1.   Project Title	
Climate Change Resilience: Disaster Risk Management and Renewable Energy. Economic, Environmental and Health Impact in Georgia
	
2.  EU assistance tool

	
Twinning	
3.  Beneficiary Administration	
•	The name of the institution;
- Ministry of Internally displaced persons from the occupied territories, Labour, Health and Social Affairs of Georgia (MoIDPLHSA)
- L. Sakvarelidze National Center for Disease Control and Public Health (NCDC) (implemental body):

•	General structure, number of employees; Please attach the chart of the institution;
General structure-please see below Annex 1.
Total Number of employees, including regional centers 302.

•	The mandate of the institution;
NCDC is a Legal Entity of Public Law accountable to the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia, and its operation is mostly funded from the state budget allocations. The center is a leading organization in the implementation of communicable and non-communicable disease prevention and control at the national level. It develops national standards, guiding recommendations (guidelines), promotes the improvement of public health, sets up public health priorities and participates in the development of public health policy, carries out epidemiological surveillance, immunization program, performs laboratory diagnostic and surveillance activities, conducts epidemiological studies, provides consultations and responds to public health emergencies.  In order to monitor public health and support relevant policy development, NCDC produces health statistics.

Strategic Goals and Objectives
- Decrease of morbidity, disability and mortality caused by Communicable Diseases.
- Decrease of morbidity, disability and mortality caused by non-communicable Diseases
- Assessment and correction of environment hazards and behavioral risk-factors for improvement of health status in population Applied and fundamental bio-medical and bio-technological research 

  Major fields of NCDC&PH activities
1.    Public Health State Programs:
Immunization, Safe blood, TB, HIV/AIDS, Screening, Surveillance, Mother and Child Health, Occupational Health.
2.    Communicable Diseases Surveillance
Vaccine-preventable; influenza; air; water; food, and vector-borne; nosocomial; parasitic; zoonotic; especially dangerous pathogens; viral hepatitis; STI/HIV; TB
3.    Non-communicable Diseases Surveillance;
Cardiovascular, cancer, diabetes, CRDs,  risk-factors,
Health promotion, behavioral health
4.    Environmental Health
5.    Medical Statistics
6.    Public Health Laboratories and their network coverage: 3ZDLs, 7LSSs and 1 Reference Laboratory – the R. Lugar Center

•	- number of the staff that could be involved in the project preparation/ implementation process
Ministry of Environmental Protection  and Agriculture of Georgia (MoEPA) and National Environment Agency (NEA), NCDC’s Non-communicable Department, Environmental Health Department, Public Health State Programs Central and Regional Management Department. The number of involved staff in the project preparation/implementation process will be 40 persons.
	
4.  Background Information and Justification	
Environmental protection and its impact on health have become an increasing priority for the Government of Georgia. As a result of strengthening efforts in this direction the “National Environment and Health Action Plan for 2018-2022 (NEHAP2)” has been approved by the Decree N680 of the Government on December 29 2018. The main principle of NEHAP is to realize fundamental right of the people - to live in a safe environment, respectively the responsibility for the implementation of the Action Plan falls under healthcare and environmental sectors together with the respective line ministries from the sectors of Economy, Justice, Agriculture, Education, Finance, Infrastructure, Foreign affairs and Local Administrations.  

Analyzing the environmental health policy situation in Georgia in relation to selected Parma and Ostrava Declarations commitments,  follow up action in  short and long term perspective to support  NEHAP implementation in coming years, put of focus on next NEHAP 5 Strategic objectives (SO):
1. Improve access to safe water and sanitation, including for each child.
2. Improve access to healthy and safe environment for Children and Youth to ensure their increased physical activity
3. The impact of ambient and indoor air pollution on human health assessed and implemented measures to reduce the harmful effects
4. Prevention of morbidity caused by exposure to chemical substances.
5. Integration of health issues in climate change adaptation and mitigation policy.
Currently, there is an urgent need to direct coordinated actions to overcome the lack of inadequate methodologies, legislation and procedures, laboratory capabilities in Georgia, as well as human and financial resources, challenging an assessment of environmental risk factors’ impact on human health properly. 

