Abstract
INTRODUCTION: Climate change poses a growing global health threat, disproportionately affecting low- and middle-income countries (LMICs) with fragile health systems and limited adaptive capacity. The health workforce plays a critical role in managing climate-sensitive health risks but often lacks adequate training. Building climate-resilient health systems therefore requires equipping health workers with the relevant knowledge, skills, and adaptive capacities. The goal of this review was to synthesize existing literature to inform the creation of a climate-health competency framework appropriate for a diverse health workforce. METHODS: A scoping review was conducted to examine climate-health competency frameworks across peer-reviewed and grey literature, institutional reports, and global policy documents. Frameworks were analyzed for geographic origin, scope, workforce role differentiation, and contextual applicability, with particular attention to LMIC relevance. This was followed by framework construction as described below. RESULTS: Most existing frameworks originated from high-income countries (HICs) and presuppose strong institutional capacity, digital infrastructure, and governance systems-conditions not typical in LMICs. Furthermore, they rarely distinguish competencies across different health workforce roles, limiting practical implementation. From the synthesis, a consolidated KSTCP framework was derived, encompassing five domains: Knowledge, Systems Thinking, Technical Skills, Communication and Leadership, and Practice. Two major gaps were identified: (1) limited LMIC-specific frameworks, and (2) insufficient role differentiation. To address these, a cadre-specific competency set was developed for clinical, public health, and community health workers, aligned with their distinct functions in service delivery and community engagement. CONCLUSION: The proposed framework provides actionable, context-sensitive guidance for educators, policymakers, and development partners to strengthen health workforce capacity for climate resilience. It offers globally relevant competencies that differentiate workforce roles to support effective implementation, with particular significance for LMICs, where capacity constraints make targeted workforce development especially important. Implementing cadre-specific climate-health competencies can enhance preparedness and adaptive responses within climate-vulnerable health systems.