Key messages

• In Bharatpur, Nepal, the project survey found one in five households had been affected in the past five years by the mosquito-borne disease dengue fever (18.4%). Skin infections were the second most reported infectious disease, affecting 11.5% of households. Proximity to garbage disposal sites was found to be associated with incidence of both dengue and skin infections, and lack of adequate sanitation and clean water is a hypothesized driver for skin infections.

• Nature-based solutions (NBS) have potential to reduce hazard from infectious disease through filtering water, mitigating flooding and reducing urban temperatures. Local actors participating in project workshops were particularly interested in applying green streets and rainwater harvesting in Bharatpur.

• Strengthening solid waste management is recommended as a priority action to reduce hazard from dengue, by increasing collection frequency and ensuring city-wide provision of municipal collection services. Improving piped water supply to peri-urban areas is recommended as a priority action to improve hygiene, reduce skin infections and address critical health inequities among vulnerable populations.

• The study emphasizes that to improve public health outcomes from infectious disease, NBS cannot substitute for basic urban infrastructure and services.