A narrative literature review was conducted to synthesize evidence on the health impacts of climate change in Africa, the vulnerabilities of existing health systems, and strategies to strengthen climate-resilient health systems. This design facilitated the integration of evidence from epidemiology, environmental health, health policy, and systems science. Narrative reviews afford flexibility in selecting diverse source types—including conceptual papers, policy documents, commentaries, and empirical studies—that collectively illuminate the climate-health relationship (Snyder, 2019).

As a secondary analysis of published literature, the study did not require formal ethical approval. All sources are appropriately cited, findings are faithfully represented, and conflicts or evidential gaps are acknowledged to ensure transparency.

A comprehensive literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the WHO Institutional Repository for Information Sharing (IRIS). Grey literature sources included the WHO, the African Development Bank (AfDB), the Intergovernmental Panel on Climate Change (IPCC), the United Nations Environment Program (UNEP), and national health ministries. Search terms encompassed "climate change," "global warming," "public health," "health systems," "Africa," "Sub-Saharan Africa," "climate-sensitive diseases," "extreme weather events," "health adaptation," "mitigation," and related terminology. Boolean operators were applied to enhance specificity. Priority was accorded to literature published between 2010 and 2024.

Sources were included if they were published in English in peer-reviewed journals, institutional reports, or policy briefs; focused on the health impacts of climate change, climate-health adaptation strategies, or health system resilience in African countries or in LMICs with comparative relevance to Africa; addressed at least one of the following themes: climate change trends, direct and indirect health impacts, health systems strengthening, governance and policy frameworks, community engagement, financing mechanisms, research and innovation, or monitoring and evaluation; and provided substantive empirical, theoretical, or policy-relevant insights applicable to the African context.

Literature was excluded if it focused exclusively on high-income country settings with no transferable lessons for Africa; addressed climate change from a purely physical science perspective without linkage to public health outcomes; or was inaccessible in full text or of insufficient quality to meaningfully inform the review.

Given the diversity of source types, a uniform appraisal instrument was not applied. Instead, structured critical appraisal assessed relevance, methodological rigor, source credibility, and thematic alignment. Priority was accorded to peer-reviewed empirical studies, high-quality systematic reviews, and reputable institutional reports. Sources with unsupported conclusions or potential conflicts of interest were treated with appropriate caution. Appraisal was informed by the Critical Appraisal Skills Program (CASP) framework, adapted to the heterogeneous source types included, enabling assessment of internal validity, relevance to the African context, and the adequacy of conclusions.

Sources were screened at the title and abstract level, followed by full-text review. Extracted data included study design, geographic focus, thematic domain, key findings, and identified barriers or enablers. An extraction matrix facilitated systematic comparison. Thematic synthesis followed Thomas & Harden's (2008) three-step approach: free coding, development of descriptive themes, and generation of analytical themes aligned with six domains: climate science and health implications; African vulnerabilities; health system resilience; governance and policy; community engagement; and financing and collaboration. A total of 22 peer-reviewed articles, institutional reports, and policy documents were included. The flow of study identification, screening, and inclusion followed PRISMA-aligned principles: an initial pool of over 120 records was identified, 56 were retrieved for full-text review, and 22 met all inclusion criteria. Free coding was applied iteratively; codes were grouped into descriptive themes and refined into the six analytical domains.

A fundamental imperative exists to identify pathways for transitioning toward low-carbon, sustainable, and equitable development while simultaneously building resilience to a changing climate (Chersich et al., 2018). Climate change is projected to adversely affect vital ecosystems and global temperatures, with particularly severe consequences for vulnerable populations—including those in low-income countries, infants, children, women, older adults, and individuals with pre-existing illness or disability (Rublee et al., 2021). These projections underscore the need to deepen understanding of how climate change cuts across the entire health sector—extending well beyond infectious disease to encompass health facility functionality and health system resilience. Across the included studies, there is strong convergence that climate change disproportionately affects vulnerable populations in Africa, although mechanisms differ across ecological and socio-political contexts (Wright et al., 2024; Rublee et al., 2021; Chersich et al., 2018). Several studies consistently report that climate change exacerbates infectious disease burdens in Sub-Saharan Africa, particularly through vector expansion, water insecurity, and health infrastructure disruption (Wright et al., 2024; Mosadeghrad et al., 2023; Dos Santos et al., 2022).

