Navigating the climate-health nexus: an interest-holder analysis of the public health gaps in Uganda's climate response.

BACKGROUND: Climate change is increasingly recognised as a major threat to health in Uganda, yet gaps in implementation, financing and coordination may limit the country's climate-health response. This study aimed to understand how national-level interest-holders perceive the availability, adequacy and functioning of policy, governance and financing mechanisms for integrating health into climate action. METHODS: In-depth interviews were conducted with nine key interest-holders purposively selected from ministries, departments and agencies responsible for health, climate change, planning and finance and from academic institutions engaged in climate and health programming and research. A total of 14 individuals were approached and 9 agreed to participate. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Saturation was assessed iteratively by monitoring whether successive interviews yielded new codes or substantively new themes. RESULTS: Interest-holders described a relatively strong climate policy and legal framework that increasingly recognises health but does not fully operationalise climate-health action. Implementation was reported to be constrained by underfunding, fragmented and siloed governance and weak subnational capacity. Climate-related hazards were reported to be damaging health facilities, disrupting access to care and increasing climate-sensitive disease burdens, while local innovations and emerging climate-smart practices remain too limited to guide implementation at scale. Major gaps in evidence for effective health-focused adaptation and mitigation and in climate-health training and public education were identified as limiting the ability of decision-makers, health workers and communities to anticipate and respond to climate risks. CONCLUSIONS: Uganda's relatively robust climate policy framework is undermined by incomplete implementation, driven by constrained financing, limited evaluation and fragmented delivery systems. Strengthening climate-resilient health systems will require embedding climate-health policies into routine health planning and financing, empowering local action using climate information and investing in research, training and public education. Cross-sectoral actions grounded in whole-government and multisectoral governance approaches are also essential to address climate-health challenges.