As stated by the ADB, the Brunei Darussalam-Indonesia-Malaysia-Philippines East ASEAN Growth Area (BIMP-EAGA) is a regional cooperation initiative to reduce disparities across and within its member countries. Among its five strategic pillars is the environment pillar, which emphasizes sustainable approaches with two of four strategic priorities addressing climate change: (i) adaptation and mitigation efforts and (ii) promotion of clean and green technologies.

The environment pillar promotes sustainable development through climate change adaptation and mitigation, clean and green technologies, and environmentally responsible practices. It is implemented through the BIMP-EAGA Environment Cluster, 1 of 12 clusters that translate regional priorities into action. Leadership rotates among its member countries every 3 years.

PROJECT RATIONALE AND LINKAGE TO COUNTRY/REGIONAL STRATEGY

Indonesia, Malaysia, and the Philippines face growing climate-related threats. Environmental changes' driven by deforestation, palm oil expansion, and mining, have increased the risk of zoonotic diseases. Disasters, including typhoons, frequently disrupt health service delivery. The United Nations' Intergovernmental Panel on Climate Change (IPCC) reports that climate change has adversely impacted water security, food production, infrastructure, health, and well-being. All three countries face rising rates of noncommunicable diseases, a resurgence of infectious diseases, and health issues related to aging.

Health care contributes 4%-5% of global greenhouse gas emissions, underscoring the need for low-carbon, climate-resilient health systems. Such systems are crucial for responding to climate-related shocks that increasingly threaten population health. The World Health Organization (WHO) projects 250,000 additional climate-related deaths each year and $2 billion-$4 billion in direct damages to health systems from 2030-2050. Reducing the carbon footprint of health facilities is critical for sustainable and resilient health system operations.

Sarawak. In 2021, Malaysia's constitution was amended to reflect the special status of the states of Sarawak and Sabah, safeguarding measures such as the independence of the Sarawak High Court, which distinguishes Sarawak from the less autonomous peninsular states. In 2023, Malaysia's government granted Sarawak autonomy over health and education. The Sarawak Ministry of Public Health, Housing, and Local Government oversees multiple agencies, including the Sarawak State Health Department. Three-quarters of Sarawak's 271 health facilities are in poor condition, and frequent coastal flooding cuts off access to essential services. Sarawak has about 3,000 hospital beds, almost 1,000 of which are in Sarawak General Hospital (SGH) in Kuching.

Kalimantan. Indonesia's largest region plays a strategic role in national development. Under the decentralized health system, the five provincial governments are responsible for local health-care services. The Ministry of Health oversees national policies, and regional health agencies manage public hospitals and community centers. In Central Kalimantan, 80% of hospitals have 24-hour access to electricity and clean water. Deforestation and peatland degradation contribute to transboundary haze and worsening rates of respiratory diseases.

Mindanao. Zamboanga Peninsula, in western Mindanao, traversed by the Philippine Fault Zone and the site of one of the world's largest earthquakes, faces frequent severe weather that disrupts agriculture, food security, and nutrition. Rural communities have limited health services, under-resourced facilities, and shortages of health workers'challenges that worsened during public health emergencies. Urban areas, including Zamboanga City, contend with inadequate drainage and flood-prone informal settlements. Strengthening health services across the region is critical, with national policies set by the Department of Health and local authorities managing regional programs and infrastructure.

Linking with ongoing TA in Sarawak. This TA will complement the ongoing multiyear TA to develop green city action plans (GCAPs) for 14 cities, including Kuching, Sarawak's capital. This initiative plays a crucial role in advancing Malaysia's nationally determined contributions. For Sarawak, the GCAP is expected to be transformative, with comprehensive carbon footprint assessments, the identification of pollution sources, and the development of an infrastructure pipeline. The pipeline includes investments aimed at mitigating air pollution and improving public health.

The TA is aligned with the following impact: climate change resilience across BIMP-EAGA strengthened, with improved health system resilience and a foundation for decarbonization established. The TA will have the following outcome: climate change adaptation and mitigation efforts under the environment pillar of BIMP-EAGA advanced, with benefits for health system resilience realized.

ADB Team Leader:

Vasoontara Yiengprugsawan
Email: vyiengprugsawan@adb.org 

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