Vol. 4 No. 1 (2026)
Integrating Climate Resilience into Primary Care: A Review of Opportunities within South Africa's National Health Insurance Framework (2021–2026)
Abstract
Climate change poses a significant and escalating threat to public health in South Africa, exacerbating disease burdens and straining a fragmented health system. This review examines the critical opportunity to integrate climate resilience strategies into primary healthcare (PHC) through the ongoing development of the National Health Insurance (NHI) framework. Employing a narrative synthesis, we systematically analysed peer-reviewed literature, government policy documents, and relevant grey literature published between 2021 and 2026. A structured search strategy was executed across academic databases, with clear inclusion criteria focusing on NHI implementation phases and climate adaptation in the South African health sector. The analysis identifies convergent priorities, revealing that the NHI’s emphasis on strengthening PHC, community-oriented care, and infrastructure presents a strategic platform for mainstreaming specific climate interventions. Evidence from the literature substantiates the potential for integrating early-warning systems for climate-sensitive diseases, clinic-level heat-health action plans, and targeted training for healthcare workers on climate-related health impacts. The argument posits that without such deliberate integration, the NHI’s goals of equitable access and universal health coverage will be undermined by escalating climate shocks. The review concludes that the current policy window is crucial for embedding climate resilience into the core of South Africa’s health system redesign, offering a model for other nations seeking to build robust, responsive, and equitable health systems.
Read the Full Article
The HTML galley is loaded below for inline reading and better discovery.
How to Cite
Keywords
Research Snapshot
Desktop reading viewReferences
- , S.A.H.H.A.H.P.S.2.A.P.T.F.C.(.&.W.H.R.I.2.I.T.P.2.D.T.R.W.O.B.T.M.D.O.B.B.S.I.A., & sides., T.I.H.C.(.W.F.T.W.T.B.O.A.S.P.T.I.R.O.D.A.E.A.P.A.E.T.S.A.D.O.I.R.G.C.A.T.O.B. (2023). Abstract. Vox Sanguinis. https://doi.org/10.1111/vox.13534 http://dx.doi.org/10.1111/vox.13534
- Addaney, M., Kwadwo Dumenu, W., & Jarbandhan, D.B. (2023). Introduction to Climate Change, Adaptation Policy and Resilient Development in Africa. Climate Change in Africa. https://doi.org/10.1007/978-3-031-30050-9_1
- Afinowi, O.A. (2023). Multi-Level Climate Change Adaptation Governance in Lagos in Nigeria and the Western Cape in South Africa. Climate Change in Africa. https://doi.org/10.1007/978-3-031-30050-9_6
- Akinrinde, O.O., & Telukdarie, A. (2024). Policy (In)Consistency and Sustainable Development Goals in Africa: A Systematic Literature Review. Annals of Spiru Haret University Economic Series. https://doi.org/10.26458/2345 http://dx.doi.org/10.26458/2345
- Fortoen, E.A. (2024). National Health Insurance (Nhi) and the Podiatry Profession in South Africa. https://doi.org/10.2139/ssrn.4991341
- Gbomagba, M., Afinowi, O.A., & Kumi, N. (2023). Climate Change Adaptation Governance in Africa: The Legal and Institutional Frameworks. Climate Change in Africa. https://doi.org/10.1007/978-3-031-30050-9_3
- Kamwendo, T. (2023). Improving Access to Healthcare in South Africa through the National Health Insurance Scheme: A Hit or a Miss?. Politeia. https://doi.org/10.25159/2663-6689/14991
- Khavhagali, V., Reckien, D., Biesbroek, R., Mantlana, B., & Pfeffer, K. (2023). Understanding the climate change adaptation policy landscape in South Africa. Climate Policy. https://doi.org/10.1080/14693062.2023.2268576
- Makoni, M. (2023). South Africa passes National Health Insurance Bill. The Lancet. https://doi.org/10.1016/s0140-6736(23)01294-1
