Floods in Kerala and Assam have once again exposed the enormous challenge of protecting and saving lives during climate-related disasters. Understandably, the immediate focus shifts to rescue operations, relief camps and rebuilding damaged infrastructure. Less visible, but equally critical, is the work unfolding within public health systems. Hospitals are preparing for medical emergencies, surveillance teams are monitoring disease outbreaks, laboratories are testing water quality, community health workers are reaching vulnerable households, and public health officials are coordinating responses across departments. Long after floodwaters recede, it is the health workforce that prevents a natural disaster from becoming a prolonged public health crisis.
These responses underscore an important but often overlooked reality. Climate adaptation is often discussed in terms of resilient infrastructure, early warning systems, and disaster preparedness. These investments are essential, but they are not sufficient. The resilience of health systems ultimately depends on the workforce that delivers adaptation where it matters most—within communities, health facilities, and public health programmes. India has made important progress in recognising this reality. Through initiatives such as the National Programme on Climate Change and Human Health and its state counterparts, states have begun efforts to strengthen surveillance systems, develop region/city-specific heat action plans, improve emergency preparedness, and integrate climate considerations into several public health programmes. Kerala’s response to the current floods illustrates how health departments are increasingly incorporating public health measures into disaster response.
Despite this progress in putting systems in place, questions about sustaining these capacities remain. As climate-related hazards become more frequent and complex, can these capacities be sustained across all states, districts, and levels of the health system? More specifically, how can these surge capacity needs be met, given the huge shortage of health workers across cadres in India? More importantly, are these capacities being systematically embedded within the health workforce, or do they continue to depend on individual relief-specific programmes, committed personnel, and emergency mobilisation?
The answer lies in how we conceptualise health workforce development. It is not simply about building individual competencies but also about strengthening the systems that enable those competencies to be applied in practice. Many of the foundational competencies required for climate adaptation already exist within health systems. Disease surveillance, emergency preparedness, risk communication, outbreak investigation, and community engagement are well-established public health functions. What is changing is the context in which they must now operate. Health workers are increasingly expected to anticipate climate-sensitive disease patterns, respond to more frequent extreme weather events, protect vulnerable populations in such situations, and coordinate across sectors that influence health outcomes. Rather than replacing existing public health competencies, climate change requires expanding and reorienting them through a climate lens while introducing selected new competencies where needed.
Recognising these emerging demands, governments, academics and international organisations have started to invest in climate-health competency frameworks and training programmes. Globally, there has been growing interest in defining the competencies needed to prepare the health workforce for climate change. However, many existing competency frameworks are designed for well-resourced health systems and assume the availability of robust climate information systems, institutional capacity, and training environments that differ substantially from those found across many low- and middle-income countries, including India.
Evidence from analysis of climate-health governance across South and Southeast Asia indicates that workforce development remains fragmented, with climate-health training largely confined to donor- or project-supported initiatives. While these programmes address immediate capacity gaps, they are yet to translate into institutionalised competency development within health workforce policies, education systems, or career pathways.
This is where India’s next phase of climate-health adaptation must focus. Building climate-resilient health systems requires moving beyond isolated training programmes towards institutionalising climate-health competencies across the entire workforce lifecycle. Competencies should be integrated into pre-service education, continuing professional development, supportive supervision, workforce planning, and performance management. They must also reflect the distinct roles of community health workers, clinicians, public health professionals, managers, and policymakers, recognising that each cadre contributes differently to climate adaptation. Equally important, competency development must be supported by sustained governance, financing, and institutional mechanisms so that knowledge can be translated into routine practice rather than activated only during emergencies.
As India strengthens its climate resilience agenda, investing in the health workforce should no longer be viewed as a supporting activity. It is the foundation on which resilient health systems are built. The next climate emergency will test not only the resilience of our infrastructure, but also the preparedness of the people entrusted with protecting public health.
The writer is health systems researcher at CSEP New Delhi. Views are personal.
As India strengthens its climate resilience agenda, investing in the health workforce should no longer be viewed as a supporting activity. 
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