Strategies for Adapting the Public Health System to Future Climate Crises and Pandemics in North Aceh Regency

Abstract

Climate change and potential future pandemics pose interconnected and cascading threats to health systems, particularly in disaster-prone regions such as North Aceh Regency, Indonesia. However, empirical evidence on district-level health system preparedness that simultaneously addresses climate and pandemic risks remains limited. Purpose: This study aimed to assess health system preparedness, identify community vulnerabilities, and formulate context-specific adaptation strategies for addressing climate-related risks and potential future pandemics in North Aceh Regency. Method: A sequential explanatory mixed-methods design was employed. The quantitative phase assessed health facilities and households across high-, moderate-, and low-risk areas. All primary healthcare facilities were included through total sampling, with facility respondents selected purposively, while households were selected using multistage and systematic random sampling. A total of 27 facility respondents and 230 households were included. Quantitative data were analyzed descriptively and using Kruskal–Wallis and Spearman correlation tests. The qualitative phase involved purposively selected stakeholders and used in-depth interviews and focus group discussions, followed by directed content analysis. Results: Overall health system preparedness was moderate, with major weaknesses in disaster-resilient infrastructure, logistics and supply chains, and service continuity. Preparedness differed significantly across risk strata (p=0.008), while higher disaster risk was associated with lower preparedness (ρ=-0.51; p=0.007). Cross-sectoral coordination showed the strongest positive association with preparedness (ρ=0.61; p<0.001). Implications: Adaptation policies should prioritize high-risk areas, integrated surveillance, resilient infrastructure and supply chains, and institutionalized cross-sectoral coordination. Conclusion: Strengthening district health system resilience requires integrated structural and operational adaptation rather than fragmented single-hazard preparedness.