Health System Adaptation to Climate Change: A Scoping Review of Strategies, Barriers, and Policy Responses

Abstract

Background: Climate change is disrupting health systems through extreme heat, floods, storms, drought, shifting infectious disease patterns, infrastructure damage, and widening inequities. Although climate-resilient health systems are prominent in health policy, evidence on actual adaptation strategies, implementation barriers, governance responses, and evaluation gaps remains fragmented.

Objectives: This scoping review mapped evidence on health system adaptation to climate change, focusing on adaptation strategies, barriers and enablers, policy and governance responses, equity considerations, and research gaps.

Methods: A PRISMA-ScR-informed scoping review was conducted. SciSpace, Google Scholar, PubMed, and arXiv were searched from inception to April 2026 using structured terms related to climate change, health systems, adaptation, resilience, governance, financing, workforce, infrastructure, surveillance, and service delivery. Supplementary targeted searches were also conducted. From 831 records identified, 350 unique records were screened, 60 full-text sources were assessed, and 14 key sources were included. Data were charted using a structured template aligned with the six WHO health system building blocks and synthesized narratively.

Results: Adaptation strategies were identified across leadership and governance, health financing, workforce, medical products and infrastructure, health information systems, and service delivery. Reported strategies included mainstreaming climate into health plans, multisector coordination, climate finance reform, workforce training, facility retrofitting, water and energy resilience, early warning systems, climate-health surveillance, continuity-of-care planning, and disaster preparedness. Major barriers were inadequate financing, weak workforce preparedness, fragmented data systems, limited infrastructure investment, policy mimicry, and poor implementation evidence. Equity concerns were prominent but rarely measured.

Conclusion: The literature shows a growing policy architecture for climate-resilient health systems, but implementation and evaluation remain weak. Stronger climate finance, implementation science, surveillance, workforce preparation, and equity-focused governance are urgently needed.