Building a climate resilient health system: Lessons from Health National Adaptation Planning (H-NAP) in Uganda

John Bosco Isunju , Aisha Nalugya, Bridget Nagawa Tamale , Justine N Bukenya, Doreen Nakalembe, Jovan Galiwango, Solomon T. Wafula , Trasias Mukama, Richard Mugambe, Gimaiyo Gerishom, Shrestha Suraj Man, Didacus B. Namanya , Hebert Nabaasa, Rhoda K. Wanyenze

Climate change is increasingly affecting both health and the systems required to deliver care, particularly in low-resource settings. In response, Uganda developed its Health National Adaptation Plan (H-NAP) 2025–2030 to guide climate change adaptation in the health sector. However, limited analytical attention has been paid to how low-resource countries are developing and institutionalising health adaptation planning, what enables these processes, and what constraints shape early implementation. This paper examines the development and early implementation of Uganda’s H-NAP using a qualitative insider policy and process case study approach. The analysis draws on policy and planning documents generated during and around the H-NAP process, including the H-NAP itself, the national Climate Change Health Vulnerability and Adaptation Assessment (VAA), and related strategic and technical materials. Guided by a climate-resilient health systems lens, the paper explores how the H-NAP emerged, how it was developed, how it frames resilience within the health sector, and what lessons its early institutionalisation offers for low-resource settings. The findings show that Uganda’s H-NAP emerged through a sequenced process of agenda setting, evidence generation, stakeholder engagement, iterative drafting, and institutional validation. The national VAA was central in reframing climate change as a health systems issue by documenting risks to facilities, service continuity, preparedness, utilities, and vulnerable populations. The H-NAP was subsequently developed as a systems-oriented adaptation instrument addressing leadership and governance, workforce development, evidence systems, integrated risk monitoring and early warning, infrastructure and supply chains, environmental determinants of health, emergency preparedness, financing, and climate-informed programming. The Ugandan case suggests that health adaptation planning can be strengthened by country-specific evidence, strategic leadership by Ministry of Health (MOH), and broad-based multisectoral engagement through consultations, technical review, and validation; however, implementation remains constrained by financing gaps, limited institutional ownership, coordination challenges, and the difficulty of translating national policy into sub-national action. Uganda’s H-NAP therefore demonstrates that the value of H-NAPs depends on whether they move beyond paper commitments through sustained financing, institutional coordination, technical capacity, and effective sub-national implementation. Importantly, it shows that Uganda should be understood not as a model to be adopted/emulated mechanically, but as a case that offers transferable lessons for other low-resource settings.