Facilitators and barriers to mainstreaming climate change adaptation and mitigation into sub-national health systems: Perspectives from primary health care managers in low-resourced settings of Ghana

Abstract

Objectives This article explores the perspectives of primary healthcare managers on context-specific facilitators and barriers to mainstreaming climate change adaptation and mitigation into the operations in three primary healthcare (PHC) systems in low-resourced settings of the Upper East Region of Ghana. Study design A framework approach utilising inductive coding, guided by the Consolidated Framework for Implementation Research Index (CFIR Index) dimensions, to examine the perspectives of PHC managers on facilitators and barriers to mainstreaming climate change adaptation and mitigation in PHC operations. Methods Between October 31 and November 25, 2022, 18 purposively sampled PHC managers from three PHCs in the Upper East Region of Ghana participated in key informant interviews on facilitators and barriers to mainstreaming the WHO frameworks on building climate resilience and environmentally sustainable health systems. Key-informant interview guides were used to generate the data. Inductive codes were generated along secondary themes of suitability of the framework for PHC, PHC systems and stakeholders, PHC programming attributes and culture, and PHC managers’ identification with the WHO framework. Results The WHO framework is perceived as suitable because of its alignment with health systems/PHC vision and its potential to enhance staff safety and client satisfaction. PHC programming attributes and culture, such as positive and open learning environments, strong networks, and well-developed systems and structures, were reported as facilitators. Furthermore, high-risk perception, perceived service improvements, and self-efficacy were reported as facilitators. PHC systems and stakeholders are reported as barriers due to the absence of policy frameworks and incentives, inadequate staff and system capacities, and the cost of mainstreaming. Conclusion Mainstreaming climate action into PHC policies, protocols, and programmes with built-in accountability mechanisms and financing is critical for sustained action.