Experiences of district health management team members during Cyclone Freddy (2023) in two districts of Malawi: a qualitative study

Abstract Background The health impacts of climate change-induced extreme weather events, such as Cyclone Freddy, constitute an emerging public health challenge requiring urgent attention. In Malawi, Cyclone Freddy destroyed infrastructure, accelerated the spread of infectious diseases, and exacerbated breeding conditions for disease vectors, leading to adverse health outcomes. This study aimed to explore the experiences of the District Health Management Teams with the effects of Cyclone Freddy and to compare these effects between the urban (Blantyre) and rural (Phalombe) districts of Malawi. Methods A descriptive qualitative study was conducted using key informant interviews with members of the District Health Management Teams in Blantyre and Phalombe districts of Malawi. Participants were purposively selected based on their roles and experience in managing the district health system. Data were analyzed using thematic analysis. Results Fifteen in-depth interviews were conducted with members of the District Health Management Team. The results were grouped into three main themes: the effects of Cyclone Freddy on the health system, coping strategies, and challenges faced when responding to Cyclone Freddy. The effects of Cyclone Freddy included the destruction of health infrastructure, increased demand for healthcare services and supplies, disruption of health information system networks, overstretched health workers, and psychological and mental health challenges. The coping strategies reported include the recruitment of temporary and surge health workers, the establishment of temporary shelters, mobile and outreach clinics, and collaboration with partners. The challenges include limited access to health facilities, inadequate staff, and limited space for service delivery. Conclusions Cyclone Freddy posed substantial challenges to the district health systems of Blantyre and Phalombe, Malawi. The results indicate that DHMT members in both districts were significantly affected by Cyclone Freddy, which compromised the capacity of their health systems to deliver essential healthcare services. However, the rural district of Phalombe experienced more extensive damage to health infrastructure than the urban district of Blantyre. This difference partly reflects disparities in infrastructure resilience and vulnerability to climate-related hazards. Given the increasing frequency and intensity of climate change-induced extreme weather events, DHMTs should prioritize investments in climate-resilient health infrastructure to strengthen the capacity of health systems to withstand and respond effectively to such events.