Not Enough to Meet a Growing Threat: A Scoping Review of Climate Adaptation and Intervention Strategies in Health Facilities across Low- and Middle- Income Countries

Background Climate change is intensifying pressures on health systems, with facilities in low- and middle-income countries (LMICs) facing the greatest risks due to existing structural vulnerabilities. However, little is known about how these facilities are adapting or strengthening their resilience to climate-related shocks. This scoping review addresses this gap by synthesising documented climate-related adaptations and interventions in LMIC health facilities and assessing their alignment with the WHO 2023 Operational Framework for Climate-Resilient and Low-Carbon Health Systems. Methods Search terms were applied to MEDLINE, PubMed, Embase, Web of Science, Scopus, CINAHL and APA PsycINFO electronic databases, for articles published from inception to July 2025. Studies from LMICs, related to climate change and focused on health facility adaptations were included. Articles were extracted in Covidence software, and a narrative synthesis approach applied to identify key themes and patterns in the articles. Results In total, ten studies met the inclusion criteria. India contributed three studies, while Pakistan, Vietnam, Nepal, South Africa, Nigeria, Iran, and South Korea each contributed one. Our results reveal a narrow concentration of interventions across three domains (1) climate-smart health workforce development (2) climate-related emergency preparedness and management and (3) climate resilient infrastructure and technologies. Reported actions included simulation-based training, community-oriented education, ward relocation, ventilation and air-purification improvements, solar energy installations, water purification systems, and rapid spatial reconfigurations during floods. Although these interventions demonstrate efforts by facilities to maintain continuity of care under climate pressure, they remain small in scale, highly localised, and largely reactive. Several critical components of the WHO framework such as climate-transformative governance, sustainable financing, integrated risk monitoring and early warning systems, climate-informed health programmes, and climate and health research were entirely absent in the review. Barriers to adaptation included infrastructural vulnerability, weak governance, fragmented coordination, limited resources, workforce constraints, and behavioural challenges. Conclusion Climate related adaptations in LMIC health facilities remain limited, but available evidence shows that even small changes can strengthen resilience. Practical steps such as staff training, better infrastructure, stronger WASH systems, and clearer emergency procedures improve readiness and help keep care running during climate shocks. Yet major gaps remain, especially in long term evaluation and in the structural and governance weaknesses that limit sustained progress. Building a stronger evidence base and investing in facility resilience will be critical as climate risks continue to rise.