Social protection and climate resilience among informal workers in Pakistan: a qualitative study of the Benazir income support programme in Khyber Pakhtunkhwa

Abstract

Background

Informal sector workers in low- and middle-income countries are disproportionately vulnerable to climate shocks due to precarious livelihoods, limited social protection, and structural inequities. In Pakistan, the Benazir Income Support Programme (BISP) and one-time cash grants are the primary safety nets, yet their contribution to climate resilience remains underexplored. This study explored how BISP and emergency cash assistance shape the dimensions of climate resilience among informal sector workers in Khyber Pakhtunkhwa, with particular attention to access barriers, gendered power relations, informal coping strategies, and climate sensitivity of programme design.

Methods

A qualitative phenomenological design was applied between April and June 2025 across three climatic zones of Khyber Pakhtunkhwa: north, central and south. A multistage purposive sampling strategy was used to ensure diversity across geography, occupation, gender and urban–rural residence. Thirty in-depth interviews were conducted with informal workers aged 18 years and above who had been directly affected by a climate shock in the past five years. Six focus group discussions were also conducted with 36 institutional stakeholders from social protection, disaster management, health and local government sectors. Data were collected in Pashto and Urdu, transcribed, translated into English and analysed using qualitative thematic analysis within a descriptive phenomenological orientation.

Results

Thematic analysis identified five themes and ten sub-themes: (1) Inadequate and inflexible financial support (static assistance amid dynamic crises; debt, instability, and recovery fatigue); (2) Barriers to accessing social protection (digital gaps and bureaucratic complexity; cultural and logistical barriers); (3) Gendered constraints and local power structures (aid without autonomy; gatekeeping and informal exploitation); (4) Everyday adaptation and informal resilience (social networks and mutual aid; flexible routines and low-tech innovations); and (5) Towards responsive and climate-sensitive aid (disaster-specific, localised relief; early warning and infrastructure gaps).

Conclusions

Pakistan’s social protection systems provide critical but limited relief against climate shocks for informal workers. To build long-term resilience, reforms are required to make these systems climate-sensitive, adaptive, and gender-transformative. The findings offer policy lessons for other LMICs seeking to strengthen social protection as a pathway to climate resilience.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28367-0.

Introduction

Climate change constitutes a paramount challenge of the 21 st century, threatening livelihoods, health, and socio-economic stability worldwide, with particularly severe consequences for low- and middle-income countries (LMICs) [1–3]. Altered weather patterns and the rise in extreme events undermine agricultural production, cause crop failures, and increase food insecurity for millions [4]. Vulnerable populations are disproportionately affected, with climate impacts exacerbating poverty and inequality [5]. Developing countries are especially exposed due to financial constraints, reliance on climate sensitive industries such as agriculture, and insufficient infrastructure to withstand severe shocks [5–7].

Pakistan exemplifies these vulnerabilities, experiencing frequent floods, droughts, and heatwaves that compound existing socio-economic challenges [8]. The 2010 floods affected 20 million people, caused 1,800 deaths, destroyed over 400 health facilities, and inflicted damages worth US$10 billion [9]. Food insecurity was simultaneously aggravated, affecting nearly 30% of the population and leaving an additional five million people undernourished [9]. More recently, the 2022 floods impacted more than 33 million people, caused 1,700 deaths, led to US$2.3 billion in agricultural losses, and generated total damages of nearly US$30 billion [10, 11]. Beyond these immediate impacts, Pakistan’s climate crisis is shaped by governance and institutional capacity. The government has formulated frameworks such as the National Climate Change Policy, the Disaster Risk Management Framework, and ongoing revisions of the National Adaptation Plan (NAP) [12]. However, implementation remains hindered by weak institutional coordination, limited administrative capacity, and inadequate funding [13, 14]. Climate expenditure has historically remained below 0.004 percent of GDP, substantially lower than estimated regional adaptation needs of 1.5 to 3.0 percent of GDP [15]. Beyond material losses, climate shocks have intensified social inequities, disrupted governance systems, reinforced gendered vulnerabilities, and exposed structural weaknesses in disaster preparedness and social protection delivery.

Khyber Pakhtunkhwa (KP), a province in north-western Pakistan with a population of over 30.5 million and an annual growth rate of 2.9%, is particularly vulnerable to climate change owing to its diverse geography [16, 17]. Northern districts face glacier lake outburst floods, central plains experience heatwaves and urban flooding, while southern areas are vulnerable to prolonged drought and water scarcity [18–20]. While climate shocks affect the broader population through infrastructure damage and service disruption, informal workers experience immediate income collapse due to the absence of contractual protection, wage security, or contributory insurance mechanisms [21]. However, vulnerability within KP is not uniform. Informal workers face structurally distinct risks compared to formally employed populations. Approximately 70 percent of Pakistan’s workforce is engaged in informal employment, and a substantial proportion of KP’s population resides in rural areas dependent on climate sensitive livelihoods [22, 23]. Unlike formally employed groups with contractual safeguards or contributory insurance mechanisms, informal workers lack unemployment protection, employer compensation schemes, and access to formal credit or social insurance during crises [20, 24, 25].

