An approach to improving the climate resilience and environmental sustainability of primary care facilities in Cederberg sub-district

Aim Primary care facilities in South Africa face growing risks from climate change and environmental degradation, yet practical tools to strengthen local resilience remain limited. This article describes a participatory approach to assessing and improving the climate resilience and environmental sustainability of primary care facilities in the Cederberg sub-district, Western Cape. Method The project adapted the Health Facility Climate Vulnerability and Capacity Assessment (VCA) tool developed by the Climate Action Accelerator and complemented it with a carbon footprint evaluation using the Climate Impact Checkup tool from Health Care Without Harm. The VCA followed five steps: (1) a desk review to identify climate hazards and contextual vulnerabilities; (2) a facility audit across four WHO domains (workforce; water, sanitation and waste; energy; and infrastructure); (3) focus group tabletop discussions to explore responses to climate events; (4) synthesis of findings into a risk and solution matrix; and (5) prioritisation of feasible interventions. The process engaged healthcare workers and managers across six facilities and generated 43 potential solutions, 14 of which were prioritised for implementation. Findings The VCA fostered awareness, collaboration, and action planning for climate resilience, while the carbon audit highlighted pathways for emissions reduction. The carbon footprint analysis revealed emissions of 10.5 kg CO₂e per consultation, with 90% arising from supply-chain activities, notably metered-dose inhalers. The process helped staff connect climate-related events with service delivery and learn how to become more resilient. Conclusion Together, the VCA and carbon footprint analysis offer a replicable model for incorporating learning on climate adaptation and mitigation into primary care systems in low- and middle-income countries.