Climate Change is "the greatest threat to global health in the 21st century". Climate change can impact security and, in general, quality of life in a number of ways. The increasing frequency of climate-induced extreme weather events and disasters can aggravate political instability and put livelihoods at risk. Also. Air pollution and climate change are closely related. The main sources of CO2 emissions are not only key drivers of climate change, but also major sources of air pollutants. Furthermore, many air pollutants that are harmful to human health and ecosystems. If on the one hand, the increase in temperatures and the increasingly frequent extreme events have a direct impact on human health, on the other they act indirectly on the determinants of health. The latter is the set of conditions finely regulated by economic, political and social systems that influence not only the mere presence/absence of disease but also the state of physical, mental and social well-being of the individual.

The COP21 Paris Climate Agreement has set the high ambition to keep the average warming of the Earth well below 2 ̊C, and even to 1.5 ̊C. Across such immediate and short-term timescales, policymakers at the governmental level and strategic decision-makers in corporations have to make difficult choices. While keeping their focus on the long-term growth of the economies, the well-being of populations and the continuity of businesses, decisions are required to improve and adapt the resilience of the society to climate change and variability. On the other hand, the COP25 of Madrid 2019 which had the aim of moving from commitment to concrete action, did not achieve the desired results. The CO2 emission cutting targets that each country should have adopted by the next COP26 scheduled in Glasgow have not been defined, and no solution has been found for the application of art.

It is necessary to work on the effects of climate changes and their consequences on public health It should be noted that in Georgia the climate change impact on human health, on vulnerable groups as well as the readiness of medical institutions and response aspects have not been assessed yet. Neither adaptation to the impact of climate changes on human health nor the impact mitigation on local level have been assessed.

“Environmental Education for Sustainable Development”, promoting social dialogue and social inclusion, lifelong learning could be intended as the key to growth and jobs. The declaration, adopted at the Sixth Ministerial Conference on Environment and Health in Ostrava (2017, Czech Republic) aims to protect and promote the health and well-being of populations from environmental impacts, to consider equity, social inclusion and gender equality in our environment and health policies, to promote sustainable health and productive health benefits, a transition from fossil fuels to renewable energy. 
	
All the activities shall be directed towards the improvement of living conditions and reduction of harmful environmental impacts on health, education of adults and children towards a fossil-free energy and sustainable development. At the project level, sustainability of the Twinning, results will be guaranteed by ensuring that all procedures, management practices and tools, are embedded in the work routine of the National Environmental Agency, in collaboration with NCDC and all stakeholder institutions.

Climate change is clearly reflected on human health. In this context, the adaptation of the population to climate change plays an important role. In many cases, the adaptation process is very difficult. Climate change results in enlargement of the geographical area of the spread of diseases. According to the WHO data, three major characteristics, including heat waves, natural disasters and altered infectious background of climate change have particular health impacts. 

Climate change in Georgia, the signs of climate change have been observed since the 60s of the 20th century. The picture varies for different regions of the country. Georgia’s Second National Communication (SNC) to The United Nations Framework Convention on Climate Change (UNFCCC) describes trends of change in the climatic parameters for two periods - 1955-1970 and 1990-2005.

In 2012-2013, International Committee of the Red Cross (ICRC) Georgia carried out the pilot study on thermal waves, which led to the development of the National Thermal Wave Action Plan. It is important for Georgia, in accordance with the decision of the WHO 61st Assembly held in 2008 (to protect health of the population from the harmful effects of climate change, develop and implement an Action Plan for WHO member states), to elaborate the Action Plan, taking into consideration the following priority directions: to promote health systems to strengthen and enhance their capabilities of assessment and monitoring of health vulnerabilities; to determine climate change attributable risks and health impacts in order to protect human health and first of all, the most vulnerable groups of the population; to develop and implement relevant strategies and actions and to spread and share knowledge and good practices.

As declared in the last G7 of Milan Health Minister’ communication, “there is a need to raise public and professional awareness through information and sharing on the impact of climate and environmental-related factors on health, and on the co-benefits to the health of actions aimed at increasing resilience and addressing environmental degradation”.

