How much bilateral and multilateral climate adaptation finance is targeting the health sector? A scoping review of official development assistance data between 2009-2019.

Climate change is adversely affecting human health. Rapid and wide-scale adaptation is urgently needed given the negative impact climate change has across the socio-environmental determinants of health. The mobilisation of climate finance is critical to accelerate adaptation towards a climate resilient health sector. However, a comprehensive understanding of how much bilateral and multilateral climate adaptation financing has been channelled to the health sector is currently missing. Here, we provide a baseline estimate of a decade's worth of international climate adaptation finance for the health sector. We systematically searched international financial reporting databases to analyse 1) the volumes, and geographic targeting, of adaptation finance for the health sector globally between 2009-2019 and 2) the focus of health adaptation projects based on a content analysis of publicly available project documentation. We found that health was largely a co-benefit, not the principal objective, within the projects. We estimate that USD 1,431 million (4.9%) of total multilateral and bilateral adaptation has been committed to health activities across the decade. However, this is likely an overestimate of the true figure. Most health adaptation projects were in Sub-Saharan Africa, with average project funding comparable to East Asia and the Pacific and the MENA region. Fragile and conflict affected countries received 25.7% of total health adaptation financing. The paucity of health indicators as part of project monitoring and evaluation criteria and the lack of emphasis on local adaptation were particularly significant. This study contributes to the wider evidence base on global health adaptation and climate financing by quantifying adaptation funds directed towards the health sector and revealing specific gaps in financing health adaptation. We anticipate these results will support researchers in developing actionable research on health and climate finance and decision-makers in mobilizing funds to low-resource settings with high health sector adaptation needs.