Climate change directly affects ambient temperatures, precipitation, and the frequency and severity of extreme weather events, while indirectly influencing the social determinants of health. The continuum of climate-related health risk begins with climate change itself, proceeds through exposure and intermediary health risks, and culminates in measurable health impacts. A sound understanding of this causal chain is indispensable for designing effective policy responses.

Climate change science continues to advance rapidly, generating a substantial and growing evidence base on causes, mechanisms, projections, and impacts (Wright et al., 2024). Regardless of the indicator employed, atmospheric CO2 concentrations continue to rise. Climate change is formally defined as a statistically significant variation in the mean state or variability of climatic properties that persists for an extended period, typically decades or longer—encompassing both natural variability and anthropogenic contributions. Climate models project future conditions based on greenhouse gas emissions scenarios, drawing on techniques such as tree-ring analysis, glacial ice cores, and ocean sediment cores (Rublee et al., 2021). Contemporary modeling frameworks account for a broad range of greenhouse gases—including black carbon aerosol, ozone, methane, and CO2—and operate across spatial and temporal scales.

Anthropogenic climate change—encompassing long-term climatic shifts and increased extreme weather events—has far-reaching consequences for public health. At the most fundamental level, climate change directly impairs the natural systems that sustain life: air, water, land, food, and shelter. Prolonged heat and cold extremes, extreme precipitation, flooding, drought, and temperature fluctuations produce severe direct health consequences, including elevated morbidity and mortality, particularly among populations with limited adaptive capacity (Wright et al., 2024). Climate-related environmental shocks can also precipitate poverty traps and compound existing health deficits, affecting both the physical and psychological well-being of communities (Banwell et al., 2018).

Direct health impacts include a projected rise in heat-related illnesses—heat rash, heat exhaustion, and heat stroke—as well as deteriorating air quality and increased incidence of asthma, chronic obstructive pulmonary disease, and allergic conditions. Extreme weather events also inflict significant mental health consequences, contributing to anxiety, depression, and post-traumatic stress disorder in affected communities.

Indirect impacts operate through multiple pathways. Climate variability affects water quality, quantity, and accessibility. Altered precipitation patterns may permanently reduce stream flow and degrade water security for communities dependent on surface water sources. As temperatures rise and evaporation intensifies, competition for diminishing water and food supplies intensifies, with attendant increases in morbidity, mortality, and population displacement.

The health impacts of climate change in Africa are already manifest across a broad spectrum of outcomes. Particularly vulnerable groups include children, women, and populations in conflict-affected areas—such as parts of Uganda and the Democratic Republic of Congo—where population displacement and health service disruption have been documented (Wright et al., 2024). While conditions such as malaria and urban heat-related mortality are relatively well studied, others—including rodent-borne diseases and climate-induced stresses on fragile health infrastructure—require further investigation. Projections indicate that climate-attributable costs of malnutrition, respiratory infections, and diarrheal disease will reach USD 283 billion by 2030 (2012 prices)—a figure that starkly contrasts with Africa's total health expenditure of USD 84.4 billion in 2014, of which 38% was externally financed (Rublee et al., 2021).

Africa's diverse cultural, linguistic, and livelihood landscape is overlaid with exposure to flooding, famine, drought, desertification, temperature rise, sea-level rise, and political instability—all of which carry health consequences. Observed climate trends include a mean annual temperature increase of 1.2°C since the 1900s, with projections exceeding 2°C in some regions by 2080, alongside a 5–10% decline in rainfall in certain areas and an increase in drought frequency (Rublee et al., 2021). Climate-driven land degradation and food insecurity further erode health outcomes, while approximately 20% of the population residing in politically unstable or conflict-affected areas face compounded vulnerability. Compared with higher-income settings, African evidence reveals a distinctive pattern: climate impacts are amplified not merely by hazard exposure but by structural fragility and near-absence of climate-adaptive financing. Unlike high-income health systems, where adaptation can be incrementally added, African systems require transformative reform (Mosadeghrad et al., 2023; Ebi & Del Barrio, 2017).

