CFIR index dimensions vs adapted themes.

According to the WHO 2021 Health and Climate Change Global Survey Report, most countries’ climate change and health plans are witnessing low to moderate implementation due to (among other reasons) insufficient funding, evidence, research, and multisectoral collaboration. In Ghana, the national climate change agenda has, for over two decades, consistently prioritised its health systems, but progress is slow due to underfunding, inconsistent policies and poor mainstreaming in health system polices - “thick mainstreaming”. This study examined how Ghana’s national-level climate-resilient health systems agenda has translated to building climate-resilient Primary Healthcare (PHC) systems and identified existing barriers to further mainstreaming. In this mixed-method study, 27 District Health Management Team members (82%) %) from 3 PHC systems and 65 PHC facilities (HCF) managers (98%) from three low-resourced districts/PHCs participated in vulnerability assessments of their respective PHC and HCF using the WHO checklist. Key informant interviews were conducted and thematically analysed to explore facilitators and barriers to mainstreaming climate change action into PHC operations. The vast majority (82%) of PHCs observed multiple climate hazards. PHC systems showed incomplete preparation or medium risk with an average score of 2.3. Eighty-three per cent of PHC facilities were unprepared (unable to respond or at higher risk) for the recorded impacts of climate hazards such as storms, heatwaves, floods, droughts and wildfires. Key informants reported the mainstreaming of the national climate agenda into PHC policies and programs as facilitators, but limited human resource capacity, financing, and weak subnational inter-sectoral collaboration were reported as barriers. Based on these findings, Ghana’s national climate agenda has not adequately translated into the development of climate-resilient PHC systems. We recommend investments in capacity development and in mainstreaming Ghana’s national climate agenda into PHC operational policies, protocols, and standards, with inbuilt monitoring mechanisms to catalyse sustainable climate action within PHC amidst scarce resources.