Climate and Health Systems Transformation in South Africa

Project Overview

Climate change is already reshaping health risks and health system performance across South Africa. Rising temperatures, floods, droughts, air pollution, and shifting disease patterns are increasing the burden of illness while also disrupting the delivery of care. At the same time, the health sector is both affected by and contributing to climate change. Building climate-resilient and low-carbon health systems is therefore not only a matter of environmental responsibility, but a central part of protecting population health and ensuring a just and equitable transition.

Commissioned by the Agence Française de Développement (AFD), this project examines how climate change and health intersect in South Africa and explores how climate action can strengthen health systems while advancing equity and resilience. The study maps the emerging climate-health landscape, identifying key system vulnerabilities, institutional barriers, and strategic opportunities for transforming the health sector. The aim is to support policymakers, development finance institutions, and health system leaders to identify pathways where climate action can improve both health outcomes and health system sustainability.

By positioning health at the centre of South Africa's climate transition, the project highlights how climate action in the health sector can strengthen system resilience, reduce emissions, and ensure that the benefits of the just transition reach people's lives.

Our Role

Pivot Collective was commissioned by AFD to lead a national scoping study on the climate-health nexus in South Africa. The study examined how climate change is affecting health outcomes, health system infrastructure, governance arrangements, and investment priorities.

Our team conducted an extensive landscape analysis combining policy and literature review with interviews and dialogues involving stakeholders across government, research institutions, civil society organisations, and development finance institutions. This work included convening a national stakeholder dialogue and facilitating participatory sense-making workshops to surface shared priorities and practical pathways for action.

The resulting analysis synthesised evidence across multiple domains, including health system governance, infrastructure resilience, climate-related disease risks, financing mechanisms, and cross-sector coordination. It also identified strategic opportunities for aligning climate adaptation, health system strengthening, and decarbonisation.

The findings informed AFD's evolving investment strategy on climate-resilient health systems in South Africa and were shared publicly through a national webinar hosted by the South African Presidential Climate Commission. They are synthesised in the report Positioning Health at the Heart of the Just Transition, which outlines key system challenges and proposes integrated pathways for strengthening climate-resilient and low-carbon health systems in South Africa.

The work also contributes to ongoing dialogue between policymakers, development finance institutions, and health system actors about how climate-health priorities can translate into concrete investment strategies and institutional reform.

What We're Learning

The scoping study highlights that climate resilience in the health sector is fundamentally a systems challenge. Across policy analysis and stakeholder dialogues, participants emphasised that progress on climate and health is often slowed not by a lack of ideas or policy commitments, but by structural barriers within the health system itself. Fragmented governance, unclear mandates across national and provincial levels, and limited mechanisms for coordination make it difficult to translate climate-health ambitions into operational programmes and investments.

A second insight is that many of the most promising opportunities for climate-health action lie within existing systems and investments, rather than entirely new initiatives. Infrastructure grants, facility revitalisation programmes, workforce training systems, and procurement frameworks already shape how the health system evolves. Integrating climate resilience and decarbonisation into these mechanisms can strengthen core health system functions, rather than treating climate adaptation as a stand-alone programme.

The research also highlighted the importance of aligning climate-health priorities with the realities of public finance and institutional capacity. Rigid procurement processes, centralised financial systems, and uneven provincial readiness often constrain innovation and local adaptation. Strengthening the ability of provinces, facilities, and frontline actors to access and manage climate-related resources will therefore be essential for translating national commitments into practical change.

Finally, the study underscores that effective climate-health action must be grounded in equity and community leadership. Climate-related health risks and system vulnerabilities are unevenly distributed across South Africa, with poorer and historically marginalised communities facing the greatest exposure and the least adaptive capacity. Ensuring that climate action strengthens health systems therefore requires approaches that prioritise underserved areas and centre community knowledge and frontline health workers in planning and decision-making.

Taken together, these insights suggest that the challenge is not simply to design new climate-health programmes, but to align governance, financing, and learning systems so that climate and health priorities can be implemented at scale across the health system.