With global estimates showing an increasing trend in flooding and its adverse effects on communities and population health, resilience is presented as a concept with potential to help integrate disaster risk management, sustainable development, and climate change adaptation concerns. Resilience research and practice have conceptual and empirical challenges of how to understand, characterize and measure resilience, particularly at community level. Using a multidimensional framework, this paper takes a systems approach to understanding, characterizing, and measuring community flood resilience. Through cluster analysis, bivariate methods and multivariable‐adjusted binary logistic regression modeling, we developed a context and hazard specific construct of community flood resilience and investigated its predictor variables. The factors defining the community flood resilience construct captured the community needs to withstand disasters through purpose‐built infrastructure, early warning systems for preparedness and utilization of local human capacity for adaptation. These results strengthen the previous arguments for utilizing a comprehensive multidimensional framework for resilience analysis. Access to services for improved health and psychosocial well‐being was significantly associated with the three‐item measure of being more flood resilient. Additionally, a strong sense of place and resistance to relocation were presented as key elements of resilience, maintaining community system function, and preserving livelihoods. The study further found that these key factors would not be adequate to guarantee community flood resilience outside the transformative capacity of a well‐resourced village civil protection committee that can prepare and mobilize stakeholders in response to flood emergencies. Our results suggest that, in the context where policymakers seek to strengthen resilience of communities without relocating them, a focus on public health and on strengthening and utilizing local capacities as adaptation, are key in disaster risk management policymaking and implementation. For the international research community, this study demonstrated the importance of utilizing context and hazard specific measures for defining, characterizing, and measuring resilience to inform policy.

Floods are among the most frequently occurring natural hazards in Malawi, often with public health implications. This mixed methods study assessed the capacity for and implementation status of the disaster risk management (DRM) strategy for the health sector in Malawi, using flooding in the Nsanje District as a case. Data were collected using desk review and a workshop methodology involving key officials from government ministries, national and international development partners, and the academia. The results show that Malawi had recently strengthened its DRM institutional frameworks, with a pronounced policy shift from reactive to proactive management of disasters. Health sector personnel and structures were key contributors in the design and implementation of DRM activities at all levels. Development partners played a significant role in strengthening DRM coordination and implementation capacity. Lack of funding and the limited availability, and often fragmented nature, of vulnerability and risk assessment data were identified as key challenges. Limited human resource capacity and inadequate planning processes at district level impeded full implementation of DRM policies. These findings call for community-level interventions for improved coordination, planning, and human resource capacity to strengthen community disaster resilience and improve public health. The approach used in this study can serve as a model framework for other districts in Malawi, as well as in other low- and middle-income countries in the context of Sendai Framework implementation.

As disasters increase in frequency and magnitude with adverse effects on population health, governments will be forced to implement disaster risk management policies that may include forced relocation. Ineffective public consultation has been cited as one reason for failure of these policies. Using the deliberative polling method, this study assessed the capacity of rural communities to participate in flood risk management policy priority setting and the impact of providing accurate and balanced information on policies by comparing pre-and post -deliberation data. The study also assessed the level of trust on whether government and community would use the results of this study. Results indicated strong community support for policy options to reduce vulnerability in communities and strong resistance to relocation. As all the top five ranked policy options were concerned with population pressure, gender, and social service issues, which are all conceptually considered social determinants of a healthy community, this study concludes that public health considerations are central to flood risk policy development and implementation. The study revealed high levels of trust in government and the community relating to flood risk management, which policymakers in low-to-middle income countries can capitalise on for meaningful community consultation for effective disaster risk management.