Climate change intensifies health risks globally, yet health systems in low- and middle-income countries remain poorly integrated into national adaptation frameworks. In southwest coastal Bangladesh, salinity intrusion threatens drinking water access and population health, with documented links to hypertension, pre-eclampsia, kidney dysfunction, and gastrointestinal disease. Women bear a disproportionate burden through water-related labor and constrained healthcare access. While prior research has addressed environmental causes of salinity and water security technologies, the political economy of health system integration into adaptation efforts remains unexplored.

This qualitative study conducted 11 semi-structured expert interviews with practitioners from government, non-governmental organizations, international organizations, research institutes, and universities. Thematic analysis used an inductive-deductive approach guided by a political economy framework.

Ten of eleven experts confirmed the virtual absence of health-specific adaptation interventions beyond water provision. Diverse water strategies exist but are undermined by implementation gaps, short-term funding cycles, and absent maintenance. Institutional barriers, including technocratic dominance in adaptation planning, insufficient health budgets, and weak cross-sectoral coordination, systematically marginalize health and gender concerns.

Health adaptation gaps in coastal Bangladesh are structurally produced, not incidental. This study is among the first to apply a political economy lens to this context, demonstrating how donor-driven and infrastructure-led adaptation logics marginalize preventive and gender-responsive health care. Effective adaptation requires integrating health into national frameworks with dedicated budgets, building climate-informed health worker capacity, and establishing cross-sectoral coordination between health, water, sanitation, and hygiene (WASH), and gender sectors.