Overview of Results

This guide presents the infrastructure-focused component of the broader Climate-SMART PHC facility inventory. After excluding measures classified under readiness, service continuity, and skills, the guide includes 6 infrastructure domains, 23 subdomains, and 88 technologies or measures. Together, these measures capture the main infrastructure-related options identified as relevant to improving the safety, resilience, and environmental performance of primary health care (PHC) facilities, particularly in low- and middle-income country settings. 

The distribution of measures across domains was not uniform. The largest groups were found in Energy resilience (19 measures), Structural and site resilience (18), and Thermal safety and passive survivability (17). These were followed by Air quality protection (14), Water security, sanitation and safe environmental services (11), and Healthy facility environment and exposure reduction (9). This pattern suggests that the strongest body of practical guidance currently available for PHC infrastructure still clusters around building and site protection, thermal safety, utility continuity, and core environmental health services.

The final classification results show a clear concentration of measures in the High and Medium relevance categories. Of the 88 measures included, 34 were rated High, 26 were rated Medium, and 12 were rated Very High. Only a smaller number fell into the Low (12) and Very Low (4) categories. Overall, this suggests that the infrastructure measures retained in the guide are not only technically valid, but also broadly aligned with the practical needs of PHC facilities. At the same time, the predominance of High over Very High ratings indicates that many measures are relevant and useful, but not always universally feasible or equally appropriate across all PHC contexts.

A consistent pattern also emerged when the final ratings were read together with the other classification variables. The measures considered most relevant were usually those that combined strong functional value for PHC, reasonable cost–value fit, manageable implementation and maintenance demands, and good applicability to existing facilities. In practice, this means that higher-priority measures were often those that could be implemented through retrofit or adaptation, or in both retrofit and new construction contexts. Measures that depended mainly on major reconstruction, complex procurement, or highly specialized technical support were less likely to emerge as top priorities.

Across the inventory, the most important infrastructure patterns were those that protect the basic conditions required for PHC facilities to remain safe and functional under climate stress. These include site drainage and flood management, safe access and building envelope protection, thermal buffering and passive survivability, energy continuity for essential services, and water, sanitation, and wastewater safety. Taken together, the results suggest that the most relevant infrastructure strategies for PHC are not necessarily the most technologically advanced, but those that are practical, robust, and adaptable to the realities of routine service delivery in lowresource settings.

Most infrastructure measures were rated as highly or moderately relevant for PHC.
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.

Practicality mattered more than technological sophistication.
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.

Retrofit-friendly measures stood out.
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.

Basic facility operability remained the central priority. 
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.