Thesis Project



Building climate-smart local health systems in the developing world: Lessons from the Philippines



Climate change has recently been considered an emerging critical concern for health systems worldwide. International organizations have developed frameworks and started initiatives to help strengthen health systems in both mitigating and adapting to climate change, i.e. in becoming ‘climate-smart.’ Unfortunately, over the past decade, there has been a failure to streamline, sustain, and scale up (3s) existing climate and health pilot projects especially in developing countries. Moreover, proposed frameworks have only been applied mostly at the national level, and their usefulness to inform actions at the local level is still yet to be examined. Understanding how frontline local health systems can be made ‘climate-smart’ and testing some local activities and strategies may help address this delivery gap.



This doctoral thesis, also called Doctoral Engagement in Leadership and Translation for Action (DELTA) Project, aims to:

  • Develop a framework for assessing and designing ‘climate-smart’ local health systems in the Philippines and consider its potential applications to other developing countries
  • Investigate current practices, gaps, challenges, and opportunities in ‘climate-smart’ responses of local health systems in selected municipalities in the Philippines
  • Identify strategies and opportunities for building ‘climate-smart’ local health systems in the Philippines at the local, national, and international levels


Specific Research Questions

  • What does it mean for a health system to be ‘climate-smart’? Is it the right construct to describe health system response to climate change (both adaptation and mitigation)? Are proposed frameworks reflective of and useful for local contexts? What features are unique to the local setting? What elements are missing in the frameworks?
  • When it comes to ‘climate-smart’ local health systems, what do we mean by a ‘local health system’? What are its goals, functions, responsibilities, processes, boundaries, capacities, and assets? Who are the actors in a local health system? How do all of these health system elements align with the goal of being ‘climate-smart’?
  • What are the climate and health challenges being faced by local health systems? How are these problems identified and diagnosed? Which of these problems are solvable by the local health system, and which ones are beyond their jurisdiction and capacity and therefore requires external help?
  • What is already happening in local health systems in the Philippines when it comes to becoming ‘climate-smart’ (both mitigation and adaptation)? What are the existing good practices, if any? What are the gaps, challenges, and opportunities?
  • How can ‘climate-smartness’ of local health systems be built? Does it entail deliberate and concrete interventions or more subtle activities akin to autonomous adaptation? Are traditional health system strengthening activities and approaches (i.e. training, checklists, planning) still the proper way to achieve this goal?



This DELTA Project adopts a multiple case study design, following widely-used case study research methodology as proposed by Yin. The unit of analysis will be the ‘local health system.’ As a starting point, ‘local health system’ will refer to a municipality, which is the smallest autonomous political unit in the Philippines. However, the boundaries of the system will be consistently interrogated throughout the project to also consider smaller (i.e. barangay) or larger (i.e. district, province, region) units.


In addition to the case study approach, the DELTA Project will also adopt the Problem-Driven Iterative Adaptation (PDIA) Approach as a way of ‘muddling through’ the Philippine health system and exploring strategies and opportunities for dissemination, adoption, implementation, and scale up. Examples of activities include one-on-one meetings, oral presentations, attendance in official meetings, field observations, among others. Reflections and findings will be carefully documented.


DrPH Doctoral Project Committee


Prof. Peter Berman (chair) is Professor of the Practice of Global Health Systems and Economics at the Harvard T.H. Chan School of Public Health. A former lead health economist of the World Bank, he is a world-respected scholar and practitioner in health systems strengthening and reform with more than forty years of experience in research, teaching, and practice.


Prof. Jesse Keenan is Lecturer in Architecture at the Harvard University Graduate School of Design, where he teaches courses and conducts research in the fields of urban development and climate adaptation. He has previously advised on matters concerning real estate, investment and the environment for agencies of the U.S. Government, Fortune 500 Companies, not-for-profit community enterprises and international development NGOs.


Prof. Michael Woolcock is a Lecturer in Public Policy at the Harvard Kennedy School of Government and concurrently Lead Social Development Specialist with the World Bank's Development Research Group in Washington, D.C. Together with Professors Matt Andrews and Lant Pritchett, he co-developed the Problem-Driven Iterative Adaptation (PDIA) approach at the Harvard Kennedy School’s Center for International Development.