Tools and approaches for assessing risk and readiness of health facilities exposed to extreme weather and climatic events in Low-and-Middle Income Countries: A Scoping Review Protocol

Introduction Climate change-induced extreme weather and climatic events increasingly threaten health systems, especially those already facing chronic stress such as resource and infrastructure constraints. Additional shocks from extreme weather and climatic events may further undermine progress toward achieving universal health coverage. Indeed, with the increasing frequency and severity of these events, health facilities as health service delivery points, require appropriate tools to assess their exposure, vulnerability, and readiness for such events. However, the availability, scope, and suitability of existing assessment tools, particularly for low- and middle-income countries (LMICs), remain insufficiently documented. Methods This scoping review will synthesise evidence on tools and approaches used to assess health facility exposure, vulnerability (sensitivity and capacity), and readiness to extreme weather and climatic events through a health-systems lens. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, PRISMA-ScR, guidelines to ensure methodological transparency. An a priori search strategy will be applied to three electronic databases (Ovid Medline, Global Health, and Embase) for literature published between 1990 and 2025. To enhance coverage, we will conduct a structured search of grey literature from relevant national agencies, international organisations, and institutions focused on climate change and health, disaster management, and humanitarian health response. We will also, where feasible, contact subject-matter experts to identify unpublished or in-progress materials. Data will be synthesised narratively using a mixed inductive–deductive analytical approach, with interpretation grounded in LMIC contexts. Results Findings will be presented narratively and summarised using explanatory text, tables, and figures to highlight the characteristics, strengths, gaps, and applicability of identified tools and approaches. Conclusion This review’s synthesis will inform the development of a novel tool for assessing the risk and readiness of health facilities to extreme weather events, complementing ongoing empirical research in Kenya, a low-middle-income country setting.