Over the past decade, climate change has intensified cyclone patterns in Malawi, causing widespread devastation to communities, infrastructures and the health system. These events have exacerbated public health crises, including the 2022-2023 cholera outbreak, which recorded over 58,000 cases and 1,700 deaths. The health system faced challenges in delivering services amid these interconnected crises: responding to cyclone aftermaths, the cholera outbreak, and maintaining routine healthcare in resource-constrained settings.
Drawing from policy document reviews and 24 in-depth interviews with healthcare providers, managers, and disaster management officers in Neno and Chikwawa Districts, this study explores adapting practices, structures and protocols to address these emergencies. This research is a part of collaboration between Ben-Gurion University of the Negev and Partners in Health Malawi.
The findings reveal ad-hoc and institutional adaptations. These adaptations include enhanced coordination between local government, NGOs, health facilities, and community committees and the development of formal emergency preparedness and response mechanisms. At facility-level, strategies included personnel redeployment, temporary facilities rehabilitation, outbreak control, and community mobilization, leveraging existing community relationships. However, implementing these response mechanisms depended heavily on NGOs and international agencies, as outbreak severity and displaced populations created needs exceeding state resources and capacity.
While these adaptations mitigated immediate impacts, long-term vulnerabilities persist due to inadequate investment in preparedness and infrastructure rehabilitation, perpetuating conditions for future outbreaks. By documenting and analyzing these strategies, this research shows formalization processes for multiple-disasters preparedness in resource-constrained health systems. Findings identify strengths and limitations of current adaptation strategies, informing more resilient disaster management policies.
