Global landscape of tools to assess health system preparedness for climate change: a scoping review

Health systems must be climate-resilient to effectively respond to shifting disease patterns and other health impacts of climate change and extreme weather events. We conducted a scoping review to identify and describe the characteristics of the tools, frameworks or strategies to assess the preparedness of health systems to deal with the health impacts due to climate change and extreme weather events. We developed a protocol using the methodological framework for scoping review by Arksey and O’Malley and the PRISMA-ScR checklist for reporting the findings. The Population/concept/context (PCC) framework determined the search strategy, and systematic searches were conducted in PubMed and Embase for relevant articles. After deduplication, abstracts and full texts were screened by two reviewers independently. A pre-designed data charting form was used for data extraction. Results were summarised as a proportion. From 178 articles retrieved, 41 were included in the final review. Of that 46% (19/41) of the articles were from high-income countries and 80% (33/41) discussed multiple climate change or extreme weather events. More than half of the articles (23/41, 56%) focused on multiple climate-sensitive diseases. Risk assessment and management (18/41, 44%) were the most commonly addressed domain in the health system's preparedness. Only seven tools were identified, and three were country-specific. All the tools were available as checklists, and two included multilingual support. Four tools were designed for health facility managers. Only one tool provided recommendations, based on the assessment scores. None of the tools were found to be validated. This is the first review presenting the tools available on the health system preparedness for the health impacts of climate change or extreme weather events. Of 41, 34 (83%) articles on health system preparedness for climate change or extreme weather events were frameworks or strategies, and seven tools were available. Three of the tools were from high-income countries, indicating the need to develop validated tools to assess preparedness in low and middle-income country settings. Future reviews should expand coverage to underrepresented regions and non-English-language sources to address the evidence and language gaps.