Both natural and anthropogenic factors drive climatic change in Africa. Natural drivers include variations in solar output, orbital cycles, continental drift, volcanic activity, and phases of the El Niño Southern Oscillation (ENSO). Anthropogenic drivers include greenhouse gas emissions, land cover and land use changes, altered biophysical land surface properties, anthropogenic aerosols, and sea surface temperature anomalies in the tropical Atlantic and Indian Oceans (Wright et al., 2024). All six African regions recorded increases in average temperature between 1901 and 1930 and 1991 and 2021. The number of extreme warm days increased significantly between 1979 and 2017, with some regions—including the Arabian Peninsula, northeastern Africa, and southern Africa—recording increases of more than 20 additional extreme warm days annually (Rublee et al., 2021). Africa's climate is projected to warm by 1.5-7.0°C, with summer precipitation potentially declining by 40-60%, while equatorial and tropical regions have already experienced temperature increases of 1-3°C over the past five decades.

Africa faces a chronic and severe deficit in health system capacity and infrastructure. Sub-Saharan Africa accounts for only 30% of the global health workforce, and five of the ten countries with the most acute personnel shortages are located in Africa. Despite demonstrated strengths in addressing health and development priorities, improvements remain constrained by pervasive deficiencies in infrastructure and human resources (Rublee et al., 2021). Most health systems are poorly equipped to manage the growing burden of climate-related health risks and to adapt to climate-sensitive conditions—such as expanding transmission zones for malaria and dengue—making adaptation extremely challenging (Wright et al., 2024).

Climate change is projected to disproportionately affect vulnerable populations in Africa, with impacts mediated by social, economic, cultural, behavioral, and geopolitical determinants (Mosadeghrad et al., 2023). Early manifestations include increased illness and mortality from extreme weather events, a rising burden of climate-sensitive diseases, and altered patterns of infectious disease transmission. Strengthening the key building blocks of the health system—leadership and governance, health financing, infrastructure, health information systems, workforce, and service delivery—is therefore essential (Wright et al., 2021). Specific interventions include: developing climate change and health strategic plans; strengthening interdepartmental coordination; increasing investments for climate-related health impact mitigation; establishing standardized economic assessment tools; mobilizing domestic and international financing; adapting health facilities using climate-proof design; incorporating climate variables into disease surveillance systems; training the health workforce on climate-sensitive risks; and establishing mobile emergency services, heat-health action plans, and continuity protocols for essential services during climate-related shocks.

Resilience denotes the capacity of systems to absorb disturbances, adapt to new conditions, and learn from experience. Primary Health Care (PHC) systems are particularly well-positioned to demonstrate resilience, given their proximity to communities and their role in addressing the social determinants of health (Mosadeghrad et al., 2023). Resilient health systems must perform effectively under normal conditions while remaining robust enough to respond during crises and capable of transforming in ways that reinforce adaptive capacity (Hanefeld et al., 2018).

Most adaptation strategies are implemented at the local level but require national policy mandates, integration with climate risk assessments, and dedicated financing. Conservation and restoration of coastal ecosystems—including dunes, wetlands, and mangroves—yield co-benefits for public health and water quality (Wright et al., 2024). Innovative solutions such as the Earth Enable program in Rwanda—which replaces dirt floors with durable, waterproof materials to confer flood resilience—demonstrate the potential of context-appropriate technologies to reduce climate-related health risks at the household level (Wright et al., 2024).

