Climate change and malaria in Rwanda: multi-sectoral expert insights on adaptation strategies, capacity needs and implementation challenges

Climate change poses serious threats to global health, particularly through its impact on vector-borne diseases such as malaria. In Rwanda, shifting transmission patterns driven by climate variability present new challenges for the control and elimination of malaria. There is limited empirical evidence on multi-sectoral perspectives regarding existing strategies, implementation barriers, capacity needs and alignment of Rwanda’s climate-malaria responses with international frameworks. This qualitative study employed thematic analysis of 16 expert interviews from ministries, academia, non-governmental organisations and international organisations in Kigali, Rwanda. Participants were selected for their expertise in climate change, public health, environmental science and malaria epidemiology. Data were collected from September to November 2024 and analysed using ATLAS.ti. The 16 experts interviewed demonstrated a deep understanding of climate-malaria linkages and identified rising minimum temperature as key transmission driver. Geographical expansion of malaria into previously non-endemic highland areas in northern and western provinces strains health system resources with unexpected case increases requiring additional medication and staffing. Current adaptation measures include indoor residual spraying (IRS) in 12 high-burden districts (protecting 5.7 million people with 99.8% structural coverage) and universal long-lasting insecticidal nets distribution (97% coverage among pregnant women and children). However, resource constraints limit IRS expansion to newly endemic areas. Rwanda has established a Climate and Health Desk and completed climate-health vulnerability and adaptation assessment informing Health National Adaptation Plan development, yet data integration challenges persist with temporal misalignment between daily climate data and monthly malaria surveillance. Critical capacity gaps exist in climate-health education across health professional curricula. Socioeconomic vulnerabilities, including poverty, inadequate housing and gender disparities, exacerbate malaria risk, particularly affecting women, children and highland populations lacking immunity. Rwanda demonstrates institutional commitment to climate-resilient health through policy reforms and multi-stakeholder engagement. Yet, critical challenges persist in data integration, capacity development and financing. Study limitations include focus on Kigali-based experts potentially underrepresenting rural perspectives. Priorities include strengthening surveillance systems, integrating climate education in health training, addressing socioeconomic vulnerabilities and utilizing community platforms for sustainable, locally-driven malaria control.