Malawi’s Health System Resilience in Managing Climate- Induced Cholera Outbreaks

Malawi’s health system faces major challenges in managing cholera outbreaks, worsened by climate-induced extreme weather events (EWEs) like tropical cyclone-related floods (TCRFs). These disasters amplify existing vulnerabilities, including poor infrastructure and limited resources. The March 2022 outbreak, the most severe in two decades, impacted all 29 districts, with a case fatality rate three times the anticipated threshold of 1%. This paper examines Malawi’s health system’s resilience using a structured literature review approach guided by the WHO Operational Framework for Building Climate-Resilient Health Systems. Through secondary data analysis, case studies, and comparative assessments, it identifies key structural and operational weaknesses. It also explores the role of intersectoral collaboration and community engagement, highlighting initiatives like the Tipewe Cholera Campaign. Drawing on international best practices, the study presents evidence-based recommendations to strengthen governance, health infrastructure, workforce distribution, financing, early warning systems, and WASH (Water, Sanitation, and Hygiene) infrastructure. These measures aim to build a climate-resilient health system capable of effectively managing future outbreaks.