Climate Change Is Hitting Health Systems Where They Are Already Weakest

Climate change is not just testing how countries respond to floods, heatwaves or disease outbreaks, but whether health systems can continue functioning when environmental shocks collide with chronic shortages of money, staff, infrastructure and policy capacity.

A new study, "Climate Change and Healthcare System Resilience: Stakeholder Perspectives on Mitigating Climate-Related Health Impacts in Low-Resource Settings," published in Sustainability by Pia Schrage and Gbadebo Collins Adeyanju, examines that challenge through the experience of Nigeria. Its central finding is stark: awareness of climate-related health threats exists, but the systems needed to translate that awareness into resilience remain weak.

The researchers interviewed 17 stakeholders from government, civil society, academia and an intergovernmental organisation. Their accounts show that climate-health knowledge is growing, yet policy integration, financing, workforce capacity, institutional coordination and political prioritisation continue to lag behind the scale of the risk.

Awareness Is Growing, but Health-System Readiness Is Not

Stakeholders interviewed for the study were generally familiar with the direct health consequences of climate change. Flooding, drought, heatwaves, erratic rainfall and disease transmission were repeatedly identified as threats capable of increasing illness, disrupting services and placing additional pressure on healthcare facilities.

Participants linked flooding with cholera and malaria, described heat-related risks such as dehydration and heat exhaustion, and pointed to difficulties involving vaccine and medicine storage under extreme temperatures. They also recognised the way climate shocks can damage roads, disrupt access to health facilities and displace communities.

Knowledge became much thinner when the discussion moved from visible climate hazards to the institutional meaning of a climate-resilient health system. Some participants described resilience in terms of maintaining services and absorbing shocks, while others had little familiarity with the concept or with how resilience should be built into health-system functions.

The gap identified by the researchers is therefore not simply one of climate awareness. It is a gap between recognising danger and possessing the institutional capacity to act on it consistently through planning, financing, preparedness and service delivery.

Nigeria already has some of the building blocks required for stronger action. The study notes the presence of a national health and climate change strategy, surveillance mechanisms and a climate-change division within the health administration. Yet these foundations have not produced comprehensive, system-wide implementation.

Climate Resilience Is Still Competing With More Immediate Pressures

Health policy in Nigeria, according to the stakeholders, does not adequately incorporate climate risks and vulnerabilities into routine planning. Climate mitigation or adaptation measures may appear in some programmes, particularly when international development partners require them, but respondents did not view climate considerations as firmly embedded in domestic health policy.

The problem is closely tied to competing priorities. Participants described a health system already struggling with disease outbreaks, malnutrition, limited infrastructure, insufficient personnel and other urgent service-delivery pressures. Under such conditions, climate resilience can easily be treated as a longer-term concern rather than an immediate operational priority.

The study challenges that separation because climate change can worsen many of the pressures already burdening the system. Floods can intensify infectious disease risks. Heat can increase health demand. Environmental disruption can undermine access to facilities. Climate stress therefore interacts with existing weaknesses rather than arriving as an isolated problem.

Respondents also described Nigeria's health system as reactive rather than anticipatory. Resources and attention are often concentrated on responding after crises occur, while preparedness for future climate-related disruption remains limited.

Moving towards resilience would require climate risk to become part of ordinary health planning rather than a specialist agenda operating at the margins. The researchers argue that preparation, surveillance, risk assessment and adaptation need to be integrated into core health-system functions.

Financing, Workforce Shortages and Coordination Form the Hardest Barriers

Insufficient funding emerged as the most frequently cited barrier, mentioned by 60% of respondents. Participants described limited budgetary allocations for healthcare and inadequate resources for building infrastructure or programmes capable of withstanding climate-related shocks.

Financial constraints are particularly consequential because resilience requires investment before benefits become visible. Stronger facilities, better preparedness, more capable surveillance systems and trained health workers all demand resources at a time when the broader health system is already under significant strain.

Workforce pressures add another layer of vulnerability. Participants pointed to shortages of trained healthcare workers and the effects of health-worker emigration. A system with insufficient personnel may struggle to take on additional climate-related responsibilities while maintaining essential services.

Institutional coordination is also weak. Climate change affects health through water systems, agriculture, food security, infrastructure, environmental management and other sectors, yet the study finds limited multisectoral cooperation and insufficient communication between scientific and policymaking communities.

Such fragmentation makes climate preparedness harder because no health ministry can manage all of the relevant risks independently. Information, financing and planning need to move across institutions if health systems are to anticipate environmental threats rather than respond to them in isolation.

International support appears repeatedly in the study as another important part of the financing equation. Participants and authors emphasise that low- and middle-income countries face substantial resource constraints and may require external funding and expertise to strengthen resilience.

Nigeria's Experience Points to a Wider Development Challenge

Across low-resource settings, climate resilience is becoming difficult to separate from the everyday performance of health systems. Floods, heat, drought and shifting disease patterns do not arrive in isolation; they place additional pressure on institutions already dealing with workforce shortages, constrained budgets, fragile infrastructure and high service demand.

The Nigeria-based study shows how that pressure can unfold. Stakeholders broadly recognised climate-related health threats, yet the researchers found much weaker capacity to translate that awareness into routine planning, financing, workforce development and programme design. The problem was therefore not simply whether decision-makers understood climate risk, but whether health institutions were equipped to act on it.

For many developing countries, the same tension is likely to shape adaptation efforts. Climate preparedness must compete for resources with immediate health priorities, even though climate shocks can intensify those very pressures by disrupting access to care, increasing disease burdens and straining already limited services.

The research also shows why climate resilience cannot be treated as a stand-alone environmental programme. In Nigeria, existing surveillance systems, policy frameworks and administrative structures provide a base for action, but they have not yet produced consistent implementation across the health system.

A more effective model would embed climate risk into ordinary health-sector functions. Infrastructure planning, surveillance, workforce training, emergency preparedness and budget decisions all become part of adaptation once climate-related disruption is treated as a recurring operational risk rather than an exceptional event.

The study does not claim that Nigeria represents every low- and middle-income country, and its findings remain specific to stakeholder perceptions within one national system. Even so, the barriers it identifies, limited financing, weak coordination, workforce constraints and incomplete policy integration, are highly relevant to other resource-constrained settings facing rising climate exposure.