The Rome International Charter on Health and Climate Change, from 27 countries on December 5, 2018 during the first Scientific Symposium on Health and Climate Change, states that climate change "already kills on a large scale and will increasingly affect in the future especially children and more fragile people ". The Charter identifies key actions that will need to be activated to secure a future for the planet and humans.

According to the relevant articles Association Agreement (AA) concluded between the EU and Georgia(Art. 348, 355, 358, 359), specific emphasis has to be put on starting preparation for the adoption and implementation of national legislation, “Environment, Climate Change and Public Health”. 	
5.   Project Purpose	
For the legislation approximation and implementation of the EU best practices, the project purposes are as follows:
•	To Develop National Health Care Adaptation Strategy and Action Plan, as well as the Heat Waves Action Plan.
•	To raise awareness of the health impacts of climate changes promoting actions that reduce carbon emissions, identify opportunities for economic co-benefits from climate mitigation actions and track current policy responses at the national level.
•	To raise awareness of the health impacts of climate change, support evidence-based decision making to strengthen the climate resilience of health systems, and promote actions that improve health while reducing carbon emissions, identify opportunities for health co-benefits from climate change mitigation actions and track current policy responses at the national level.	
•	To raise awareness of the environmental and health impacts of air pollution, support evidence-based decision making to strengthen the air quality policies and promote actions that improve health while reducing emissions in the air of pollutants, identify opportunities for health, environment and economic co-benefits from climate actions and track current policy responses at the national level.
•	To promote awareness and education initiatives on environmental sustainability and social equity, on quality of growth, on active citizenship and on school-based relationships can be considered as non-technical air quality measures and, at the same time, resilience measures for climate change.
•	To encourage the implementation of the use of geothermal waters, solar energy, wind, biomass and other alternative renewable sources for domestic and/or district heating, agricultural and industrial applications.
•	To strengthen the development and adoption of a national strategy on disaster risk management (DRM) complemented by a relevant national action plan taking into account disaster risk reduction and climate change adaptation measures, in compliance with national commitments and international instruments recognized by Georgia, especially the Hyogo Framework for Action (HFA).
•	To encourage the use of best practices in water for irrigation and the implementation of thermal resistance of buildings to heat losses in Georgia that are important measures to reduce carbon emission and, at the same time, are resilience measures for climate change.
•	To encourage the implementation of pilot projects funded by donors devoted to the use of low carbon technology in public (medical or educational) institutions.
•	To provide and disseminate information from EU Member States’ Best Practices, the threats that air pollution and climate change will present to human health, on opportunities to promote health while cutting emissions (carbon, but not only), on social dialogue and inclusion that are a key for sustainable growth.
•	To implement activities identified under the chapters “Environment”, “Climate Change”, “Public Health”, “Education, Training and Youth” of the Association Agreement (AA).
	
6.   Expected Results	
•	Georgian legal and regulatory framework is assessed in-line with the provisions of the relevant Annexes of the Association Agreement related to the climate changes, adaptation, resilience and prevention of risk due to climate events affecting public health; the legislation with regard to the requirements of the UNFCC Convention and assessment of health outcomes is assessed. 
•	To set up a surveillance system to identify and analyze emerging risks, and to promote the use of evidence-based meteorological and climatic early warning systems by forecasting health impacts and risks. This system, based on an air quality modelling system, is the core of the system and it’s necessary for supporting any strategically measures.
•	Strengthening and drafting of a national strategy on disaster risk management (DRM) complemented by a national action plan taking into account disaster risk reduction and climate change adaptation measures.
•	Strengthening of a Sustainable Development Educational System to create citizens and leaders aware of the growth of the country and wellbeing of the citizens within the planet’s ecological limits.
•	Strengthening of capacity of the Environmental Health Department under the NCDC, Human Resources (including Management and Decision Makers) in collaboration with National Environmental Agency in training the trainers for fulfil requirement of the new Educational System in Compliance with EU Best Practices in relation to Environment, particularly focusing on air quality, and Climate Change, particularly focusing on adaptation, resilience and prevention of risk.
•	Strengthening of institutional capacity of the National Environmental Agency, in collaboration with the Environment and Health Department under the NCDC, in line with build the capacity of realize future scenarios supporting policy decisions able to take measures trigging co-benefit in air quality and climate changes and able to assess the relative risk involving all parties and authorities concerned.

