BACKGROUND:
Evidence shows that both developed and developing countries are refining and establishing regulatory frameworks to address climate change in health policies. However, progress in sub-Saharan African countries, including Malawi, is slower than in other regions, despite their vulnerability to multiple climate-change-induced factors. This study understands the effects of climate change on the health system, policy responses, and the factors hindering policy formulation in Malawi.

METHODS:
A descriptive qualitative study was conducted through key informant interviews with policymakers, including health planning officials and academicians. Purposive and snowballing sampling techniques were used to identify study participants. Data was analysed using thematic analysis.

RESULTS:
Twelve in-depth interviews were conducted with policymakers and two with academicians. Three main themes were identified, including the effects of climate change on the health system, policy responses, and barriers to policy formulation. The effects of climate change on the health systems reported include infrastructure damage, increased pressure on health finances, reduced human resource capacity, and service delivery disruption. Policy responses identified include the inclusion of climate change strategies in Health Sector Strategic Plan III, the establishment of the One Health Department, and the National Health Emergency Preparedness Plan. Barriers to the formulation of climate change policy reported were the lack of political will, insufficient knowledge among health workers, and inadequate research on climate change and health.

CONCLUSIONS:
The study concludes that the effects of climate change on the health system require a policy response. Generating enough evidence to inform policy is one of the key elements towards the formulation of climate change-specific health policy. The study recommends continuous sensitization and advocacy to gain political support and commitment from relevant stakeholders. Further studies must be conducted to understand how health systems’ policies are linked with other sectors in the fight against climate change.