Integrating Climate Resilience into Primary Care: A Review of Opportunities within South Africa's National Health Insurance Framework (2021–2026)

Climate change poses a significant and escalating threat to public health in South Africa, exacerbating disease burdens and straining a fragmented health system. This review examines the critical opportunity to integrate climate resilience strategies into primary healthcare (PHC) through the ongoing development of the National Health Insurance (NHI) framework. Employing a narrative synthesis, we systematically analysed peer-reviewed literature, government policy documents, and relevant grey literature published between 2021 and 2026. A structured search strategy was executed across academic databases, with clear inclusion criteria focusing on NHI implementation phases and climate adaptation in the South African health sector. The analysis identifies convergent priorities, revealing that the NHI's emphasis on strengthening PHC, community-oriented care, and infrastructure presents a strategic platform for mainstreaming specific climate interventions. Evidence from the literature substantiates the potential for integrating early-warning systems for climate-sensitive diseases, clinic-level heat-health action plans, and targeted training for healthcare workers on climate-related health impacts. The argument posits that without such deliberate integration, the NHI's goals of equitable access and universal health coverage will be undermined by escalating climate shocks. The review concludes that the current policy window is crucial for embedding climate resilience into the core of South Africa's health system redesign, offering a model for other nations seeking to build robust, responsive, and equitable health systems.