Healthcare Workers’ Climate Change Knowledge and Training Gaps in Mačva District, Serbia

Background

Climate change challenges health systems, requiring prepared and climate-competent health workers (HW). However, evidence on HWs preparedness remains limited in South-Eastern Europe (SEE). As part of a regional study conducted by SEE Network on Workers’ Health and coordinated by the Institute of Occupational Health of R.N.M, WHO Collaborating Center for Occupational Health, in North Macedonia, we assessed climate change awareness, barriers, and training gaps among HWs in Serbia.

Methods

We conducted a cross-sectional survey of 322 HWs from nine institutions across three healthcare levels (primary, secondary/tertiary, and public health institutes - PHI) in Serbia’s Mačva district in 2025. A validated, specially designed questionnaire for this regional survey assessed awareness, perceived barriers, training exposure, and policy knowledge. Differences across healthcare levels and occupational groups were examined using χ² tests.

Results

Among respondents (79% female; mean age 43±12 years), 95% acknowledged climate change and 64.3% reported moderate to high concern. Only 11.8% had received climate-related training, 3.7% were aware of relevant policies, and 5.9% reported involvement in initiatives. Key barriers included lack of training (53.1%), knowledge (43.5%), and interest (41.6%). PHI HWs reported the greatest gaps (training 65.4%, knowledge 59.3%), compared with secondary/tertiary HWs (37.8% and 35.4%), while primary level HWs most often cited lack of time for public communication (44.2%) and resources for climate action (43.4%).

Conclusions

HWs in Serbia demonstrate high awareness of climate change but limited preparedness for action. Substantial gaps in training, policy engagement, and system support (particularly among public health professionals) indicated missed opportunities to strengthen climate-resilient health systems, highlighting the need for targeted capacity-building and the integration of climate competencies into HW training.

Key messages

• Despite 95% of healthcare workers acknowledging climate change, only 11.8% received training, and 3.7% knew of climate health policies, revealing an important knowledge–action gap.

• Public health institute workers reported the highest training gaps (65.4%), highlighting level-specific capacity-building needs across the healthcare system.