Climate-resilient health systems in the face of extreme weather events in Uganda: a qualitative study in three high-risk districts

Abstract

Uganda’s climate is changing with an increase in the frequency and intensity of extreme weather events including droughts, floods, heatwaves, and landslides, with potential impact on health systems. This study documented how these events have impacted health systems and their resilience in three highly vulnerable districts of Bududa, Kasese and Moroto in Uganda, to inform strategies for building climate-resilient health systems in sub-Saharan Africa and similar settings. This study employed a case study approach using qualitative interviews among key informants who were purposively selected. A total of 55 interviews were conducted among stakeholders at the national and district levels as well as non-governmental organizations, including health and non-health officers, health workers, program managers, directors or unit heads. Interviews were audio-recorded and transcribed verbatim. Study transcripts were deductively coded considering the impacts on the health system and adaptation measures in line with the World Health Organization’s Operational framework for climate-resilient and low-carbon health systems. Study quotations were added to supplement the study findings. The study established that landslides, floods, and droughts impacted health systems in the three districts through difficulty coordinating multiple players during response, causing injuries and deaths among health workers, damaging infrastructure, drugs, and information systems. These impacts affected health services delivery. To adapt, the health system employed several strategies including instituting policies, early warning systems, capacity building for health workers, and increasing stock of medicines and supplies at district stores. The other mechanisms were improving water and sanitation at facilities, relocating some facilities, engaging the community on potential diseases and risks, and mobilizing funding to support response. Overall, factors such as a clear policy framework including mechanisms for stakeholder coordination, political will, availability of resources and health workers, high community engagement, and robust surveillance and strong early warning systems were key enablers for the health system adaptation. Extreme weather events impacted all facets of the health system, and districts undertook various mechanisms to deal with them. These lessons should be integrated into strengthening the capacity of health systems to anticipate, respond to, cope with, and recover from extreme weather events.