Climate Risks and Continuity of Essential Health Services: What Should Healthcare Leaders Assess First?
IMPLEMENTATION INSIGHTS
Climate Risks and Continuity of Essential Health Services: What Should Healthcare Leaders Assess First?
IMPLEMENTATION INSIGHTS · CLIMATE-RESILIENT HEALTHCARE
Last reviewed: October 22, 2026
Two healthcare facilities may receive the same severe weather warning but face very different risks. One may be located on higher ground yet depend on a single road for staff access, deliveries, and patient transfers. Another may have reliable road access but critical equipment in an area vulnerable to flooding. Both need to prepare, but their priorities will not be the same.
This illustrates why understanding climate-related risks requires more than identifying the hazards that might affect a hospital or clinic. Healthcare leaders also need to know how those hazards could disrupt patient care, how serious the consequences might be, and which weaknesses deserve attention first.
The challenge is particularly relevant in Viet Nam, where healthcare organizations operate under different geographical, environmental, and resource conditions. A coastal hospital, an urban outpatient clinic, and a healthcare facility serving a mountainous community may face very different combinations of hazards, infrastructure vulnerabilities, and barriers to accessing care.
Not every organization can address all potential risks at once. A useful initial assessment should therefore help leaders answer three practical questions: Which climate hazards are relevant to this facility? Which essential health services could be seriously affected? And which gaps should be addressed first?
These questions provide a starting point for strengthening climate resilience while maintaining safe, appropriate, and accessible care.
Which Climate Hazards Are Relevant to the Facility?
The first step is to understand which hazards could realistically affect the healthcare facility, its surrounding community, and the systems on which its services depend.
This requires looking beyond national descriptions of climate vulnerability. Viet Nam experiences typhoons, flooding, extreme heat, drought, saltwater intrusion, and other environmental pressures, but the significance of each hazard varies considerably by location.
A healthcare facility in a low-lying urban area may need to examine the effects of heavy rainfall and limited drainage capacity. An organization in a coastal or delta setting may face concerns related to flooding, water availability, or saltwater intrusion. Facilities in mountainous areas may need to consider severe rainfall, landslides, and restrictions on road access. Prolonged heat can create additional challenges in many locations, particularly where cooling systems, electricity supplies, or working conditions are already under pressure.
These examples illustrate possible differences in exposure rather than a fixed geographical risk classification. Actual risks depend on local conditions, facility characteristics, and existing protective measures.
An initial assessment can draw on previous disruptions, official weather and disaster warnings, local hazard information, infrastructure records, and observations from healthcare staff. Discussions with relevant authorities, utility providers, and neighboring healthcare organizations may also reveal concerns that are not immediately visible within the facility.
Past experience is useful, but it should not be the only basis for planning. A hospital that has never experienced a major disruption may still be vulnerable to future events. Changes in surrounding development, drainage, infrastructure, environmental conditions, or the characteristics of particular hazards can alter its exposure over time.
The presence of a hazard also needs to be distinguished from the consequences it could cause. Heavy rainfall does not affect every facility in the same way. Its impact depends on location, building design, external infrastructure, protective measures, and the ability to maintain essential functions.
For healthcare leaders, the question is therefore not simply whether flooding, extreme heat, or storms could occur. It is how those conditions might affect the facility's services and whether existing safeguards are sufficient.
Using the WHO Climate Vulnerability Checklists
The World Health Organization provides a useful starting point through its 2021 publication, Checklists to Assess Vulnerabilities in Health Care Facilities in the Context of Climate Change.
The publication was developed to help healthcare facility managers and health workers understand climate-related risks, establish a baseline of facility vulnerabilities, and identify areas where resilience may need to be strengthened.
WHO provides separate checklists for seven groups of hazards: floods, storms, sea-level rise, droughts, heatwaves, wildfires, and cold waves. This does not mean that every healthcare organization must assess all seven hazards in the same way. Facilities should first identify those relevant to their location and operating conditions.
