West African countries, such as Burkina Faso are particularly vulnerable to an array of health impacts due to climate change. Consequently, Burkina Faso has drafted and implemented adaptation plans and programmes, with varying levels of success. This exploratory qualitative study examines the institutional barriers faced by policymakers in this process, particularly in the health system of concern. We applied in-depth interviews with policymakers, using framework analysis. We identified the barriers to implementing climate change and health programmes and categorized the barriers according to the Framework to diagnose barriers to climate change adaptation. Policymakers identified eight interconnected barriers through the framework: Four barriers in the management phase (insufficient financial resources, frequent turnover, policy-politics disconnect /weak structural support, unsustainable programming), three in the planning phase (heft of bureaucracy/lack of political will, diverging development priorities, insufficient cooperation), one in the larger context of Burkina Faso's environment (national security). The respondents mentioned no barriers in the understanding phase. These barriers are indicative of weak institutional support systems and limited resource allocation to climate and health work in Burkina Faso.