Climate-Resilient Health Systems

Study overview

This page will continue to be updated as the study progresses
Last updated: November 13, 2025

Progress toward measurably improving health system resilience to climate-related events is uneven, partially because best practices are not yet widely recognized or well understood.

Exemplars in Global Health is partnering with the World Bank, Management Sciences for Health, Harvard T.H. Chan School of Public Health, and local research institutions on a mixed-methods positive deviance study on climate resilience in health systems, building an evidence base of strategies and interventions that have enabled certain health systems to successfully adapt to climate change. By systematically studying national or sub-national health systems that have maintained essential health services during and after climate-related events, the study aims to provide valuable lessons for directing future investments, shaping smart policies, and implementing effective interventions to build climate resilience.

Broadly, the study team will:

• Develop and validate a conceptual framework to understand how climate resilience is built and sustained, building on existing frameworks.,,

• Quantitatively identify Exemplar health systems that have demonstrated resilience to climate shocks and learning geographies positioned to adopt and adapt successful strategies.

• Work with local partners in Exemplar geographies to conduct reviews, quantitative analyses, and qualitative inquires to understand the factors that enable climate resilience in different geographical contexts.

• Translate evidence into policy and practice by synthesizing and disseminating findings in the form of actionable guidance to strengthen health system resilience in diverse contexts.

Throughout the study, a Technical Advisory Group composed of global experts in climate and health system strengthening will provide guidance on research design, execution, and dissemination.

Operational definition of a climate-resilient health system Exemplar

We define a climate-resilient health system (CRHS) Exemplar as a health system whose observed performance during and after a climate event meaningfully exceeds what would be expected given its risk profile. In this framing, the gap between the system’s observed and expected performances is its climate resilience, understood as a dynamic process of disruption, recovery, and adaptation, rather than a static state.

• Expected health system performance: A health system’s predicted performance during and after a climate event, based on the geography’s climate hazards (type, frequency, and severity), exposure (impacted populations, facilities, supply routes, and services), and structural vulnerability (including infrastructure conditions, poverty levels, equity in access to care, trust in institutions, and power dynamics).

• Observed health system performance: What the health system actually demonstrates via measurable indicators of preparedness, responsiveness, and continuity of care during and after climate-related hazards.

Figure 1, adapted from WHO’s Operational Framework for Building Climate-Resilient and Low-Carbon Health Systems, illustrates the possible trajectories that a health system’s performance could follow. An Exemplar health system may have reduced performance in the face of a climate shock or sustained stressor but can quickly recover to meet or exceed its previous performance levels.