The checklists examine four interconnected areas: the health workforce; water, sanitation, and healthcare waste; energy services; and infrastructure, technologies, products, and processes.
This structure is useful because preparedness in one area does not guarantee preparedness in another. A hospital building may remain functional during a storm, but staff may be unable to reach work. A backup generator may be available without having enough capacity to support critical services for the required period. Essential supplies may be stored safely but remain inaccessible if transportation or distribution arrangements fail.
The WHO checklists use qualitative vulnerability categories. High vulnerability indicates that the facility is unprepared or unable to respond adequately to the assessed concern. Medium vulnerability reflects basic or incomplete preparation and limited response capacity, while low vulnerability indicates stronger preparedness and response capability.
These categories can help organizations identify weaknesses that deserve closer examination. However, the findings should not automatically be combined into a single numerical resilience score or interpreted as evidence of compliance with Vietnamese regulations. The checklists are intended to support vulnerability assessment and improvement planning, not to establish a universal hospital certification system.
Local interpretation is essential. Some questions may need to be adapted to the facility's services, infrastructure, and resources. Hazards such as landslides, which may be significant in parts of Viet Nam but are not covered by a separate checklist in this WHO publication, may require additional assessment using appropriate technical resources.
The 2021 checklists complement WHO's Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities (2020) and its Operational Framework for Building Climate Resilient and Low Carbon Health Systems (2023).
For Climate & Health Vietnam, these resources provide an evidence-informed foundation for professional learning and organizational self-assessment. Their value lies in helping healthcare professionals examine vulnerabilities systematically while recognizing that appropriate decisions must reflect local conditions.
Which Essential Health Services Could Be Seriously Affected?
Once relevant hazards have been identified, the next question concerns the health services that could be disrupted.
A facility may experience an infrastructure problem without an immediate interruption to patient care. In other circumstances, a relatively limited operational disruption could have serious consequences if it affects a time-sensitive service or leaves patients without a safe alternative.
The practical task is to understand which services could be interrupted, how quickly an interruption might become clinically significant, and whether patients could continue receiving appropriate care through existing arrangements.
WHO's Health Service Continuity Planning for Public Health Emergencies: A Handbook for Health Facilities (2021) provides guidance for identifying and prioritizing health services, examining their dependencies, and developing continuity arrangements during public health emergencies. Although this is an interim handbook developed for that context, its principles can inform preparedness for other relevant emergencies, including climate-related disruptions, with appropriate adaptation.
An important consideration is that essential services cannot be defined solely through a universal list of hospital departments or medical specialties.
Emergency treatment, intensive care, urgent obstetric services, dialysis, and other time-sensitive interventions may require particular attention in facilities authorized to provide them. However, their relevance depends on each organization's scope of services, patient population, and clinical responsibilities.
In another setting, the greatest concern may involve access to essential medicines, continuity of treatment for chronic conditions, antenatal care, vaccination, or follow-up for patients who could deteriorate without timely attention.
The consequences of interruption also depend on duration. A short delay may be manageable for some activities but unacceptable for others. A service that can tolerate a brief interruption may become clinically important when the disruption continues for several days.
This is why service prioritization requires more than distinguishing emergency departments from nonemergency services. Healthcare organizations need to consider clinical urgency, potential harm from delay, the needs of the population served, and the availability of safe alternatives.
The circumstances of individual patients also matter. People with complex health conditions, limited mobility, dependence on medical equipment, or difficulty accessing alternative care may face greater challenges during disruptions. These vulnerabilities are not determined by age or diagnosis alone. Transportation, financial circumstances, social support, and communication barriers can influence whether someone can continue receiving necessary treatment.
Identifying essential services is not about declaring some patients more important than others. It is about understanding where interruptions could cause significant harm and making appropriate arrangements to protect access to care.
Prioritization also does not give an organization unrestricted discretion to suspend services or disregard its professional responsibilities. Decisions about modifying or interrupting care must remain consistent with clinical requirements, authorized service capabilities, patient rights, and applicable regulations.
