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This paper describes the work of the International Research Institute for Climate and Society (IRI) and its partners towards the development of climate services for the health sector in Africa; integrating research, operational applications and capacity building alongside policy development and advocacy. It follows the evolution of IRI's health work from an initial focus on the use of seasonal climate forecasts to a wider agenda serving climate and environmental information needs to a broad range of health-related users. Recognizing that climate information must be relevant to the priority policy and programming needs of national and international health stakeholders, this review highlights an approach that has centered not only on the assessment and creation of evidence, but also on knowledge transfer through engagement with decision-makers. Current opportunities and priorities identified for the routine use of climate and environmental information in health in Africa include: i) understanding mechanisms by which climate impacts on transmission and occurrence of disease; ii) mapping populations at risk both in space and by season; iii) developing early warning systems; iv) understanding the contributions of climate to trends in disease incidence v) improving the evaluation of the impacts of climate-sensitive interventions. While traditional metrics (e.g. peer review publications) have been important in establishing evidence for policy, the IRI's role as a knowledge broker (in research and professional capacity building, facilitation of communities of practice, and engagement in policy dialogue at local and global scale) has been critical to delivery of its mission.