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Introduction: A range of climate-sensitive diseases are endemic to the Horn of Africa, which is increasingly vulnerable to climate extremes. Global health agencies recognise the need to abandon siloed approaches to climate change and health by integrating health in climate policies, strategies, and guidelines. This structured document review aimed to examine the extent to which health, and specifically infectious diseases, are integrated into climate governance documents in this region, with a focus on Ethiopia, Kenya, Somalia, and Uganda. Methods: A desk-based search strategy identified climate governance documents from (1) open-access climate policy databases; (2) targeted websites; (3) citation chaining; and (4) a structured literature search. Data were extracted to summarise document attributes, aims, geographic scope, integration of health topics, and infectious diseases integration, rationale for inclusion, and recommendations. Results: Ninety-eight documents were included, from Ethiopia (18.4%), Kenya (63.3%), Somalia (9.2%), Uganda (6.1%), and the broader region (3.0%). Most documents were affiliated with the Government (94.9%) or intergovernmental organisations (5.1%). Dedicated human health and infectious disease sections were identified in 59.2% and 5.1% of documents, respectively. Integrated health topics included infectious diseases (89.7%; predominately malaria, cholera or acute watery diarrhoea, and typhoid fever), nutrition (55.2%), and maternal or child health (39.7%). Conclusions: Characterisation of climate governance documents in the Horn of Africa highlighted variable integration of health and infectious diseases. These results support calls for improved coherence between climate and health governance processes and evidence translation at research-policy interfaces. The structured search and review methodology may be adopted in other climate-vulnerable contexts, in collaboration with climate and health stakeholders. © 2026 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/