climate change

Climate change is making Bangladesh’s rivers too saline for farming

With limited freshwater available, parts of the country could become zones of poverty.

It has been established by now that coastal Bangladesh is being seriously affected by climate change. It is now imperative to determine the exact ways in which it is being affected and to what extent, so that specific plans to adapt to the changes can be carried out.

Studies conducted by the World Bank, Institute of Water Modelling and World Fish–Bangladesh between 2012 and 2016 have quantified the effects of increasing salinity in river waters in coastal Bangladesh, including the areas in and around the Sundarbans – the world’s largest mangrove forest that straddles the coast of Bangladesh and India.

The broad categories of climate change effects that hit coastal areas of Bangladesh are

  • Change in temperature
  • Change in rainfall
  • Sea level rise
  • Change in frequency and intensity of cyclones
  • Storm surge
  • Change in river salinity
  • Change in soil salinity

The coastal areas are also affected by changes in freshwater supply from rivers upstream.

Source: IWM, 2013
Source: IWM, 2013

The only way to adapt to these changes is to understand each change in detail. While doing that, it has to be remembered that each change has various effects on the people, animals and plants that live in the Sundarbans. This makes climate change a cross-cutting theme whose analysis requires collaboration between experts of different disciplines.

The effect of changes in the salinity of river water in the coastal areas is the result of such an interdisciplinary study, where climate scientists, GIS experts, hydrologists, ecologists, engineers and economists worked together.

We know that river water salinity in coastal Bangladesh depends on volume of freshwater discharges from the upstream river systems; surface water runoff from rainfall; salinity of the Bay of Bengal near the coast; tidal dynamics of the coastal river system; climate-induced changes in sea level, temperature, rainfall and altered riverine flows from the Himalayas. All these are expected to affect the spread and intensity of salinization of river water in the coastal area. Saltwater intrusion is expected to worsen in low-lying coastal areas.

The challenge before the researchers was to quantify this effect. The study found that the expected increase in river salinity is likely to impact accessibility of drinking water, availability of water for dry-season irrigation, wild habitats of fresh water fish, other indigenous species and nutritional intake of the poor, especially of women and children. In the Sundarbans, a shift in mangrove species is expected from Heritiera fomes to Ceriops decandra and Excoecaria agallocha.

Degradation of water quality during non-monsoon months is already apparent, and further progressive degradation of river water in a changing climate is imminent. This will progressively impact the entire ecosystem, including that of the Sundarbans. Forestry and fishery based livelihoods of millions of inhabitants of the southwest coastal region of Bangladesh – including the Sundarbans Impact Region – will be affected.

Loss of freshwater zones

The increase in salinity is likely to hit the poor hardest. In southwest coastal Bangladesh, 9.9 million people live in poverty. Of them, 5.9 million extremely poor people cannot meet the basic needs of food expenditure. At present, 2.5 million poor (including 1.4 million extreme poor) in this part of Bangladesh are already suffering from shortage of drinking water and scarcity of water for irrigation for dry-season agriculture.

The studies indicate that even in the best future case, the livelihoods of 2.9 million poor and 1.7 million extremely poor would be adversely affected by increasing salinity of river water. In the worst future case for salinity incursion considered, there will be adverse impacts on 5.2 million poor and 3.2 million extremely poor people.

This means that river water will no longer be usable for agriculture in Barguna, Bhola, Jhalokati, Khulna, and Patuakhali districts in the worst case scenario. Tentulia river, which currently provides water to the Bhola irrigation project, will be non-operational, with estimated salinity exceeding 2 ppt.

The scarcity will be severe even in the best case scenario. For example, 98% of the rivers in Khulna and 97% in Bhola will be adversely affected. However, Bishkhali and Buriswar rivers, and the upstream stretch of the Baleswar river, are expected to remain functional for irrigation in the best case scenario, with estimated salinity lower than 2 ppt.

Here are the potential adaptation measures that can be taken:

  • Desalination of drinking water
  • Widespread use of saline resistant crops
  • Expansion of Tilapia farming
  • Expansion of honey production
  • Expansion of crab culture
  • Precautionary measures before construction of buildings

With a virtual certainty that the sea level rise will continue beyond 2100 even if greenhouse gas emissions are stabilised today, the ecosystem is likely to alter significantly in the future. Families in coastal Bangladesh, especially inhabitants of the Sundarbans Impact Zone, are already on the “front line” of climate change. Already, economic necessity is driving more working-age adults to seek outside earnings in households threatened by salinization, particularly those that are relatively isolated from market centres.

For sustainable poverty alleviation, it is imperative for policymakers to begin planning to cope with the potential poverty trap that climate change may create. Implementation of new policies takes time. Therefore, the time for the policymakers and development partners to prepare and implement policies that reduce vulnerability to climate change is now.

Susmita Dasgupta is a lead environmental economist in the Research Department at The World Bank, in charge of environmental studies in the South Asia Water Initiative-Sundarbans Landscape

This article appeared on The Third Pole.

We welcome your comments at letters@scroll.in.
Sponsored Content BY 

What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.