The review found 67 publications from 30 countries, with 91% published from 2013 onwards. Africa accounted for 27 publications across 14 countries and Asia for 31 across 10 countries. Ethiopia and the Philippines were the most studied countries, with six publications each. Qualitative studies were most common at 24 of 67 studies, followed by 17 mixed-methods studies; only five used quantitative methods. Over half of the studies, 35 of 67, addressed general climate issues, while 27 focused on cyclones, hurricanes, typhoons and floods. Service delivery was the dominant adaptation area, covered in 53 publications, followed by health workforce in 36, leadership and governance in 20, health information systems in 15, essential medicines and technologies in 13, and financing in 10.

In leadership and governance, adaptation centred on embedding climate change into health policy and routine planning, improving coordination across national and local levels, and working across sectors such as environment, transport and infrastructure. The review identified 20 publications in this area. Three studies specifically stressed vertical coordination across tiers of the health system, while all references in this section highlighted stakeholder engagement in policymaking. Governance adaptation also included crisis plans, clearer command systems, and the use of existing local structures to strengthen preparedness and response. Financing was the least developed adaptation area. Only 10 publications discussed financial strategies, and the review found no concrete example of an implemented financing model. Studies called for climate resilience to be built into national health budgets, for dedicated emergency funds, and for broader access to climate finance and donor support. One example came from India after the 2008 floods, where weak financial structures limited surge capacity and resource mobilization.

Health workforce adaptation appeared in 36 studies published between 2010 and 2024. Common strategies were climate and disaster training, task-shifting, multi-tasking, staff redeployment, volunteer mobilization and stronger surge capacity. In one Ethiopian study, only 20% of 404 health professionals had received disaster-preparedness training, showing a major skills gap. The review also highlighted the role of midwives in protecting sexual and reproductive health during disasters, the value of community health workers as trusted local actors, and the need for mental health support and safer working conditions for staff. 

Service delivery was the most documented adaptation domain and appeared across the full evidence base. The review emphasized climate-proof health facilities through retrofitting, resilient design and backup power. Reported examples included stronger roofs and reflective roof paint in South Africa, Sierra Leone and The Gambia, and cross-ventilation, cool rooms and green roofs in India. Adaptation also meant preparedness plans, simulation exercises, decentralized primary care, community health workers, mental health integration, and better risk communication, including local-language communication and media partnerships. Four studies explicitly reported that multisectoral collaboration improved emergency response and resource use. 

Health information systems were covered in 15 studies from more than 10 countries. The main adaptation message was the need to connect climate, weather and health data so systems can assess risk earlier and act faster. The review described vulnerability and adaptation assessments, early warning systems, real-time surveillance and national data platforms. Three studies showed that co-design with local professionals improved uptake of early warning tools. Examples included EWARS in a Box in Fiji after Cyclone Winston and the EPIDEMIA malaria surveillance system in Ethiopia. These systems used digital tools and integrated data to improve outbreak prediction and response.

Access to medicines and technologies was addressed in 13 publications. Here the focus was continuity of care during climate shocks through better stock management, local procurement, emergency kits, storage systems, supply-sharing agreements and digital inventory tools. A study from the Philippines found that 61% of health facilities lacked enough medical supplies to maintain services during climate emergencies. In India, a survey of 29 health facilities found stock-outs lasting 6 to 10 days during periods of increased patient inflow. The review also mentioned sustainable technologies such as solar-powered microscopes and the shift from paper to digital records to reduce data loss during disasters.

The review starts from a clear climate adaptation problem: climate shocks damage facilities, interrupt supplies, disrupt care and overload already stretched systems. According to the paper, climate change could cause 14.5 million deaths and US$12.5 trillion in economic losses, with low- and middle-income countries bearing a disproportionate share. Using the WHO definition adopted in the article, a climate-resilient health system must anticipate, respond to, cope with, recover from and adapt to climate-related shocks while preserving core functions over time. The review therefore asks which adaptation strategies have been described in low-resource settings and how they are distributed across the six WHO health-system building blocks.

This study was a scoping review based on the Arksey and O’Malley framework and reported according to PRISMA-ScR. Searches were run in five databases on 6 August 2023 and later updated with OpenAlex on 10 February 2025. The review screened studies published from 1973 to 2025, but the final sample included publications from 2006 to 2025. In the PRISMA flow, 7,514 database records and 332 OpenAlex records were identified; after duplicate removal, 7,521 records were assessed, 325 full texts were sought, 315 were assessed, and 67 publications were included. Findings were coded against the six WHO health-system building blocks and summarized narratively rather than through formal quality appraisal.