Climate-related health threats in Tanzania: a multilevel analysis of key policies, strategies, and community response

Tanzania faces increasing climate-sensitive health threats, including vector-borne diseases, waterborne infections, and malnutrition. Effective preparedness at both national and community levels is critical for health system resilience and livelihood security. This study applied a multilevel mixed-methods approach to assess Tanzania's policy structures and community-level experiences related to climate-health preparedness. Between January 2024 and May 2025, we conducted a concurrent mixed-methods study. At national level, we reviewed climate-health policy documents, mapped 30 key stakeholders, and conducted 15 semistructured interviews with representatives from government ministries, research institutes, development partners, and nongovernment organizations. At community level, we surveyed 388 adults and conducted eight focus group discussions in four councils in southern Tanzania. Data were analysed and triangulated across all sources. Tanzania has developed several climate-health policies and community initiatives. However, gaps remain in cross-sectoral coordination, financing, and policy implementation. National stakeholders cited challenges in translating strategies into community-level action. Among community respondents, 77% acknowledged climate change and 97% reported exposure to hazards such as floods, drought, or extreme heat. Health impacts included malaria surges, diarrhoeal disease, and food scarcity. While 73.7% had received some government assistance, access to reliable health and climate information was limited. Households relied mainly on personal observations and informal networks. Communities and institutions jointly emphasized four priorities: strengthened risk communication, climate-smart agriculture, resilient health facilities, and inclusive early warning systems. Strengthening multilevel governance, financing mechanisms, and community-driven adaptation planning is essential to improve Tanzania's preparedness for climate-related health threats.