Examining extreme weather event preparedness, response, and recovery among community health workers in Negros Oriental, Philippines: A qualitative study

Abstract

Background: The Philippines remains one of the most vulnerable countries to extreme weather events, which will continue to increase in frequency and severity due to the climate crisis. To urgently address this challenge, community-based strategies have been emphasized as a key component of climate resilient health systems. Community health workers (CHWs) often act as an important resource to deliver health-related support and care in resource-constrained settings and may strengthen community resilience amid disasters. However, there is a need to consider how individual-context and program-specific factors may impact the ability of CHWs to support their communities during extreme weather event preparedness, response, and recovery. This study aimed to explore the experiences of CHWs during extreme weather events to understand how their positionality, existing responsibilities, and perceived capacity shaped their ability to support communities amid extreme weather events. Methods: This study was conducted in partnership with International Care Ministries (ICM), which is a Philippines-based non-governmental organization. ICM implements the Flourish program, where the organization recruits and trains Community Health Champions (CHCs) who operate as CHWs. We conducted 51 semi-structured interviews with CHWs across four municipalities in Negros Oriental, Philippines, in May-June 2023. Recruitment was facilitated through ICM’s pre-existing relationships with CHWs, and data collection and analysis were guided by the disaster risk management framework. All interviews were audio-recorded, transcribed using NVivo software, and thematically analyzed using a hybrid deductive-inductive approach. Results: Participant narratives indicated that experiences with extreme weather events were shaped by both individual and program specific factors, and that CHWs capacity to provide support within their communities varied at each phase of the disaster. Participants also outlined that their level of preparedness for current extreme weather events was impacted by their experiences with past extreme weather events. Further, although most CHWs highlighted that family members were their priority during extreme weather event response, some CHWs also exhibited a willingness to support other community members during response activities. Finally, CHWs were recognized as a source of support during extreme weather event recovery activities, despite sharing socioeconomic and demographic characteristics with other community members and experiencing the disaster in a similar way. Conclusion: Efforts to equip CHWs to support disaster preparedness, response, and recovery need to closely consider both the individual and household-level impacts of extreme weather events that are experienced by CHWs themselves. This study provides insight into how CHWs navigate extreme weather events and underscores the complexities of recognizing CHWs as both health leaders and community members in disaster risk management.