Changes in climatic conditions and increases in weather variability affect human health directly and indirectly, including through agricultural changes and urban warming. Adaptation to climate change is receiving increasing attention, given, now, the inevitability of further climate change and its diverse impacts. However, with increased international funding for adaptation comes challenges such as ensuring supportive national policy environments for developing and implementing effective adaptation activities. Adaptation at community and population levels is underpinned by governance processes, such as the nature by which decisions are taken and implemented by government, community and private organizations. Thus an understanding of the policy context is necessary to identify the factors that enable or inhibit adaptation policy and programmes. This article examines to what degree there exist enabling factors to support the development of adaptation policy and activities, with relevance to the health sector. Results of a policy analysis are presented, which used stakeholder participation to investigate the context in which adaptation decisions were made within organizations across different sectors in Cambodia. Five factors were identified as critical components of the governance environment: (1) policy development processes; (2) the existence of a political recognition of climate change and (3-5) the organizational barriers relating to coordination, funding and lack of information. Without achieving a supportive policy environment, future adaptation actions are likely to have limited effect.