INTRODUCTION:
Climate change poses escalating risks to public health, disproportionately affecting vulnerable populations and intensifying threats related to extreme heat, air pollution, vector-borne diseases, water insecurity, and environmental degradation. In the Western Cape, these pressures have highlighted the need for a coordinated, system-wide health sector response. Recognizing the critical role of governance in climate resilience, the Western Cape Department of Health and Wellness initiated a policy transformation to integrate Climate Change, Environmental Health, and One Health approaches into provincial health planning and service delivery.

METHODS:
A qualitative policy analysis was conducted to assess strategic requirements and policy gaps for climate–health integration within the Department. Data sources included internal policy documents, multisectoral engagements and interdepartmental working groups. A thematic governance framework was applied to identify systemic barriers, enabling factors, and opportunities for embedding climate resilience within the health system.

RESULTS:
Four key governance themes emerged: 1) fragmented governance arrangements requiring a dedicated provincial coordination mechanism for climate and health; 2) surveillance gaps underscored by limited early warning for climate-sensitive diseases thus highlighting the need for integrated environmental and meteorological data systems; 3) fragmented multisectoral alignment constraining implementation of One Health approaches at zoonotic and health interfaces; and 4) significant demand for capacity building through structured knowledge exchange, technical training, and standardised operational tools. These directly informed the establishment of South Africa’s first Provincial Climate Change Sub-Directorate and development of a Provincial Health Climate Change Strategic Plan encompassing mitigation and adaptation measures.

CONCLUSIONS:
Integrating Climate Change, Environmental Health, and One Health into provincial health governance requires clear institutional mandates, strengthened surveillance systems, and operationalised multisectoral collaboration. The Western Cape experience offers a scalable governance model for embedding climate resilience within public health policy, planning, and service delivery.