Developing a strategic plan for a climate-resilient health system in Iran.

Climate change is a long-standing natural process that has been significantly accelerated in recent decades by anthropogenic activities, resulting in profound shifts in climate patterns and escalating risks to human health. Iran, characterized by predominantly arid and semi-arid conditions, chronic water scarcity, and complex socio-economic constraints, is highly vulnerable to climate-related hazards, including droughts, floods, heatwaves, air pollution, and climate-sensitive diseases. In this context, health systems have a dual responsibility: to strengthen adaptive capacity and resilience while simultaneously reducing their own carbon footprint. This study aimed to develop the National Strategic Plan for a Climate-Resilient and Environmentally Sustainable Health System in Iran (2023-2027) using a participatory action research approach. A multi-sectoral national committee conducted a Strengths, Weaknesses, Opportunities, and Threats analysis to assess internal and external determinants of climate resilience within Iran's health system. Quantitative scoring of strategic factors indicated a mean score of 2.47/4 for internal factors and 2.12/4 for external factors, positioning the health system within a precautionary strategic quadrant, characterized by limited internal capacity and substantial external threats. Based on these findings, a strategic plan was formulated, including a clearly defined vision, mission, values, seven strategic goals, twenty objectives, and a set of 181 prioritized actions. The findings demonstrate that while Iran's health system possesses important structural strengths, particularly in primary health care, it faces critical challenges related to financing, workforce preparedness, and environmental pressures. This study presents a set of strategies and actions to strengthen the climate resilience of Iran's health system by 2027, emphasizing governance, financing, workforce capacity, infrastructure, information systems, and service delivery. This strategic plan provides an evidence-informed and context-specific roadmap to guide policy-makers and health managers in strengthening climate resilience and environmental sustainability, with potential relevance for other middle-income countries confronting similar climate vulnerabilities.