Extreme weather effects on health services and communities in low and lower-middle income countries: a thematic systematic review

Clinical Snapshot

Key Findings

• P Value: Not applicable (qualitative synthesis)

• Effect Size: Not applicable (thematic synthesis); predominant themes identified were displacement and disruption at community level, and vulnerability, disruption, and resilience at health service level

• Primary Outcome: Thematic synthesis of harms, responses, and outcomes across the six WHO health system building blocks in LIC/LMIC settings exposed to extreme weather events

• Nnt Or Sensitivity: Not applicable; key finding is that documented examples of resilience and recovery were substantially fewer than descriptions of vulnerability and disruption across all six WHO healthcare system building blocks in 183 included reports

• Confidence Interval: Not applicable (qualitative synthesis)

Clinical Application

Findings are directly applicable to health system strengthening planning, climate adaptation strategies, and emergency preparedness frameworks. The WHO building blocks structure facilitates translation into actionable domain-specific interventions. Implementation feasibility varies significantly by country income level, existing infrastructure, and governance capacity. Australia has direct relevance to this evidence base through its foreign aid and development health programs (DFAT/Australian Aid) in Pacific Island nations and Southeast Asian LMICs, many of which face extreme cyclone, flooding, and drought exposure. The findings support Australian investment in climate-resilient health system strengthening in partner countries. Within Australia, Torres Strait Islander and remote Aboriginal communities share some structural vulnerabilities to extreme weather events documented in this review, though Australia is classified as a high-income country. RACGP and ACRRM guidelines on disaster preparedness for remote and rural practice are relevant. The TGA and PBS frameworks are not directly applicable to LMIC settings, but Australian global health policy (including through the Kirby Institute and Burnet Institute partnerships) should incorporate these findings into program design. Health system planners, public health practitioners, disaster preparedness coordinators, and community health workers operating in LIC and LMIC settings globally, particularly in Sub-Saharan Africa, South Asia, and Southeast Asia where extreme weather event frequency and health system vulnerability intersect

Abstract

Most previous research about the dangers of extreme weather events was applicable to populations in high-income countries. Data summarising harms related to extreme weather events in low-income settings are lacking. A systematic review thematically summarising evidence about weather event-linked harms and responses in low- and lower-middle-income countries was conducted. Peer-reviewed and grey literature was systematically searched and selected. Data were extracted about harms, responses and outcomes relevant to six WHO building blocks of healthcare systems. Framework analysis was used to identify predominant themes related to harms, responses and the WHO building blocks. In total, 183 reports were included. Flooding and high winds were the most common types of extreme weather events documented. The main community experience themes identified were the displacement of populations and disruption. The main themes identified for health service delivery were vulnerability, disruption and resilience. Documented examples of resilience or recovery were far fewer for all six WHO healthcare system building blocks than descriptions of vulnerability and disruption. Extreme weather events can be highly disruptive and harmful to healthcare systems and communities in LMIC settings that are often already highly vulnerable.

References

1. 1.Brainard, J., Sedekia, Y., Jones, N. R., Matte, M., Sunday, P., Watson-Jones, D., Mapemba, D. D., Kabakama, S. A., Mulogo, E. M., Ntaro, M., Tuyet-Hanh, T. T., Hunter, P. R., & Geere, J. A. (2026). Extreme weather effects on health services and communities in low and lower-middle income countries: a thematic systematic review. Transactions of the Royal Society of Tropical Medicine and Hygiene. https://doi.org/10.1093/trstmh/trag007