Understanding What Essential Services Depend On
Identifying important services is only part of the assessment. Healthcare leaders also need to understand what those services depend on to remain safe and available.
An inpatient service may require electricity, safe water, medical gases, equipment, trained personnel, medicines, communication systems, and diagnostic support. An outpatient service may depend heavily on patient transportation, appointment systems, medicine availability, and timely referrals.
These dependencies frequently extend beyond the facility.
A hospital may have functioning equipment and sufficient staff but be unable to receive essential supplies because access roads are disrupted. A clinic may remain physically undamaged while patients cannot reach it. A referral arrangement may appear adequate under normal conditions but become difficult to use when neighboring healthcare facilities are affected by the same event.
These situations show why the continuity of care cannot always be assessed by examining the department providing a particular service. A service may be clinically essential but operationally dependent on resources managed by other departments or external organizations.
A useful assessment should identify which supporting functions are critical, whether alternatives exist, and what might happen if several dependencies fail at the same time. Leaders should also consider how long a service could remain safe and effective if a particular resource became unavailable.
The realistic limits of alternative arrangements deserve particular attention. The presence of another hospital nearby does not necessarily mean that patient transfer is feasible. The receiving facility must have appropriate capabilities and capacity, transportation must be safe and available, and necessary clinical information must accompany the patient. Communication and referral procedures must also meet relevant professional and regulatory requirements.
During a widespread emergency, several facilities may experience similar limitations. An alternative that is reliable during routine operations may become unavailable when multiple organizations require additional capacity simultaneously.
For this reason, continuity planning should distinguish between services that can continue safely at the original facility, services that may require temporary modification, and situations in which alternative care arrangements or transfers need to be considered.
These decisions should reflect patients' clinical needs, authorized service capabilities, and the conditions actually available, rather than assumptions about what other facilities might be able to provide.
Which Gaps Should Be Addressed First?
An initial vulnerability assessment may reveal many weaknesses. Some involve infrastructure, while others concern workforce availability, communication, supplies, or access to alternative healthcare services.
The difficulty is deciding where to begin.
A useful prioritization process considers the relevance of the hazard, the potential consequences for patients, the likelihood and duration of disruption where these can reasonably be estimated, the effectiveness of existing safeguards, and the availability of practical alternatives.
A relatively infrequent event may deserve early attention if it could cause serious harm and there is no reliable way to maintain the affected service. By contrast, a more frequent disruption may be manageable through safeguards that are already established and regularly tested.
This is why a numerical risk score should not determine priorities on its own. Risk ratings can support consistent discussion, but they cannot replace clinical judgment, technical assessment, or consideration of the consequences for patients.
Consider a facility that identifies several weaknesses during its initial review. One may involve an unclear communication arrangement when essential supplies are delayed. Another may concern a backup system whose operating capacity has not been verified. A third may require major infrastructure improvements that cannot be completed immediately.
These problems may all require attention, but they do not necessarily need the same response or timeframe.
A serious and immediate threat to patient safety may justify urgent action, including suitable interim safeguards while a longer-term solution is developed. Other improvements may be incorporated into maintenance plans, workforce development, infrastructure investment, or established organizational improvement activities.
Leaders should also consider whether one weakness could affect several services simultaneously. A shared dependency may deserve early attention when its failure could disrupt multiple clinical activities and no reliable alternative exists.
Resource constraints are an unavoidable part of decision-making. Smaller facilities and organizations with limited budgets may not be able to undertake major investments immediately. Nevertheless, affordability alone should not determine which risks are addressed. Potential consequences for patients and the adequacy of available safeguards remain essential considerations.
Where resources are insufficient to eliminate a significant risk, an organization may need further technical advice, temporary protective measures, coordination with external partners, or changes to service arrangements consistent with its responsibilities.
The most useful priorities are those that reflect the seriousness of the risk and provide a realistic path toward reducing it.
