Positioning health at the heart of the Just Transition

Climate change is not a future threat; it is a current danger to healthcare systems and people's well-being. In South Africa, the health system, already burdened by inequality, infrastructure constraints, and high disease rates, is under growing pressure from the impacts of climate change, rising temperatures, droughts and floods.

At the same time, the health sector contributes to emissions through energy-intensive operations, inefficient resource use, and carbon-heavy infrastructure. This dual challenge requires coordinated action to reduce the sector’s environmental footprint while preparing for climate-related demand. 

Although the Climate Change Act (2024) and the Just Energy Transition Investment Plan (JET-IP) have generated strong political momentum for a low-carbon and climate-resilient future, health remains peripheral in climate and transition strategies and there is an urgent need to advance on this crucial agenda.

At the core of a resilient health system is the question of justice and sustainability, as climate shocks disproportionately affect those already most vulnerable: rural communities, women caregivers, informal workers, and under-resourced health facilities. Therefore, building a climate-resilient health system is not only about infrastructure; it is about equity, dignity, and survival.

In this context, a new scoping study, “Climate and Health in South Africa: Pathways Toward Resilience and Equity” commissioned by AFD and carried out by Pivot Collective, maps the current state of knowledge, policy, and practice at the climate-health interface, and identifies actionable pathways and investment opportunities for low-carbon, climate-resilient health systems. 

The pathways for action identified in the study are:

1. Leadership and governance: strengthen coordination, accountability, and adaptive leadership to drive equitable, community-led, and climate-resilient healthcare action at all levels.
2. Health workforce: equip and support health workers to manage climate-related health impacts and build a more resilient and sustainable system.
3. Knowledge, data, and innovation systems: create an evidence-based system linking climate, environment, and health data to guide policy, investment, and innovation.
4. Service delivery: strengthen health services and infrastructure to withstand climate shocks, reduce emissions, and improve equity and quality of care.
5. Financing: direct and align funding to build a climate-resilient, equitable health system, prioritizing vulnerable communities and facilities.
6. Medicines and technology: transform supply chains and procurement to ensure fair access, cut environmental impact, and boost resilience to climate and resource shocks.

Another key recommendation is to prioritize equity – ensuring every action addresses historical and spatial inequities – and advance community-led resilience. These goals are key as they place social justice and people at the center of public policy and project design.