Strengthening Primary Health Care for Climate-Related Health Challenges

Climate change is no longer a distant threat-it is reshaping health outcomes across the globe right now. From heatwaves and floods to shifting disease patterns and food insecurity, the health sector faces unprecedented pressure. At the heart of the response must be primary health care (PHC)-the first point of contact for communities seeking medical support. Strengthening PHC systems to address climate-related health challenges is not just necessary; it’s urgent.

Understanding the climate-health connection 🔗

Climate change affects health both directly and indirectly. Extreme weather events cause immediate injuries and deaths, while longer-term shifts in temperature and rainfall patterns increase the risk of infectious diseases, respiratory conditions, malnutrition, and mental health disorders. The World Bank estimates that climate change may push an additional 132 million people into extreme poverty by 2030, with 44 million of those driven specifically by health impacts.

Low-income countries and small island developing states bear the heaviest burden despite contributing minimally to global emissions. In vulnerable regions, death rates from extreme weather events have been 15 times higher than in less vulnerable areas over the past decade. Primary health care serves as the entry point for most people’s interaction with health systems, making it critical that PHC services adapt to meet emerging climate-related health needs.

Challenges in primary health care delivery 🔗

Delivering effective primary health care in the face of climate challenges is hampered by several systemic issues. These barriers are particularly acute in developing countries where health infrastructure remains fragile.

Shortages of skilled health workers 🔗

The global shortage of trained health professionals is one of the most significant obstacles to strengthening PHC. According to India’s Rural Health Statistics report, there is a 7% shortfall of doctors at Primary Health Centres and a staggering 57% shortfall at Community Health Centres across rural and urban areas. This shortage makes it difficult for rural residents to access quality care, forcing patients to travel long distances at considerable cost.

Climate-related stresses further threaten key PHC functions including facility readiness, human resources, and supply chains. Health workers themselves are affected by climate impacts-facing housing instability, exposure to extreme weather, and increased disease risk-which can reduce their capacity to provide care precisely when it is most needed.

Affordability and access barriers 🔗

Over 930 million people globally spend at least 10% of their household budget on health care. An estimated 4.6 billion people worldwide still lack access to essential health services, and 2.1 billion experience financial hardship to access care. The poorest populations continue to bear the greatest burden of unaffordable health costs, with 1.6 billion people pushed into poverty due to health expenses. Climate change compounds these inequities by increasing the frequency and severity of health emergencies among populations least equipped to pay for care.

Innovative health practices transforming PHC 🔗

Technology and innovation offer powerful tools for extending PHC services to underserved communities, especially as climate change increases demand for health care in remote and vulnerable areas.

Telemedicine: bridging the gap 🔗

Telemedicine enables healthcare providers to deliver care remotely, reducing travel time and costs for patients while expanding access to specialist consultations. In India, the eSanjeevani platform emerged as a crucial tool during the COVID-19 pandemic, providing rapid access to healthcare services. This government initiative operates on a hub-and-spoke model where subcentres and primary health centres serve as spokes, while district hospitals and specialist care centres function as hubs.

With over 527 million telecom subscribers and 230,742 providers onboarded on eSanjeevani, rural healthcare in India is transforming rapidly. More than 57% of eSanjeevani beneficiaries are women and approximately 12% are senior citizens, demonstrating telemedicine’s potential to reach vulnerable populations who may face the greatest climate-related health risks.

Telemedicine is particularly valuable for disaster-affected regions where other modes of connectivity are disrupted. Mobile and portable telemedicine systems with satellite connectivity can provide essential health consultations when physical infrastructure is damaged by floods, cyclones, or other extreme weather events.

Digital health tracking and identification 🔗

Digital health records linked to unique identification systems like Aadhaar enable continuity of care across locations-critical for populations displaced by climate disasters. India’s Ayushman Bharat Digital Mission represents an effort to create interoperable digital health infrastructure that can track patient histories, coordinate care, and support surveillance of climate-sensitive diseases. Such systems allow health authorities to monitor disease outbreaks linked to changing climate conditions and deploy targeted responses.

Community participation in health care delivery 🔗

Effective PHC depends not just on facilities and technology but on engaging communities as active partners in health promotion and disease prevention. This is especially important for addressing climate-related health challenges that vary significantly by local context.

The role of community health workers 🔗

India’s Accredited Social Health Activists (ASHAs) are community health workers available in every village, with one ASHA per 1,000 population in rural areas. These workers are selected from and accountable to their own communities, creating trust-based relationships essential for health promotion. ASHAs provide referral and escort services, counseling on birth preparedness and safe delivery, and increasingly support non-communicable disease screening and management.

Community health workers serve as strong mediators for environmental and health actions. Their legitimacy as knowledge experts and close professional liaison with communities makes them uniquely positioned to address the multifaceted nature of climate impacts on health. In South Asia alone, over two million community health workers are deployed, constituting nearly half of the total health workforce in some countries.

