Methodology
This Technical Guide was developed1 through a structured review of international references on climate-resilient, safe, and environmentally sustainable health care facilities, with a specific focus on their relevance for primary health care (PHC), maternal, newborn, and child health, and low- and middle-income country contexts. The reference base combined global health-sector frameworks, PHC-oriented guidance, health facility resilience tools, retrofit standards, and hazard-specific technical documents from WHO, UNICEF, the World Bank, PAHO, FEMA, and other supporting sources cited above. [1–20]
The analysis organized this material into technical domains and subdomains relevant to PHC facilities, allowing similar types of measures to be reviewed together. Within this structure, each measure was treated as a distinct analytical unit, enabling a consistent comparison across different types of interventions, including building features, retrofit solutions, environmental controls, utility systems, and operational actions.
A central component of the methodology is the use of a small set of classification variables that allow measures to be compared not only in technical terms, but also in terms of their practical relevance for PHC in low-resource settings. Four variables are particularly important:
- Cost–value fit for PHC settings, which assesses whether a measure is financially justified in relation to its likely practical benefits in PHC facilities, using a scale from Very Low to Very High;
- Applicability to retrofit or new construction, which distinguishes whether a measure is mainly feasible for upgrading existing facilities, depends on new construction, or can be applied in both contexts;
- Implementation and maintenance complexity, which captures the non-financial difficulty of adopting and sustaining the measure, including installation requirements, need for technical expertise, maintenance burden, and dependence on specialized systems;
- MNCH / PHCF applicability, which expresses the overall relevance of the measure for maternal, newborn, and child health services in PHC facilities.
Among these, the MNCH / PHCF applicability rating functions as a synthetic prioritization variable, derived from the combined interpretation of the other dimensions. This means that a measure is not only assessed on whether it is technically effective, but also on whether it is realistically feasible, financially appropriate, and operationally suitable for PHC facilities in low- and middle-income countries. In this way, the methodology explicitly prioritizes measures that are both impactful and implementable in real-world PHC contexts.
Key messages from the results
The final classification showed a clear concentration of measures in the High and Medium applicability categories, indicating that a substantial share of the technologies reviewed are not only technically valid, but also broadly appropriate for primary health care facilities in low- and middle-income country contexts.
The measures that emerged as more relevant were generally those with clear functional value, reasonable cost– value fit, and manageable implementation and maintenance demands. This means that the strongest priorities were often not the most advanced technologies, but the ones most likely to deliver direct and realistic benefits in routine PHC conditions.
Many of the more relevant measures were those that could be applied through retrofit or adaptation of existing facilities, or in both retrofit and new construction contexts. This is particularly important in LMIC settings, where PHC infrastructure is often older, physically constrained, and more likely to be upgraded incrementally than replaced through new construction.
Across the review, the most consistent thematic priorities were measures that protect the minimum conditions required for PHC facilities to remain safe and functional. These included building and site protection, thermal safety, energy continuity, water supply, sanitation, and wastewater safety. Taken together, the results suggest that the most valuable infrastructure strategies for PHC are those that are practical, robust, and adaptable, and that help facilities continue operating during climate-related stress or disruption.
Video Gallery
References
AI Disclaimer: This document benefited from the use of artificial intelligence tools for image generation, text editing, and drafting support. All content has been reviewed, validated, and adapted by the author, who retains full responsibility for its accuracy and interpretation.