Effects of climate-related extreme events on health system functionality in sub-Saharan Africa

Background

Sub-Saharan Africa (SSA) is a global epicentre of climate vulnerability. While climate health research often focuses on disease incidence, the impact on health system functionality remains fragmented. This systematic review synthesizes evidence on how climate-related extreme events disrupt health systems in SSA, mapped against the WHO building blocks framework.

Methods

Following PRISMA 2020 guidelines, we searched five electronic databases and grey literature for studies published between 2000 and 2026. The review included quantitative, qualitative, and mixed-methods studies focusing on extreme events and health system components in SSA. A thematic narrative synthesis was employed to analyze disruptions, equity impacts, and resilience strategies.

Results

Twenty-eight studies across 15 countries were identified. Floods (60.7%) and droughts (53.6%) were the primary hazards. Disruptions were most prevalent in service delivery (92.9%), health workforce (82.1%), and infrastructure (75.0%). Floods and cyclones typically caused acute infrastructure damage and facility closures, while droughts induced prolonged surge demand, straining supply chains and workforce capacity. Health workers faced “dual vulnerability” as both responders and victims. Significant inequities were observed, with children under five, rural populations, and internally displaced persons suffering the greatest access barriers. Resilience strategies centered on community-based approaches and local infrastructure adaptations, such as solar energy, but were frequently hindered by chronic underfunding and fragmented governance.

Conclusions

Climate extremes amplify existing structural weaknesses in SSA health systems. Transitioning toward climate-resilient systems requires integrated policies that move beyond acute emergency response toward long-term strengthening of infrastructure, workforce support, and equitable service delivery.

Key messages

• Climate-related extreme events disrupt health system functions in sub-Saharan Africa, exposing critical weaknesses in service delivery, workforce, infrastructure, and medical product access.

• Without equity-focused, climate-resilient strategies, these disruptions will widen health disparities and undermine progress toward resilient and equitable health systems.