Making Decisions When Information Is Incomplete
Many healthcare organizations may not have detailed local climate projections, comprehensive infrastructure assessments, or complete records of previous disruptions.
This should not prevent them from beginning a preliminary assessment.
Useful information may already be available through local hazard records, official warnings, facility inspections, maintenance reports, operational experience, and the knowledge of clinical and technical staff.
The important distinction is between what is known, what is reasonably suspected, and what still needs to be verified.
Staff may report, for example, that access to a healthcare facility becomes difficult during prolonged rainfall. Their experience is valuable, but the frequency, severity, and consequences may require further investigation. A backup system may be recorded as available, while its actual capacity during a prolonged disruption remains uncertain.
Acknowledging these uncertainties helps leaders identify where further information, testing, or technical assessment would make the greatest difference.
Where possible, healthcare organizations should use information from competent meteorological, disaster management, environmental, and health authorities. Historical experience should be considered alongside credible information about changing environmental conditions and future hazards.
Findings should also be revisited when circumstances change. A major weather event, infrastructure modification, expansion of clinical services, change in patient demand, or new local hazard information may alter the organization's exposure and priorities.
An assessment is most useful when it informs decisions and is updated as new evidence becomes available. It should not become a document completed once and then left unchanged.
Applying the Approach in Viet Nam
Viet Nam's updated National Climate Change Adaptation Plan for 2021–2030, with a vision to 2050, was issued under Prime Ministerial Decision No. 1422/QD-TTg on November 19, 2024. It provides important national policy context for strengthening adaptive capacity, reducing climate-related vulnerability, and improving preparedness.
Healthcare organizations must also operate within the country's existing legal and professional framework.
The Law on Medical Examination and Treatment, Law No. 15/2023/QH15, effective January 1, 2024, provides the overarching legal framework for medical examination and treatment activities. Subsequent amendments are reflected in Consolidated Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026.
For hospitals, Ministry of Health Circular 19/2013/TT-BYT addresses healthcare quality management, while Circular 35/2024/TT-BYT, effective January 1, 2025, establishes basic hospital quality standards within its specified scope of application.
These instruments provide relevant context for organizational responsibilities and healthcare quality. They should not, however, be interpreted as automatically requiring every healthcare facility to use WHO's climate vulnerability checklists or obtain a separate climate resilience certification.
WHO guidance can support education, self-assessment, and improvement, but it does not replace Vietnamese legislation, applicable technical regulations, professional requirements, or the responsibilities associated with an organization's authorized services.
There is also relevant experience within Viet Nam.
From 2021 to 2023, WHO and Vietnamese partners supported pilot activities at three district hospitals to strengthen climate resilience and environmental sustainability. The work addressed four broad areas: water, sanitation, hygiene, and healthcare waste management; workforce capacity and awareness; energy efficiency and green energy; and improvements in infrastructure, technologies, and products.
WHO's December 2023 account highlighted the importance of practical improvements, collaboration, and approaches suited to local circumstances. The activities were intended to generate experience that could inform future guidance, rather than demonstrate that a single model was suitable for every healthcare facility.
In September 2026, WHO reported that Viet Nam was one of two countries selected to test 20 indicators related to climate resilience and greenhouse gas emissions in healthcare facilities. WHO Viet Nam and the Ministry of Health's Viet Nam Administration of Disease Prevention convened national and local stakeholders to review the global pilot, examine data availability, consider the practicality of the indicators, and identify opportunities for further capacity development.
These activities demonstrate growing attention to climate resilience within Viet Nam's healthcare system. They also highlight an important distinction: pilot activities and emerging measurement approaches can inform learning and improvement, but they should not be presented as evidence that a particular assessment model has already been validated or implemented across all healthcare facilities in the country.
For individual organizations, the appropriate starting point remains an understanding of their own hazards, services, dependencies, and existing safeguards.
A large hospital may require a detailed multidisciplinary assessment supported by clinical and technical expertise. A smaller facility may begin with a focused review of the hazards most relevant to its location and authorized services, expanding the assessment where significant concerns are identified.
