{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:58:45Z","timestamp":1790668725121,"version":"4.1.0"},"reference-count":70,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Public Health Challenges"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Climate change presents an escalating threat to health systems worldwide, with rural populations in low\u2010income countries disproportionately affected. In Zambia, where primary healthcare (PHC) is the main access point for most communities, extreme weather events and environmental degradation increasingly disrupt service delivery and threaten health outcomes. However, limited evidence exists on how these climate risks intersect with systemic vulnerabilities in rural health systems. We explored the pathways through which climate change disrupts rural PHC delivery in Zambia and identified priority domains for adaptation and resilience\u2010building. We conducted a narrative synthesis of national data, peer\u2010reviewed literature, and regional case studies to assess climate\u2010related risks affecting rural health systems. The analysis focused on five critical domains: infrastructure damage, energy insecurity; water, sanitation, and hygiene (WASH) vulnerabilities; supply\u2010chain disruptions; and geographic accessibility. Findings were contextualized within Zambia's rural health landscape and aligned with the World Health Organization (WHO) framework on climate\u2010resilient health systems. Rural PHC services in Zambia face intersecting climate risks, including flood\u2010induced infrastructure damage, widespread energy and water insecurity, disrupted supply chains, and reduced access to care during extreme weather. These challenges are compounded by structural weaknesses, such as limited off\u2010grid infrastructure, seasonal transport barriers, and insufficient integration of climate resilience into national and district health planning. Vulnerable populations, especially women, children, and those in remote areas, experience the greatest barriers under climate stress. Strengthening climate resilience in Zambia's PHC system requires urgent, equity\u2010focused interventions across infrastructure, energy, WASH, and logistics. Mainstreaming climate adaptation into health policy and planning is essential to protect vulnerable populations and sustain health service delivery. Enhancing PHC resilience is not only critical for climate preparedness but also central to achieving universal health coverage and long\u2010term health system sustainability.<\/jats:p>","DOI":"10.1002\/puh2.70390","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T07:46:17Z","timestamp":1790667977000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Strengthening Rural Primary Healthcare for Climate Resilience in Zambia: An Equity\u2010Centered Approach"],"prefix":"10.1002","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0174-455X","authenticated-orcid":false,"given":"Newton","family":"Nyirenda","sequence":"first","affiliation":[{"name":"Chikankata District Health Office Ministry of Health  Chikankata Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Muturi","sequence":"additional","affiliation":[{"name":"University of the District of Columbia  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2808-0319","authenticated-orcid":false,"given":"Lweendo","family":"Muchaili","sequence":"additional","affiliation":[{"name":"Mulungushi University  Livingstone Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6687-3051","authenticated-orcid":false,"given":"Matenge","family":"Mutalange","sequence":"additional","affiliation":[{"name":"Mulungushi University  Livingstone Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Collins","family":"Himabala","sequence":"additional","affiliation":[{"name":"WaterAid Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7918-6682","authenticated-orcid":false,"given":"Donald","family":"Kaoma","sequence":"additional","affiliation":[{"name":"Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Ernest","sequence":"additional","affiliation":[{"name":"Chilenje First Level Hospital Ministry of Health  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3620-690X","authenticated-orcid":false,"given":"Caren","family":"Mbulo","sequence":"additional","affiliation":[{"name":"University of Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4218-6352","authenticated-orcid":false,"given":"Jackson","family":"Shawa","sequence":"additional","affiliation":[{"name":"University of Zambia  Lusaka Zambia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1272-9838","authenticated-orcid":false,"given":"Linda","family":"Siachalinga","sequence":"additional","affiliation":[{"name":"Griffith University  Gold Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21040434"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/11786302241298789"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010024\u201011695\u20105"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.5334\/aogh.2514"},{"key":"e_1_2_13_6_1","unstructured":"World Health Organization \u201cOperational Framework for Building Climate Resilient Health Systems.\u201d (World Health Organization 2015) https:\/\/www.who.int\/publications\/i\/item\/operational\u2010framework\u2010for\u2010building\u2010climate\u2010resilient\u2010health\u2010systems."},{"issue":"1","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5334\/aogh.4743","article-title":"Building Climate Resilience in Health Systems: A Climate Vulnerability and Capacity Assessment in a Rural Hospital in Chad","volume":"91","author":"Schwerdtle P. 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