Climate change has a profound and escalating impact on the health of people around the world. Acute events such as cyclones, tornadoes, fires, and flooding are predicted to become more common and severe, as are slower-moving changes such as drought, aridification, extinction of pollinators, and temperature extremes. In addition to augmenting economic stress, migration, and forced displacement, these changes also hinder access to and engagement in health services. Treatment interruption is of particular importance to people living with HIV (PLWH), where missing medication doses can lead to drug resistance and poor outcomes. The Solutions 4 Sustainability (S4S) project was designed to evaluate the response of the health system in Mozambique to the catastrophic cyclones (Idai and Kenneth) which occurred in the Spring of 2019.

In order to better understand how health systems and communities might best prepare for climate emergencies, particularly in settings of high HIV prevalence, we designed a study using key informant interviews (KII), focus group discussions (FGD) and a semi-structured electronic questionnaire to identify strengths and gaps in the health system response to the 2019 cyclones; we also focused on continuity of care for chronic diseases such as HIV. Furthermore, we explored the effects of the COVID-19 pandemic on the health system, to elicit opinions on similarities to the cyclones and the response, and whether lessons had been learnt from the cyclones on how to manage chronic diseases during emergencies. Study findings could inform the development of a comprehensive preparedness and response plan for resilient health systems. The recommendations provided by the stakeholders interviewed could also serve as a model to inform other countries facing similar threats.