Navigating the climate–health nexus: an interest-holder analysis of the public health gaps in Uganda’s climate response

Abstract Background Climate change is increasingly recognised as a major threat to health in Uganda, yet gaps in implementation, financing and coordination may limit the country’s climate–health response. This study aimed to understand how national-level interest-holders perceive the availability, adequacy and functioning of policy, governance and financing mechanisms for integrating health into climate action. Methods In-depth interviews were conducted with nine key interest-holders purposively selected from ministries, departments and agencies responsible for health, climate change, planning and finance and from academic institutions engaged in climate and health programming and research. A total of 14 individuals were approached and 9 agreed to participate. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Saturation was assessed iteratively by monitoring whether successive interviews yielded new codes or substantively new themes. Results Interest-holders described a relatively strong climate policy and legal framework that increasingly recognises health but does not fully operationalise climate–health action. Implementation was reported to be constrained by underfunding, fragmented and siloed governance and weak subnational capacity. Climate-related hazards were reported to be damaging health facilities, disrupting access to care and increasing climate-sensitive disease burdens, while local innovations and emerging climate-smart practices remain too limited to guide implementation at scale. Major gaps in evidence for effective health-focused adaptation and mitigation and in climate–health training and public education were identified as limiting the ability of decision-makers, health workers and communities to anticipate and respond to climate risks. Conclusions Uganda’s relatively robust climate policy framework is undermined by incomplete implementation, driven by constrained financing, limited evaluation and fragmented delivery systems. Strengthening climate-resilient health systems will require embedding climate–health policies into routine health planning and financing, empowering local action using climate information and investing in research, training and public education. Cross-sectoral actions grounded in whole-government and multisectoral governance approaches are also essential to address climate–health challenges.