Learning from COVID and climatic events to build a resilient health system: Western Cape Department of Health

Background The devastating KwaZulu-Natal floods in early 2022 were a reminder of the extensive damage to property and loss of life that climate change will exacerbate in South Africa. Extreme weather events are projected to increase in frequency and intensity in the southern African region. In recent years, the Western Cape has experienced fires, floods, drought, load-shedding, and COVID-19. Approach This chapter reflects on the experience of the Western Cape Department of Health around a series of adverse events in the province. The main lessons are identified, and a framework is suggested to strengthen the health sector’s response to climate change. The Department has been on an intentional learning journey to strengthen the health system, build health-system resilience, and to learn from these events. In addition to the need to adapt to external events, the health system itself contributes to greenhouse gas emissions. As such, the Department has discussed the mitigation activities it is engaged in to reduce its contribution to climate change. Building on the lessons learned from adverse events, the Department has identified five focus areas to strengthen the health sector’s ability to respond to climate change: (i) structural and relational aspects of governance; (ii) stewardship, leadership, and management; (iii) partnerships and intersectoral collaboration; (iv) system capacities; and (v) learning oriented culture. Conclusions As the impacts of climate change are increasingly felt, there is an urgent need to share lessons from the health sector’s response to adverse events. This learning can assist in implementing adaptive actions that strengthen health-system functions and that mitigate the health sector’s greenhouse gas emissions. Health-sector leadership in South Africa needs to participate actively in climate action through the Presidential Climate Commission and other fora. The chapter concludes with recommendations that speak to the focus areas and shared learnings that can be helpful in other settings where health systems face climate risks.