Greening Health Systems: Lao PDR’s Path to Climate-Ready and Inclusive Primary Care

The Community Resilience Partnership Program Project Brief No. 3, released by the Asian Development Bank (ADB) in October 2025, details the Green Primary Care Project in the Lao People's Democratic Republic (Lao PDR). Developed with the Asian Development Bank Institute, the International Institute for Environment and Development (IIED), the Agence Française de Développement (AFD), and the Nordic Development Fund (NDF), the project showcases how traditional ecological knowledge (TEK) and community-based resilience strategies can transform primary health care into a system that is climate-resilient, inclusive, and gender-responsive. Led by Alexo Esperato Martinez, Senior Health Specialist at ADB, the initiative comes as Lao PDR faces severe climate impacts, extreme heat, floods, droughts, and landslides, which threaten lives and destroy health infrastructure. Ranked 92nd in the 2022 Climate Risk Index and 140th in the ND-GAIN Country Index, the country suffers from limited resources, untrained health workers, and poor infrastructure, with one-fourth of its 1,232 health facilities lacking clean water and electricity. These challenges have intensified the spread of malaria, dengue, and diarrheal diseases, while also worsening malnutrition among vulnerable communities.

A Vision Rooted in Equity and Adaptation

The Green Primary Care Project aligns with the government's Health Sector National Adaptation Plan (H-NAP) and Health Sector Reform Strategy (2021–2030), designed to help the nation achieve universal health coverage by 2025. Supported by the Community Resilience Partnership Program Trust Fund (CRPPTF), the project integrates a climate equity lens into primary health care, the foundation of the country's health system. Extensive consultations in the five most climate-affected provinces, Champasak, Louangphabang, Oudomxay, Savannakhet, and Xiangkhouang, revealed urgent community needs for climate-resilient health centers, improved early warning systems, and localized communication in minority languages. To close the gap between the Ministry of Health and communities, the project partnered with the Lao Front for National Development (LFND), a nationwide organization with deep roots at the village level. This partnership is central to building local climate ambassadors and empowering village health committees to drive climate adaptation and strengthen public awareness.

Traditional Ecological Knowledge at the Core

One of the project's defining features is its systematic use of traditional ecological knowledge, a body of indigenous practices involving water management, herbal medicine, and food preservation that can directly mitigate health risks linked to climate change. By embedding TEK into health policy, training, and research, the project bridges traditional wisdom and modern health systems. The CRPPTF allocated $100,000 for initial climate documentation and institutional capacity building, followed by $1 million in technical assistance to expand the research and training components. This assistance focuses on three areas: establishing a national research agenda on TEK and nature-based health solutions; training healthcare workers through pre-service and in-service programs on climate-related diseases and emergency preparedness; and improving community readiness through mobile-based early warning systems and gender-sensitive training in climate resilience.

Financing and Community Impact

ADB has supported the Green Primary Care Project with a $10 million grant from the Asian Development Fund and a $30 million concessional loan to implement programs across 51 districts in five provinces. The project will directly benefit 2.5 million people, half of them ethnic minorities reliant on public health care. It aims to ensure that 80% of health facilities have disaster management plans, that community adaptation measures are implemented in 70 villages, and that 18 health facilities (nine hospitals and nine centers) are upgraded with climate-smart, gender-responsive designs. Over 200 primary care workers will be trained in managing climate-induced conditions, 40 medical scholarships will be awarded, half to women, and 50 community water systems will be restored. By merging infrastructure improvement with social inclusion, the project promotes both environmental and social resilience, ensuring that climate adaptation begins with the people most affected by its consequences.

Women at the Heart of Climate Resilience

The project's gender strategy tackles deep-rooted inequalities that make women more vulnerable to climate impacts. It recognizes that maternal and child health risks increase during heatwaves and food shortages, while limited access to healthcare and the prevalence of gender-based violence (GBV) compound their vulnerability. To address this, the project includes GBV response protocols in primary care manuals, trains health committees in 70 villages on women's health and the gendered effects of climate change, and forms networks of female climate and health ambassadors to lead community outreach. Health centers are being redesigned to include private spaces for gender-sensitive services, while women receive scholarships in family medicine to enhance leadership in healthcare. These interventions not only strengthen community resilience but also advance gender equality in the health system.

From Local Wisdom to National Policy

The Green Primary Care Project represents a model of how research, policy, and indigenous knowledge can converge to create sustainable climate solutions. Through the CRPP, Lao PDR has developed a "research-to-policy" system where TEK and nature-based insights directly inform national health strategies, from early warning systems to climate curricula. As Alexo Esperato Martinez notes, this approach enables the project to "incorporate Indigenous ecological knowledge and nature-based solutions into major interventions such as policy reforms, workforce training, and early warning systems." Ultimately, the initiative reflects a shift from reactive disaster response to proactive community adaptation, from top-down planning to grassroots empowerment, and from conventional health care to holistic climate resilience. It stands as a blueprint for other developing nations, showing that by valuing local wisdom and inclusion, even the most vulnerable communities can build a healthier, more sustainable future.