Establishing climate-resilient health systems requires coherent policy and governance architecture spanning four domains: health system structures, operations, and interactions; information for policy; risk assessment; and governance frameworks (Bowen et al., 2011). Coherence across policies, legislation, and strategies affecting health systems is essential, as is the alignment of governance arrangements across multiple levels of jurisdiction. South Africa's National Climate Change Response Policy (NCCRP), developed in 2012, and the seven associated Climate Action Plans illustrate promising legislative intent. However, implementation at provincial and local levels remains inconsistent (Quintana et al., 2024).

Significant governance gaps persist in the climate-health nexus. Climate and health policies must be co-developed to maximize synergies, given that improved population health is a major co-benefit of effective climate action (Pongsiri & Bassi, 2021). Empirical evidence increasingly supports the establishment of global and national climate-health policy networks, monitoring observatories, and evaluation frameworks to track progress and inform adaptive management (Wright et al., 2021).

Public health forums convened by local government provide valuable platforms for community engagement in climate-health policy development and implementation (Gould & Rudolph, 2015). Effective community involvement is foundational to resilience: communities on the frontlines of climate impacts possess local knowledge that is critical for contextualizing climate events and calibrating health responses. Community-based organizations strengthen public health surveillance, improve health data quality, motivate local health workers, and advocate for equitable health systems—though their sustainability may be constrained by dependence on external donor funding (Gould & Rudolph, 2015). Capacity-building initiatives equip individuals and communities with the knowledge and skills needed to respond to climate-induced health challenges. Landscape and climate scenario tools support anticipatory governance. At the same time, case studies developed through EU-funded initiatives offer actionable insights for enhancing adaptive capacity in health systems, particularly in contexts of drought, extreme heat, vector-borne disease, and malnutrition (Hess et al., 2011).

The complex, wide-ranging, and temporally diverse nature of climate-induced health impacts demands ongoing investment in research, innovation, and novel technologies (Wright et al., 2024). Climate-smart health systems must apply innovative approaches to manage complex datasets, enhance epidemiological modeling, and contextualize surveillance information. Climate-adapted disease surveillance systems require integration of local vector, host, and pathogen dynamics with climate data across scales—necessitating sustained investment in climate monitoring infrastructure, modeling capacity, and multidisciplinary research collaboration (Dos Santos et al., 2022). Priority research gaps include a deeper understanding of differential vulnerabilities across health systems and regions, and the development of broader integrated human assessment models that capture dynamic interactions among climate change, environmental exposures, and health outcomes—spanning health, non-health environmental, and socioeconomic domains (Wright et al., 2024; Madrigano et al., 2021).

Case studies across Africa highlight five cross-cutting themes: the centrality of multi-sectoral collaboration; the value of innovative data use and technology; the imperative of prioritizing vulnerable populations; the effectiveness of integrated planning; and the importance of mobilizing diverse financing. The South African Health and Climate Change Adaptation Plan (SAHCCAP) exemplifies meaningful cross-sectoral collaboration. At the same time, a multi-sectoral, contract-based approach with local authorities has demonstrated potential for promoting accountability, community engagement, and sustained investment.

Despite the compelling evidence base, implementation of climate-resilient health systems faces significant obstacles. Climate change is often accorded low socio-political priority in countries where health systems are already overwhelmed by poverty, malnutrition, and endemic disease (Ebi & Del Barrio, 2017). The multi-sectoral nature of the challenge complicates coordination, while differences between global adaptation frameworks and local framings of climate risk impede adoption. Limited technical capacity, inadequate human resources, and financing shortfalls further hinder efforts to scale interventions. Overcoming these barriers demands sustained political will, broad stakeholder engagement, and governance structures capable of mobilizing and sustaining financing for climate-health system strengthening (Dos Santos et al., 2022; Gould & Rudolph, 2015).

Robust monitoring and evaluation (M&E) are indispensable for ensuring that climate-health adaptation investments yield measurable outcomes (Ebi et al., 2018). The UNFCCC Warsaw Mechanism and the 2030 International Development Agenda both recognize the imperative to track the effectiveness of climate-health interventions (Thomson et al., 2014). An indicators and metrics framework tracking six elements of climate-health resilience—monitoring, assessment, understanding, management, intervention support, and enabling environments—provides a structured approach applicable to LMICs. Despite the escalating health costs of climate change, no comprehensive global system currently monitors the effectiveness of programs designed to address these risks, representing a critical gap.

