Disaster preparedness of health systems in LMICs in the face of climate change: a systematic mapping review of vulnerabilities and response strategies.

BACKGROUND: Climate change has intensified the frequency and severity of natural disasters, disproportionately impacting health systems in low-and middle-income countries (LMICs) that face unique vulnerabilities due to limited infrastructure, workforce shortages, and constrained resources. This systematic mapping review examined disaster preparedness within LMICs' health systems and identified common components of disaster preparedness, existing gaps, and adaptive strategies aimed at improving preparedness. METHODS: A systematic search of PubMed, Embase, CINAHL, and Web of Science was conducted in March 2025, following PRISMA guidelines. Empirical studies published in English that addressed climate-related disaster preparedness in LMIC health systems were included. Data extraction was performed using a structured template, and methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was used to identify key themes. RESULTS: Of 518 records screened, 20 studies met the inclusion criteria. Study populations included health systems, healthcare workers, hospital administrators, disaster responders, and affected patients. Natural disasters examined included floods, earthquakes, droughts, cyclones, and landslides. Common preparedness components included workforce training, infrastructure capacity, stock and supply readiness, communication systems, and coordination and partnership. While some systems demonstrated adaptive strategies such as backup resources and coordination protocols, most faced persistent gaps in training, policy implementation, and system resilience. The findings indicate that enhancing resilience in LMICs requires investment in human capital, robust infrastructure, and coordinated emergency protocols. CONCLUSION: The findings underscore that strengthening disaster preparedness in LMICs' health systems requires targeted investments in workforce development, infrastructure resilience, and cross-sector collaboration. These efforts are critical for building climate-resilient health systems capable of withstanding future emergencies.