Urban areas in the Global South are highly vulnerable to natural hazards, yet they are underrepresented in research monitoring climate adaptation efforts. To address this gap, we analyse 64 local adaptation plans from 37 cities with over one million inhabitants to assess how adaptation is being planned in South America and the role of nature-based solutions (NbS). Results show that plans tend to emphasize educational, informational, and behavioural measures, whereas engineering and technological approaches are least prioritised. The types of measures vary by hazard: NbS are the preferred options for adapting to floods and heatwaves, whereas engineering and technological approaches are preferred for droughts. Support for NbS in national adaptation plans was found to be linked to local adaptation priorities. The findings reveal key gaps in adaptation planning, particularly in public health and risk-transfer measures, which are rarely considered. Together, our findings provide policymakers, planners, donors, and researchers with valuable insights for improving urban climate resilience in South America.