree in advance how requests are raised and escalated. Simple written arrangements between departments, kept short and specific, prevent long delays when something fails.

Build it into routine monitoring

Resilience fades if it is assessed once and forgotten. A handful of indicators on water availability, toilet functionality, hand hygiene, waste management and power can be added to routine supervision checklists and facility reporting.

Review them before the seasons that carry the greatest risk, such as the monsoon or the peak of summer heat, so that repairs are made while there is still time. Tracking these indicators also strengthens the case for investment when budgets are being prepared.

Practical takeaways

1. Assess each facility against its own hazards, using staff and community knowledge alongside technical data.
2. Check the basics first: water, sanitation, hygiene, waste, energy and the building itself.
3. Fund operation and maintenance alongside every capital investment.
4. Assign clear responsibility at facility and district level, across departments.
5. Monitor a small set of indicators routinely and review them ahead of high-risk seasons.

None of these steps requires new technology. They require attention, modest recurrent funding and clarity about who is accountable, which is where most resilience is won or lost.