"SCALE-up" - a new framework to assess the effectiveness of climate change adaptation interventions for human health and health systems.

Climate change is a grave threat to human health and wellbeing. Adaptation is one mechanism (the other is mitigation) by which we can intervene to increase adaptive capacity and preparedness to protect people. Adaptation interventions (evidence-based adjustment of programs/practices that lead to improved response and resilience to climate change) are being conducted around the world. However, existing conceptual frameworks to assess the effectiveness of these interventions, especially with respect to improving health outcomes and systems are not readily applied in areas where these are needed. This is applicable to both interventions intended to improve health as well as those without a health-focus but which may have health co-benefits. To address this gap, we conducted a multi-vocal review comprised of a scoping review and key informant interviews, which informed the development of an initial assessment framework. We included 21 academic articles and 12 reports (from the grey literature) for data collation and synthesis. Of the 21 articles analyzed, only seven presented primary evidence of health improvement outcomes, such as reduction in neo-natal care unit admissions was partially attributed to moving the maternity ward to the cooler, lower floor of the hospital. From the 10 interviewees, we learnt that most existing tools to assess the effectiveness of adaptation are for country or regional (several countries sharing borders within a large section of a continent) scales (e.g., Notre Dame Global Adaptation Initiative Index) and none focused specifically on health / health co-benefits. From these learnings together with a guiding concept, we crafted the first iteration of an assessment framework, SCALE-up, comprising six steps that prompt a researcher to consider the effectiveness of their adaptation intervention at a project-scale, including from a health benefit perspective. We apply the framework in four scenarios: hot days-heat; floods; droughts; and vector-borne diseases, to illustrate how the framework may help guide the researcher to think about effectiveness from project proposal stage. The next steps are to implement and pilot the framework in the four proposed scenarios and refine the framework.