Climate-responsive community health initiatives 🔗

In Pune, India, community participation is being used to strengthen climate-responsive health systems. Local health workers and villagers collaborate to integrate climate adaptation into village-level healthcare planning. ASHAs provide heat stress early warning messages to families, while Village Health Sanitation Nutrition Committees take up climate-sensitive health issues in their budgeting and planning processes.

The ClimateCare Champions Program in Andhra Pradesh has trained thousands of frontline health workers to prevent, prepare for, and respond to climate-related health needs. In 2025, over 2,200 frontline health workers across 51 Primary Healthcare Centres received training on recognizing and managing heat-related illness-critical knowledge as extreme heat events become more frequent.

Social insurance schemes for affordable care 🔗

Financial protection from health costs is essential for ensuring that climate-related health emergencies do not push families into poverty. Social insurance schemes play a vital role in making care accessible and affordable.

From RSBY to Ayushman Bharat 🔗

The Rashtriya Swasthya Bima Yojana (RSBY) was launched in 2008 to provide cashless hospitalization to families below the poverty line, providing coverage up to ₹30,000 per family annually. The scheme used biometric-enabled smart cards for identification and enrolled over 36 million families. RSBY was a pioneer in recognizing that health insurance could protect poor households against the risk of health spending leading to deeper poverty.

RSBY has since been subsumed into Ayushman Bharat-the Pradhan Mantri Jan Arogya Yojana (PM-JAY), which provides significantly higher coverage of up to ₹5 lakh per family per year. As of March 2024, the scheme had issued 334 million cards and empanelled nearly 30,000 hospitals, with 57.6% being public hospitals and 42.4% private. This expansion ensures that climate-related health emergencies-from heat stroke to flood-borne diseases-can be treated without catastrophic out-of-pocket expenses.

Addressing remaining gaps 🔗

A significant limitation of these insurance schemes is that they focus primarily on hospitalization rather than outpatient care. Outpatient expenditure forms a major part of household health spending, particularly for chronic conditions that may be exacerbated by climate change. Expanding coverage to include outpatient services would provide more comprehensive protection against climate-sensitive health costs.

International aid and partnerships 🔗

Strengthening PHC to address climate-related health challenges requires resources beyond what many developing countries can mobilize domestically. International partnerships and aid play a crucial role in filling financing gaps and transferring knowledge and technology.

WHO’s leadership on climate and health 🔗

The World Health Organization leads global efforts to address climate change’s health implications. WHO’s response centres around three objectives: promoting actions that both reduce carbon emissions and improve health; building better, more climate-resilient and environmentally sustainable health systems; and protecting health from the wide range of climate impacts. WHO supports countries in assessing health vulnerabilities, developing climate-informed surveillance systems, and closing the financing gap for health adaptation.

A joint WHO-World Bank monitoring report from December 2025 found that while most countries have made progress in expanding health service coverage, significant gaps remain. Low-income countries achieved the fastest gains but still face the largest gaps in service delivery and financial protection.

World Bank investments in health systems 🔗

The World Bank Group is committed to helping countries achieve universal health coverage by strengthening primary care systems and ensuring affordable, quality health services for all. The Bank has set an ambitious goal of supporting countries to deliver quality, affordable health services to 1.5 billion people by 2030.

In December 2025, the World Bank and the Global Fund signed a memorandum of understanding to help developing countries build stronger, more resilient health systems. The partnership plans to mobilize at least US$2 billion over three years in joint financing to strengthen primary healthcare and expand access to essential services. The collaboration focuses on sustainable financing, supply chain strengthening, and health workforce capacity building.

The World Bank has already made significant climate-related health investments across more than 100 countries, with about 80% allocated to adaptation interventions such as urgent nutrition support, surveillance systems, and emergency response centres. Through its Climate and Health Program, climate considerations are being integrated into the Bank’s $30 billion health portfolio.

Building climate-resilient primary health care 🔗

The World Health Organization has developed an operational framework for climate-resilient health systems built upon standard health system building blocks: leadership and governance, service delivery, health information systems, health workforce, essential medical products and technologies, and financing. This framework helps healthcare leaders design strategic plans to adapt to climate change risks while strengthening overall system performance.

Key actions for building climate-resilient PHC include: training health workers to recognize and manage climate-sensitive conditions; ensuring health facilities can withstand extreme weather events and maintain operations; developing early warning systems for heat emergencies and disease outbreaks; integrating climate considerations into health planning and budgeting; and strengthening supply chains to ensure essential medicines remain available during climate emergencies.

What do you think? How can your community better prepare its health systems for climate-related challenges? What role could digital health tools and community health workers play in protecting vulnerable populations in your area?

References

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