The Paris Agreement, UNFCCC, WHO, and multilateral climate initiatives advocate for substantially increased climate finance for health (Borghi et al., 2024). Multiple financing mechanisms exist, including the Green Climate Fund, the World Bank, the Adaptation Fund, the Global Environment Facility, and the Climate Investment Funds. However, climate-smart global health funding has yet to be placed on a permanent trajectory, and vulnerable countries must actively engage in 2030 financing negotiations to secure climate-resilient health financing provisions. Domestic resource mobilization is equally critical. Governments are urged to prioritize climate-resilient health investments within national fiscal frameworks, shifting public expenditures toward climate-adaptive development (Borghi et al., 2024; Wright et al., 2021). Multi-sectoral and international partnerships—encompassing academia, civil society, the private sector, and South-South cooperation—are also essential for sustaining the research, knowledge, and financing flows required to build durable resilience (Wright et al., 2024).

The findings of this review align with, yet extend, prior narratives on climate and health in Africa. Earlier reviews focused primarily on disease burden and climate exposure pathways, with limited attention to health system resilience or financing mechanisms (Chersich et al., 2018; Thomson et al., 2014). More recent work by Wright et al. (2024) and Mosadeghrad et al. (2023) has begun to address system-level responses but tended to treat individual building blocks in isolation. This review offers a more comprehensive, cross-domain synthesis that explicitly links climate adaptation to all six WHO health system building blocks, contextualized within Africa’s governance and financing realities.

Governments across Africa should explicitly incorporate climate adaptation into national health strategies and ensure climate finance mechanisms are accessible to health ministries. Health system managers need tools and training to embed climate risk assessment into routine planning, facility design, and surveillance. Priority research gaps remain in understanding how governance structures and financing arrangements enable or constrain climate-resilient health system development; future studies should adopt mixed-methods designs capturing both quantitative health outcomes and qualitative governance processes.

This review has several methodological limitations. Restriction to English-language sources may have excluded relevant evidence from francophone and lusophone African contexts. Narrative synthesis is susceptible to selection bias and subjectivity in thematic interpretation. The heterogeneity of source types makes direct comparison difficult. Additionally, given the rapid evolution of the evidence base, some findings may have been superseded by research published after the search period (2010–2024).

Notwithstanding the formidable challenges posed by climate change, viable and evidence-informed solutions exist. Successful interventions demonstrate that meaningful progress is achievable when responses are grounded in local context and attentive to the needs of people, ecosystems, and cultures (Wright et al., 2024). Simplistic, decontextualized, or globally uniform responses will prove insufficient. Although Africa faces disproportionate adverse consequences, its youthful demographics and deep reservoir of contextual knowledge may position it to develop innovative, regionally appropriate solutions (Rublee et al., 2021). Governments, civil society organizations, universities, health teaching institutions, and technical colleges must modernize education systems to equip successive generations with the interdisciplinary competencies required to navigate the climate change challenge. Youth engagement and empowerment are not peripheral concerns—they are central to long-term resilience. The rapid adaptation of global educational institutions during the COVID-19 pandemic offers a meaningful precedent for the systemic transformation needed to address the existential threat of climate change (Wright et al., 2024).

Africa has already experienced significant climate-related changes and is projected to be among the regions most severely affected. Disruptions to mental and physical health and threats to the public health architecture underscore the urgent need for a whole-of-systems approach in vulnerable nations (Wright et al., 2024). Future efforts should maximize the mobilization of climate finance, strengthen the relevance of climate services to public health decision-making, and deepen co-design between health systems and affected communities. Human and financial resource capacity should be developed through Africa-for-Africa initiatives, and academic institutions should collaborate to produce accessible, multilingual research evidence that informs inclusive climate adaptation strategies across the continent (Rublee et al., 2021).

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