Sierra Leone is among the most vulnerable countries in the world to the adverse effects of climate change such as extreme heat, droughts, wildfires, and floods. High population densities and inadequate housing, substantial economic dependence on agriculture, and poverty and lack of socioeconomic basic needs in the population, increases the risks in the face of climate change. The objective of the Climate and Health Vulnerability Assessment (CHVA) is to provide recommendations to enhance health system resilience to climate change, including health interventions and strategies for adaptation in Sierra Leone as well as assist decision makers in the country with planning effective adaptation measures to reduce climate-related health risks.