Translating national climate policies to resilience actions at the subnational level in low resource settings: Lessons from Ghana’s health systems.

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 a decade, consistently prioritized 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 identifies existing barriers to further mainstreaming. In this mixed method study, 27 District Health Management Team members (82%) and 65 PHC facilities (HCF) managers (98%) from three low resourced districts/PHCs participated in vulnerability assessments of their respective PHC and HCF using WHO checklist. Key informant interviews were conducted, and thematically analyzed, to explore facilitators and barriers to mainstreaming climate change action into PHC operations. The vast majority (82%) of PHCs observed multiple climate hazards. Eighty-three percent 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 building climate resilient PHC systems. We recommend investments in capacity development and mainstreaming Ghana’s national climate agenda into PHC operational polices, protocols and standards, with inbuilt monitoring mechanisms to catalyze sustainable climate action within PHC amidst scarce resources.