Climate change is rising building pathologies in Africa through heat stress, moisture ingress, and flooding, yet responses remain weak. This systematic review examines stakeholder roles in diagnosing climate-induced building pathologies and developing adaptation to the gaps in stakeholder-based diagnosis-response relationships in the African contexts. A systematic review guided by PRISMA synthesised 12 peer-reviewed studies, published after 2020, through a thematic analysis. The originality is in the re-conceptualisation of the building pathology and adaptation via a stakeholder lens, where the focusing on the technical, social, and governance perspective is involved instead of considering that the aspect of adaptation is a matter of engineering. The first identifiers of building risks are residents and occupants, investment decisions are made by owners and landlords, technical decisions are made by professionals, and policy and community-scale intervention are made by governments and non-governmental organisations. Risk perceptions among the stakeholders are sharply divergent and influence the sense of urgency and priorities. Common obstacles include lack of funds, fractured governance and lack of technical capacity, and the facilitators are the cohesion of communities, local knowledge, and policy enabling environments. The paper gives an informed synthesis on the part of stakeholders and suggests an effective framework to inform and guide inclusive diagnosis and adaptation with practical, actionable recommendations on how to build professionals, policymakers, and communities.