Climate change is threatening the sustainability of health systems performance and development goals. Integrating climate change adaptation into development work does not require implementing development activities in a completely new way. It requires considering the climate impacts and identifying opportunities to adapt and transform as necessary. Health systems strengthening activities should include climate considerations by promoting and building capacity for effective and iterative risk management across all levels, fostering multi-sectoral engagement, and identifying actions and investments over the short- and long-term to increase system resilience.