Climate change adaptation and mitigation in African health systems: a scoping review of research and policy translation.

OBJECTIVES: African health systems emit relatively low emissions yet experience disproportionate climate shocks. The objective is to map climate-health adaptation and mitigation research across African health systems and examine the translation of global climate and health commitments into domestic laws, policies and plans in the Southern African Development Community (SADC). DESIGN: Scoping review, reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES: Six databases (OVID/Medline, Clarivate Analytics/Web of Science Core Collection, Embase.com, Elsevier/Scopus, Africa Index Medicus and Ebsco/CINAHL) were searched to obtain research literature. For the grey literature, one database (Climate Change Laws of the World) and targeted websites (SADC, national departments of health and environment, Alliance for Transformative Action on Climate and Health) were searched up to January 2025. ELIGIBILITY CRITERIA: Studies addressing health systems in African countries and reporting on climate change adaptation and/or mitigation were included. Language and time restrictions were not applied. Studies that measured climate-related disease mortality and morbidity were excluded. DATA EXTRACTION AND SYNTHESIS: Data were extracted by one author and independently checked by another author. The data were thematically organised using a framework for building climate-resilient and low-carbon health systems. RESULTS: We included 78 research and 15 grey literature publications. Research literature was predominant in two framework domains: climate-smart health workforce and climate-resilient and low-carbon infrastructures, technologies and supply chains. Only two SADC countries (South Africa and Mauritius) had a Climate Change Act, while four countries (South Africa, Tanzania, Madagascar and Zambia) had a national health adaptation plan. Madagascar was the only SADC country that had conducted a national public hospital greenhouse gas emission assessment. CONCLUSIONS: Immediate climate threats drive responses in African health systems to prioritise adaptation over mitigation in both research and governance. Stronger integration of climate objectives into health systems planning will be essential to support climate-resilient and sustainable low-carbon implementation.