This study focuses on investigating the impact of climate change on the availability of safe drinking water and human health in the Southwest Coastal Region of Bangladesh (SWCRB). Additionally, it explores local adaptation approaches aimed at addressing these challenges. The research employed a combination of qualitative and quantitative methods to gather data. Qualitative data were collected through various means such as case studies, workshops, focus group discussions (FGDs), interviews, and key informant interviews (KIIs). The study specifically collected qualitative data from 12 unions in the Shyamnagar Upazila. On the other hand, through the quantitative method, we collected respondents’ answers through a closed-ended questionnaire survey from 320 respondents from nine unions in the first phase of this study. In the next phase, we also collected data from the three most vulnerable unions of Shyamnagar Upazila, namely Poddo Pukur, Gabura, and Burigoalini, where 1579 respondents answered questions regarding safe drinking water and health conditions due to climate change. The findings of the study indicate that local communities in the region acknowledge the significant impact of sea-level rise (SLR) on freshwater sources and overall well-being, primarily due to increased salinity. Over 70% of the respondents identified gastrointestinal issues, hypertension, diarrhea, malnutrition, and skin diseases as major waterborne health risks arising from salinity and lack of access to safe water. Among the vulnerable groups, women and children were found to be particularly susceptible to waterborne diseases related to salinity. While the study highlights the presence of certain adaptation measures against health-related problems, such as community clinics and health centers at the upazila level, as well as seeking healthcare from local and paramedical doctors, it notes that these measures are insufficient. In terms of safe drinking water, communities have adopted various adaptation strategies, including pond excavation to remove saline water (partially making it potable), implementing pond sand filters, rainwater harvesting, and obtaining potable water from alternative sources. However, these efforts alone do not fully address the challenges associated with ensuring safe drinking water.