•	Institutional capacity of the NCDC is strengthened, in line with future scenarios due to the climate changes and related risk management with the involvement of all parties and authorities concerned.
•	To set up a surveillance system to identify and analyze emerging risks, and to promote the use of evidence-based meteorological and climatic early warning systems by forecasting health impacts 
•	
	
•	Involvement of sub-national institutions and administrations in the construction and application of policies to combat climate change (also through their direct involvement in the international context through the signing of Under2Coalition by the most important institutions e.g. metropolitan areas).
•	Support to the most vulnerable sections of the population (children, the elderly, and patients with chronic diseases) in relation to the effects of climate change.
•	The National Health Care Adaptation Strategy and Action Plan, among them, for medical facilities is developed
•	The Heat Waves Action Plan is developed
•	The  education concept document able to provide the knowledge, skills and tools needed to design and deliver training programs in different productive and relational contexts is developed.
•	
	
7.  Key Activities	
The activities on integration of health issues in climate change adaptation and mitigation policies, not only be valuable for the health sector, but for environment too. These activities may include:
•	Develop/update construction guidelines and other relevant technical documents considering climate change conditions, enhance monitoring systems to allow further modelling of climate change implications for health impact.
•	Strengthen a surveillance system, able to identify and analyze emerging risks using the output of the evidence-based meteorological and climatic early warning systems by forecasting health impacts and risks, supporting a disaster risk management system.
•	Develop National Modelling Center able to run a state-of-the-art 3D modelling system, fed by the most possible accurate and up-to-date available information concerning emission sources, the geography of the area, meteorology, and background air quality and any other related environmental events.
•	Set up of the modelling system, implemented in operational mode, running autonomously on a daily cycle, providing air quality and climate forecasts over Georgia. Its results, summarized at the end of each year, will also allow performing a periodic country-wide air quality assessment complementing what available from fixed and mobile monitoring activities.
•	Realization of some scenarios that assess different sets of measures to improve the air quality and reduce the carbon footprint of Georgia; including legislative, economic and health impact assessment of the single scenarios, including the assessment of climate policies.
•	Enhance emergency response against extreme climate events and natural hazards and strengthen disaster preparedness and prevention, integrate climate change considerations into the health care system.
•	Establish functional response protocols to air pollution or climate-induced environmental or health emergencies.
•	Implement disaster risk prevention and preparedness measures including for flooding, drought and forest fires.
•	Drafting an Institutional Implementation Plan for the Environmental Health Department under the National Center for Disease Control and Public Health, to strengthen the necessary response due to the climate change consequences.
•	Evaluate the vulnerability to climate change, health impacts and adaptation (health care aspects),
That should include itself the assessment of current and future risks of climate change on population health.
•	Promote a conscious, responsible and effective transfer of scientific data between institutions on data on climate changes, environmental pressures, wellbeing and social conditions and mutual effects among stakeholders for the promotion of global and local health and well-being and the reduction of vulnerability.

	
Reduce the share of greenhouse gas emissions in national emissions by Health care facilities, which may include:
•	Determination of the share of greenhouse-gas emissions from the medical institutions, in the country's general emissions
•	 Detailed analysis of energy efficiency in the health system and the assessment of hospital safety
•	Introduction of the use of the renewable energy, within the frameworks of the pilot project, in several hospitals of Georgia. 

	
8.   Tentative start of the project:	
September 2020	

9.  Contact Details	
Contact person (Official) Responsible for political steering of the project (at Deputy Minister’s level)	
Name, Surname:	
Tamar Gabunia	
	Position:	First Deputy Minister of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia	
	Address:	Address: 144, Ak. Tsereteli Ave. Tbilisi, Georgia, 0119	
	Tel:	Phone: ( +032 ) 2 51 00 27 
	
	E-mail:	 tgabunia@moh.gov.ge
	
Contact person
Technical detail; to ensure	Name, Surname:	Nino Giuashvili	
the day to day management of the project	Position:	Adviser 
National Center for Disease Control and  Public Health  of Georgia	
	Address:	 99 Kakheti Highway, 0198 Tbilisi Georgia	
	Tel:	  +995 595 49 19 91	
	E-mail:	  ngiuashvili@gmail.com	
Date of Application:	 25.02.2020		

Annex 1. 

