Work

Climate-resilient health systems barriers and challenges in Bangladesh: a systematic scoping review

Year: 2026

Type: review

Abstract: Assessing health system readiness for escalating climate-related health risks has garnered global attention since the 26th Conference of the Parties in 2021. Bangladesh has substantial evidence on the public health impacts of climate change and has recently adopted a Health National Adaptation Plan (HNAP). But it lacks a policy-oriented, evidence-informed roadmap for integrating climate considerations into health system planning and operation. To address this critical policy-implementation gap, we systematically synthesised peer-reviewed literature on the multifaceted barriers and systemic challenges to operationalising a climate-resilient health system in Bangladesh. We conducted the scoping review following the Arksey and O'Malley Framework, with methodological guidance from the Joanna Briggs Institute. We used an adapted Population-Concept-Context framework and conducted a structured literature search across PubMed, Scopus and Embase in two waves (June 2023 and September 2025). We charted and reported the search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The review protocol has been registered on the Open Science Framework. In the dual-wave database search, we retrieved 1153 articles from PubMed (176), Scopus (803) and Embase (174), of which 32 were scoped for the review. The evidence-based articles comprised 20 original research articles (63%), 7 reviews (22%), 3 commentaries (9%), 1 case report (3%) and 1 research protocol (3%), published between 2013 and 2025. Five thematic areas emerged: systemic vulnerabilities in the health system amid climate change impacts; gaps in sexual and reproductive health services; gaps in mental health services; gaps in the health system for climate-induced migrants; and operational and policy barriers to climate-resilient health system transformation. We systematically mapped the findings and actionable recommendations to the WHO climate-resilient health system components, aligned evidence with HNAP 2026, and provided a structured evidence-to-policy roadmap for health system resilience. Climate change functions as a systemic 'threat multiplier' in Bangladesh's health system, disproportionately exacerbating inequities and service deficits towards critically marginalised populations. Our findings align with the WHO climate-resilient health system framework and HNAP, providing key action points for strategic health-system transformation. Health-system adaptation and climate impact mitigation in Bangladesh require strengthening leadership and governance, local-to-national coordination, financing, health workforce, and data systems to anticipate, respond to, and recover from climate-related health threats.

Source: BMJ Public Health

DOI: 10.1136/bmjph-2025-004059