These patterns of vulnerability are closely linked to the concept of resilience, which has become central within climate and development discourse. Resilience is commonly defined as the capacity of individuals, households, and systems to absorb, adapt, and transform in response to shocks [26, 27]. Absorptive capacity refers to short term coping responses that stabilise consumption during crises. Adaptive capacity involves incremental adjustments, such as livelihood diversification or adoption of risk reducing practices, that reduce future exposure. Transformative capacity entails systemic changes that address structural drivers of vulnerability, including governance weaknesses, social inequities, and exclusion from formal protection systems [26]. Importantly, resilience is not socially neutral. Climate shocks intersect with pre-existing inequalities related to poverty, gender, occupation, and access to services, resulting in marginalised groups facing greater exposure to risk while possessing fewer resources to cope, adapt, or recover [28]. Without deliberate attention to equity and redistribution, resilience approaches risk reinforcing existing power asymmetries [28, 29].

Within this resilience framework, social protection has increasingly been positioned as a key policy instrument for strengthening responses to climate shocks [30]. It encompasses social assistance, social insurance, labour market interventions, and universal schemes, each with distinct implications for climate resilience [31]. Social protection comprises institutional mechanisms aimed at safeguarding individuals and households from poverty, livelihood disruptions, and adverse socio economic or environmental shocks [32]. When effectively designed, social protection programmes, particularly social assistance, can operate across protective, preventive, promotive, and transformative functions, thereby contributing to absorptive, adaptive, and transformative capacities [33]. Evidence from LMICs illustrates exemplifies this potential [34, 35]. For example, in Ethiopia, the Productive Safety Net Programme improved food security and reduced reliance on negative coping strategies during droughts, thereby strengthening households’ capacity to absorb climate shocks [36, 37]. In Kenya, the Hunger Safety Net Programme increased food consumption during drought periods, while the Inua Jamii programme improved dietary diversity and nutrient intake, supporting both short-term coping and nutritional resilience [38, 39]. In India, the Mahatma Gandhi National Rural Employment Guarantee Act provided seasonal income while simultaneously investing in water conservation and soil fertility, illustrating how social protection can contribute to adaptive capacity through climate-relevant public works [40, 41]. In Latin America, cash transfer programmes such as Ecuador’s Bono de Desarrollo Humano and Brazil’s Bolsa Família have demonstrated more transformative effects, including enhanced social inclusion and women’s agency, which are critical for addressing the structural dimensions of vulnerability under climate change [42–44]. Despite these examples, many social safety nets remain primarily aligned with poverty alleviation and short-term coping rather than explicitly integrating climate risk considerations into programme design.

In Pakistan, the Benazir Income Support Programme (BISP) represents South Asia’s largest cash transfer programme, reaching 5.6 million families by 2021, approximately 40 percent of those living below the poverty line [45]. Evaluations have documented measurable impacts on women’s empowerment, household food security, and child nutrition [46–48]. During climate crises, BISP and the Ehsaas programme have been temporarily scaled up, including one time disbursements of PKR 25,000 to over 250,000 households following the 2022 floods [10, 49]. While such transfers contribute to absorptive capacity by addressing immediate needs, they remain largely poverty targeted and reactive [50]. In contexts such as Pakistan, resilience therefore depends not only on household coping mechanisms but also on governance coordination, early warning systems, social cohesion, and institutional flexibility.

Informal workers are among the most climate-vulnerable groups, due to lack of stable incomes, secure employment, and access to safety nets Operating outside formal labour regulation and social security systems, they are concentrated in climate sensitive sectors and face structural exclusion from contributory insurance and unemployment benefits [51]. Informal sector workers employment is mostly concentrated in climate-sensitive livelihoods such as agriculture, daily wage labour, construction, and small-scale enterprises, with livelihoods characterised by income instability, limited savings, and exclusion from formal protection schemes [52, 53]. Women in the informal economy experience compounded disadvantages, including wage disparities, restricted mobility, and limited decision-making authority [54]. In KP, where informal employment forms the backbone of the provincial economy, climate shocks expose a significant mismatch between vulnerability and institutional support [55].

Despite growing global literature on adaptive social protection, there remains limited qualitative evidence exploring how poverty-targeted cash transfer programmes function in recurrent climate shock settings, particularly among informal sector workers in Pakistan. Existing evaluations of BISP have largely focused on poverty reduction, nutrition, and women’s empowerment, with limited or no attention to its role in shaping absorptive, adaptive, and transformative dimensions of climate resilience. Therefore, this study aims to explore how social assistance provided through the Benazir Income Support Programme and emergency cash grants shapes climate resilience among informal sector workers in KP, Pakistan. Drawing on lived experiences and institutional perspectives, it explores the adequacy, accessibility, and gendered dimensions of social protection in contexts of recurrent climate vulnerability, with implications for other low- and middle-income countries (LMICs).