DEPUTY DIRECTOR GENERAL IN RESEARCH

LUGAR CENTER FOR BUPLIC HELATH RESEARCH

BIO SECURITY AND ESPECIALLY
DANGEROUS PATHOGENS DEPARTMENT

BIOSAFETY DIVISION

NATIONAL REPOSITORYESPECIALLY

ESPECIALLY DANGEROUS PATHOGENS LAB

ZOO-ENTOMOLOGY LAB

GENERAL BACTERIOLOGY LAB

VIVARIUM

ANALYSUS RECEIVING AND PROCESSING GROUP

VIROLOGY AND MOLECULAR BIOLOGY DIVISION

MOLECULAR EPIDEMIOLOGY LABORATORY

COMMUNICABLE DISEASES DEPARTMENT

INFLUENZA AND OTHER
RESPIRATORY VIRUSES LABORATORY

HIV/AIDS, TB, STI AND HEPATITIS DIVISION

POLIOMYELITIS AND OTHER ENTEROVIRUSES LABORATORY

VACCINE PREVENTABLE,
RESPIRATORY AND ZOONOTIC DISEASES DIVISION

TISSUE CULTURE LABORATORY

ALIMENTARY, NOSOCOMIAL AND PARASITIC DISEASES DIVISION

SEROLOGY LABORATORY

IMMUNIZATION DIVISION

VACCINES EXPEDITION AND COLD CHAIN DIVISION

ONE HEALTH DIVISION

DEPUTY DIRECTOR GENERAL

ADMINISTRATIVE DEPARTMENT

HUMAN RESOURCES
MANAGEMENT and Professional Development Division

LEGAL DIVISION

INFORMATION TECHNOLOGY DIVISION

TECHNICAL SUPPORT DIVISION

FINANCIAL ECONOMIC DEPARTMENT

FINANCE DIVISION

PROCUREMENT DIVISION

ACCOUNTING DIVISION

LOGISTICS DIVISION

QUALITY CONTROL DIVISION

DEPUTY DIRECTOR GENERAL

THE GLOBAL FUND HIV/AIDS AND TB PROGRAM IMPLEMENTATION UNIT

NON-COMMUNICABLE DISEASES DEPARTMENT

CHRONIC DISEASES AND TRAUMATISM DIVISION

MATERIAL AND CHILD HEALTH DIVISION

HEALTH PROMOTION DIVISION

ENVIRONMENTAL HEALTH DEPARTMENT

ENVIRONMENTAL RISK-FACTORS
ASSESSMENT AND MONITORING DIVISION

DEPUTY DIRECTOR GENERAL

PUBLIC HEALTH STATE PROGRAMS CENTRAL and REGIONAL MANAGEMENT DEPARTMENT

PROGRAMS MANAGEMENT DIVISION

REPORTING DIVISION

MERETI DIVISION (ZDL)

ADJARA DIVISION (ZDL)

POTI UNIT (LSS)

SAMEGRELO-ZEMO SVANETI UNIT (LSS)

RACHA-LECHKHUMI-KVEMO SVANETI UNIT (LSS)

MEDICAL STATISTICS DEPARTMENT

SAMTSKHE-JAVAKHETI UNIT (LSS)

NON-COMMUNICABLE DISEASES AND
HEALTHCARE RESOURCES UTILIZATION STATISTICS DIVISION

KAKHETI UNIT (LSS)

DATA ANALYSIS AND REPORTING DIVISION

GURIA UNIT (LSS)

POPULATION REGISTRIES DIVISION

SHIDA KARTLI UNIT (LSS)

INTERNATIONAL AND
PUBLICRELATIONS DIVISION

GENERAL  DIRECTOR	
		
PREPAREDNESS AND RESPONSE TO PUBLIC HEALTH RISKS DIVISION