- Makungo, R., & Nkuna, T.R. (2023). Prioritising climate coping and adaptation strategies for smallholder farmers in Luvuvhu River Catchment, South Africa. Climate Services. https://doi.org/10.1016/j.cliser.2023.100361
- Maphunye, K., & Dibie, R. (2025). HEALTH POLICY ANALYSIS IN SOUTH AFRICA. Transforming Healthcare in Africa. https://doi.org/10.2307/jj.24751877.26
- Mazibuko, S.M., Govender, P., & Nadasan, T. (2025). Stakeholders’ views on public-private partnerships for rehabilitation services in South Africa ahead of National Health Insurance. South African Family Practice. https://doi.org/10.4102/safp.v67i1.6013
- Mkhwanazi, T. (2024). Assessing the National Health Insurance (NHI) in South Africa: Policy Formulation, Stakeholder engagement and Implementation Challenges. European Journal of Medical and Health Research. https://doi.org/10.59324/ejmhr.2024.2(6).27
- Mokoena, S.V., & Naidoo, P. (2024). A quantitative study to evaluate the controls and accountability measures in place to alleviate the leadership and governance challenges impacting the realization of the National Health Insurance (NHI) in South Africa. Health Research Policy and Systems. https://doi.org/10.1186/s12961-024-01251-2
- Mpanza, N., & O’Keeffe, P. (2024). Young people’s participation in the National Health Insurance Policy in South Africa. Research Handbook on the Sociology of Youth. https://doi.org/10.4337/9781803921808.00040
- Mukudu, H., Otwombe, K., Fusheini, A., & Igumbor, J. (2023). Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa. Southern African Journal of Public Health. https://doi.org/10.7196/sajph.2023.v6.i2.173
- Mukudu, H., Otwombe, K., Fusheini, A., & Igumbor, J. (2023). Modelling and forecasting of primary healthcare utilisation, perceived quality of care and non‐emergency referrals to hospitals in a national health insurance pilot district of South Africa. Southern African Journal of Public Health. https://doi.org/10.7196/shs.2023.v6.i2.173
- Naidoo, V., Suleman, F., & Bangalee, V. (2024). Medical Insurance Representatives Perceptions on National Health Insurance Primary Healthcare Re-Engineering in South Africa: A Qualitative Study. Journal of Primary Care & Community Health. https://doi.org/10.1177/21501319241237044
- Narain, S., & Mathye, D. (2023). Strategies to integrate physiotherapists into primary health care in South Africa. South African Journal of Physiotherapy. https://doi.org/10.4102/sajp.v79i1.1796
- Ngang, C.C. (2023). Climate Change Impediments to Realising the Right to Development in Africa. Climate Change in Africa. https://doi.org/10.1007/978-3-031-30050-9_2
- Nyahunda, L. (2024). Integration of indigenous knowledge systems (IKS) into climate change mitigation and adaptation endeavours: milestones and gaps in South Africa and Zimbabwe’s climate policy frameworks. Climatic Change. https://doi.org/10.1007/s10584-024-03822-2
- OBISANYA, T.A., & JEGEDE, A.O. (2025). Topic: Mobility as Climate Change Adaptation in South Africa: Exploring the legal and policy significance of Artificial Intelligence.. https://doi.org/10.31223/x5d729
- Oweibia, M., Elemuwa, U.G., Akpan, E., Daniel, E.T., Oruikor, G.J., Tarimobowei, E., Okoho, E.E., Elemuwa, C.O., Raimi, M.O., & Babatunde, A. (2024). Analyzing Nigeria’s Journey Towards Sustainable Development Goals: A Comprehensive Review From Inception to Present. Qeios. https://doi.org/10.32388/8o5qeg
- Sithole, E. (2023). Climate change journalism in South Africa: noticeable improvements, less than adequate. https://doi.org/10.15626/fojo.s.202301
- van Wyk, S. (2025). Climate Change Law and Policy in South Africa and Mauritius: Adaptation and Mitigation Strategies in Terms of the Paris Agreement. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.5284066