Neither approach should be considered sufficient for every organization. The depth of assessment must reflect the risks involved, applicable requirements, and the potential consequences of service disruption.
From Initial Assessment to Practical Priorities
An initial climate risk assessment does not need to resolve every uncertainty or produce a comprehensive investment program.
Its immediate purpose is to help healthcare leaders understand which hazards are relevant, which services could experience serious disruption, and where existing safeguards may be insufficient.
The findings should be specific enough to guide the next decision. An organization may identify concerns requiring immediate attention, others needing further technical investigation, and longer-term improvements that should be considered through existing planning and investment processes.
These findings should connect with established emergency preparedness and service continuity arrangements rather than remain in a separate document. Significant concerns should be reviewed by appropriately qualified personnel, particularly where there is uncertainty about whether existing arrangements can support safe care.
Over time, assessments can improve through lessons from actual disruptions, practical exercises, staff experience, and new evidence. Starting with limited information is reasonable when uncertainties are acknowledged and important risks are not dismissed without adequate consideration.
For Climate & Health Vietnam, this is an area where credible evidence can support practical professional learning. Making international resources more accessible, explaining their relevance to Vietnamese healthcare settings, and encouraging collaboration across clinical, management, and technical disciplines can help healthcare organizations make more informed decisions.
WHO's vulnerability checklists provide a valuable foundation, but they cannot replace an understanding of the facility and the people it serves. Their greatest contribution is helping healthcare professionals recognize weaknesses that might otherwise remain overlooked and identify where further action is needed.
For healthcare leaders, the first assessment should not become an exercise in documenting every possible climate hazard. It should help determine where disruption could have the most serious consequences for patients and where timely, feasible improvements could make the greatest difference.
The most useful place to begin is where a relevant climate hazard, an essential health service, and an insufficient safeguard come together.
Selected References and Policy Context
International guidance
World Health Organization. Checklists to Assess Vulnerabilities in Health Care Facilities in the Context of Climate Change. 2021.
World Health Organization. WHO Guidance for Climate-Resilient and Environmentally Sustainable Health Care Facilities. 2020.
World Health Organization. Health Service Continuity Planning for Public Health Emergencies: A Handbook for Health Facilities. Interim version for field testing. 2021.
World Health Organization. Operational Framework for Building Climate Resilient and Low Carbon Health Systems. 2023.
World Health Organization. Safe, Climate-Resilient and Environmentally Sustainable Health Care Facilities: An Overview. 2024.
World Health Organization. Indicators of Climate Resilience and GHG Emissions in Health Systems. March 11, 2026.
Selected Viet Nam evidence and experience
World Health Organization. Viet Nam: Learning Lessons on Climate Resilient and Environmentally Sustainable Health-Care Facilities. December 22, 2023.
World Health Organization. Donors Making a Difference: WHO and Partners Help Make Progress Towards a Safer and Healthier Viet Nam. September 10, 2026.
Viet Nam policy and regulatory context
Prime Minister. Decision No. 1422/QD-TTg, dated November 19, 2024, issuing the updated National Climate Change Adaptation Plan for 2021–2030, with a vision to 2050.
National Assembly. Law on Medical Examination and Treatment No. 15/2023/QH15, effective January 1, 2024, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026.
Ministry of Health. Circular 19/2013/TT-BYT on healthcare quality management in hospitals.
Ministry of Health. Circular 35/2024/TT-BYT on basic quality standards for hospitals, effective January 1, 2025.
Professional scope: This article is intended for professional education, evidence synthesis, and knowledge sharing. It does not constitute legal advice, clinical practice guidance, a facility-specific climate vulnerability assessment, regulatory approval, or accreditation or certification criteria. References to WHO publications do not imply WHO endorsement of Climate & Health Vietnam. Healthcare organizations should interpret international guidance in accordance with applicable Vietnamese regulations, relevant technical requirements, their authorized scope of services, and their own clinical and operational circumstances.