Climate variability and change are exacerbating many current climate-sensitive health outcomes and have the potential to affect the ability of health system institutions and organizations to maintain or improve health burdens in the context of changing climate and development patterns. Advancing management of these risks requires systems-based and holistic approaches to adaptation. Research and practice that crosses disciplinary boundaries are vital for supporting evidence-based policies and programmes to effectively and efficiently address the health risks of climate variability and change in the context of multistressor environments. This document in the first part reviews and synthesizes the first five years of implementation (2008–2013) of projects on health adaptation to climate variability and change in low- and middle income countries worldwide. The second part of the report presents results of qualitative research undertaken to document lessons learned and good practice examples from health adaptation projects to facilitate assessing and overcoming barriers to implementation and to scaling up.