Assessing governance structures for climate-resilient and sustainable health systems: development of the PHONIC framework

Background: The consequences of climate change have detrimental effects on human health. The establishment of functional governance structures is considered crucial for addressing health challenges, as such structures provide the foundation for coordinated and coherent action. At present, no standardised and internationally applicable approach exists for assessing and benchmarking governance structures for climate and health at national level. Therefore, the objective of this study was to develop the PHONIC framework, a tool designed to assess governance structures for climate-resilient and sustainable health systems. Methods: We followed a four-step approach: First, we selected a methodology, originally designed for assessing food environment policies, and assessed its applicability to governance structures for health and climate change. This methodology comprises five key stages, as well as a set of indicators and a catalogue of good practice examples. Second, we identified and adapted existing indicators, through online consultations with international experts, and collated good practice examples for the assessment of governance structures for climate-resilient and sustainable health systems. Third, we piloted the framework with national expert groups in two countries, Germany and Kenya. Finally, we evaluated the PHONIC framework's application and revised the methodology based on the findings from the pilot phase. Results: The final PHONIC framework includes a set of ten indicators across three thematic areas: three indicators focused on governance, four on policy development, and three on cross-sectoral collaboration. In addition, we compiled a catalogue of good practice examples for climate-resilient and sustainable health systems, currently comprising 47 examples from 32 countries. The piloting revealed opportunities, such as the participatory process, but also challenges regarding the narrow focus on health systems. Conclusions: The PHONIC framework, with its participatory and adaptable approach, enables the benchmarking and comprehensive analysis of the strengths and weaknesses of governance structures for climate-resilient and sustainable health systems at country level. The potential of the framework could be expanded by including international experts from a broader geographic scope and systematic searches for good practice examples. Decision makers in the health sector can use the outcomes of the PHONIC framework to identify the most relevant areas and actions for improvement of their climate change and health governance.