Exploring barriers and facilitators to integrating health equity into health and climate change policies in Nepal - a qualitative study among federal level stakeholders.

backgroundHealth is foundational for climate action, and integrating climate and health policies to achieve health equity is widely recognized. While there is a growing global momentum for collaborative health and climate initiatives, more effort is needed to incorporate health equity into national climate policies. Achieving this necessitates identifying both barriers and facilitators of integrated policymaking. This study examines the barriers and facilitators to integrating health equity into climate change-related policies at Nepal's federal level.

methodsWe interviewed 14 key stakeholders from three major federal ministries, a high-level government entity, and a government partner institution in Nepal, all with diverse roles and responsibilities. To facilitate discussions, we developed an interview guide informed by two policy analysis frameworks: Health Equity Policy Process Analysis Framework and Schlossberg's Framework of Environmental Justice. Using both inductive and deductive approaches, we identified five key facilitators and four major barriers to integrating health equity in climate change-related policies in Nepal. We present these barriers in relation to WHO's climate-resilient health systems framework.

resultsA wide array of facilitators was identified, broadly categorized as a) acknowledgement of the need to integrate health equity in climate change policies, b) political leadership, c) global influences, d) established mechanisms and structures in place for collaboration and e) the federal structure. Barriers identified were largely systemic and encompassed a) knowledge gaps, b) ownership and accountability, c) resource constraints: human resources and budget and d) data limitations. Among these, the issue of ownership and accountability emerged as an overarching theme, cutting across all barriers. Similarly, financing and knowledge gaps were identified as significant obstacles to progress.

conclusionsThe findings underscore the need for a more structured approach, with clearly delineated responsibilities to ensure all relevant sectors contribute to the goal of health equity in climate action. Developing well-defined guidelines outlining the roles and responsibilities of different sectors involved in climate action is crucial for fostering ownership and ensuring that health equity is effectively integrated into climate change policies, as well as aiding in resource allocation. We recommend future research to explore the potential role of policy champions within ministries in advocating for and advancing health equity within climate change-related policies.