Building climate-resilient, low-carbon health systems: A knowledge, attitudes and practices study with the primary healthcare workforce in Lebanon

Background: Climate change poses increasing threats to human health and health systems, particularly in low- and middle-income countries where exposure and vulnerability tend to be high and readiness to adapt tends to be low. A climate-smart health workforce - equipped to address climate-related health risks and reduce the environmental footprint of healthcare - is a core pillar of resilient health systems. This study explored the knowledge, attitudes, and practices of Lebanon's primary healthcare workforce concerning climate change and health, to inform capacity-building efforts. Methods: We conducted a qualitative study using a knowledge, attitudes and practices framework, comprising three focus group discussions (n = 24) with primary healthcare professionals. Data were collected in March 2025, using a semi-structured discussion guide. Thematic analysis was conducted using the Framework Method. Findings: Participants expressed general awareness of climate-related health risks - particularly respiratory illness and waterborne disease - but demonstrated limited understanding of underlying drivers or systemic impacts. While climate change and health issues were often discussed informally in personal settings, they were rarely integrated into professional practice. Existing sustainability efforts varied across facilities. Nearly all participants reported no prior climate change and health training but expressed strong interest in flexible, practice-oriented learning opportunities. Interpretation: Despite growing awareness, Lebanon's primary healthcare workforce lacks structured education and institutional support to respond effectively to climate-related health challenges. Embedding climate change and health competencies into health workforce development - through locally adapted, scalable training programs - is needed to build climate-resilient and low-carbon health systems in Lebanon and similar settings.