Building climate-resilient primary care: A convergent mixed-methods climate vulnerability and capacity assessment in the Cederberg subdistrict, South Africa.

OBJECTIVES: To evaluate the climate resilience of primary care facilities and services in the Cederberg subdistrict of the Western Cape, South Africa.

STUDY DESIGN: We conducted a convergent parallel mixed-methods study to assess the climate vulnerability and adaptive capacity of a primary care network. Quantitative facility audits and qualitative focus groups were undertaken, with subsequent integration to identify risks and generate context-specific adaptation options.

METHODS: The study combined a structured audit of primary care facilities with a rapid qualitative assessment involving focus groups with health workers. Quantitative and qualitative datasets were analysed separately and then synthesised to map vulnerabilities and propose feasible adaptation measures. The subdistrict management team later used the integrated findings to prioritise adaptation actions.

RESULTS: Across six primary care facilities, extreme heat was the most significant hazard, particularly where indoor temperatures rose above 40 °C, contributing to staff fatigue, overcrowding as community members sought refuge, and a higher risk of heat-related illness. Heat was also linked to increased drought and wildfire risk. Irregular and excessive rainfall further disrupted service delivery through flooding, road closures, delays in essential supplies, and increased waterborne and respiratory illness. Coastal facilities faced additional exposure to storm surge and sea-level rise. Environmental and operational sustainability challenges, including reliance on carbon-intensive electricity, waste-related emissions, inconsistent water quality, and limited backup water supply, amplified these climate-related risks. The assessment identified a consolidated set of risks across heat, rainfall, flooding, and sustainability domains, and generated 42 feasible adaptation options across infrastructure; governance; service delivery; workforce; energy; and water, sanitation and waste.

CONCLUSIONS: This study demonstrated that facility-level VCA assessments can successfully guide climate resilience planning in African primary care settings. The VCA process identified context-specific hazards, risks and feasible adaptation options across key domains of health system function. The approach provides an adaptable framework for other African settings seeking to strengthen primary care resilience to climate impacts. Transitioning from assessment to implementation will require local capacity to conduct VCAs independently and access to sustainable climate finance to support action.