Methods

Study design

This study employed a qualitative phenomenological design to explore how socio-economic incentives, particularly the BISP and one-time cash grants, influence the climate resilience of informal sector workers in KP, Pakistan. A phenomenological orientation was adopted to enable an in-depth exploration of participants’ lived experiences and the meanings they attributed to support mechanisms in the context of climate-related shocks. This approach is especially well suited to contexts where subjective realities and personal interpretations are central to understanding social phenomena [56, 57]. This study adopted a relativist ontology, acknowledging realities as shaped by socio-economic and environmental contexts [58, 59], and a constructivist epistemology, viewing knowledge as co-produced between researchers and participants [60].

Participant recruitment

A multistage purposive sampling strategy was used in this study to capture variation across geography, occupation, gender, and age. This approach has previously been applied in qualitative research to ensure maximum variability and representation across system levels and settings [61, 62]. In the first stage, three climatic zones of Khyber Pakhtunkhwa were identified: northern, central, and southern. In the second stage, one district was purposively selected from each zone: Swat (north), Peshawar (central), and Dera Ismail Khan (south). In the third stage, two local government areas within each district were chosen to represent both urban and peri urban or rural contexts. This approach reflects guidance on purposeful sampling that recommends beginning with maximum variation to capture diverse contexts and then narrowing through criterion-based selection to achieve depth of understanding [63].

Eligibility for informal sector workers required participants to be at least eighteen years of age, currently engaged in informal employment within one of the selected districts, and to have directly experienced at least one extreme weather event such as flooding, drought, or a heatwave within the past five years. Individuals were excluded if they had previously served as paid community mobilisers, volunteers, or informants for aid distribution agencies, in order to minimise institutional bias. Those with cognitive, speech, or language impairments that prevented meaningful participation in an interview-based study were also excluded. For institutional stakeholders, eligibility was defined as holding an active professional role in social protection, disaster management, health, or community development within the study districts. Those occupying purely administrative or symbolic positions without direct engagement with communities were excluded.

Recruitment strategies were adapted to the two participant groups. For informal sector workers, community elders, peer groups, and representatives of non-governmental organisations acted as intermediaries, introducing the research team and fostering trust. To reduce external visibility and enhance accessibility, local researchers from the northern, central, and southern zones were recruited. Potential participants were approached in homes, markets, streets, and other workplaces, and were provided with a study information leaflet in the local language alongside a verbal explanation of the study aims, procedures, potential risks and benefits, and assurances of confidentiality. Recruitment and scheduling were adapted to minimise barriers for women and marginalised groups participation: female interviewers were available, interviews were arranged flexibly around work and household responsibilities, and family accompaniment was permitted when requested. Participation was voluntary, with individuals given adequate time to consider their involvement. In total, forty-five informal sector workers were approached (fifteen per climatic zone) for the in-depth interviews (IDIs), of whom thirty consented to participate in the IDIs (ten per zone).

Institutional stakeholders were identified through purposive sampling of relevant sectors, including social protection, disaster management, health, and community development. Initial introductions were facilitated by district offices and organisational representatives, after which formal letters and follow-up calls were used to extend invitations. Interested stakeholders received a study information leaflet and a verbal briefing outlining the study’s aims, procedures, potential risks and benefits, and assurances of confidentiality. Participation was voluntary, and informed consent was obtained before involvement. In total, thirty-six stakeholders were recruited (twelve per zone) and organised into six focus group discussions (FGDs) (two per zone, six participants each).

Data collection

Based on the sampling strategy, data were collected from six purposively selected local government areas within three districts: Mingora and Kabal in Swat (northern zone), Peshawar City and Charsadda (central zone), and Dera Ismail Khan and Tank (southern zone). This selection encompassed both urban and peri-urban/rural contexts, enhancing the diversity and contextual depth of the dataset. Data were collected between April and June 2025 through thirty IDIs with informal sector workers (ten per climatic zone) and six FGDs with institutional stakeholders (two FGDs per zone, each with six participants).

Semi-structured topic guides were developed by a multidisciplinary team at Khyber Medical University, bringing together expertise in qualitative research, global health, epidemiology and biostatistics, climate change, climate finance, and public health data science. Efforts were made to draw on this diversity of expertise, together with relevant literature on climate resilience and social protection in LMICs, to develop guides that were methodologically robust and contextually relevant. Separate versions were prepared for IDIs and FGDs to capture both the lived experiences of informal workers and the institutional perspectives of programme implementers and policymakers.

IDIs were conducted at participants’ worksites or in nearby safe settings by bilingual, trained research associates (one male and one female), each lasting approximately 30 min. FGDs were facilitated by the female principal investigator in private community venues, such as school facilities, with each session lasting between 30 and 45 min. All IDIs and FGDs were conducted in the local language (Pashto or Urdu). Reflective notes were made by the researchers after each session to enhance reflexivity [64]. Informed consent was documented in accordance with participant preference and literacy level, either by signed form for those with sufficient education or by thumb impression for those with limited formal education. All participants provided consent for both participation and audio recording. The first IDI and FGD were piloted to assess the appropriateness of the topic guides; as no substantive revisions were required, both were retained in the dataset. In qualitative research, data saturation refers to the point at which further data collection no longer generates new codes, themes, or insights, and additional data collection are unlikely to add substantive value to the analysis [65]. Data saturation in this study was reached after thirty IDIs and six FGDs, at which point no new themes emerged and participant accounts became repetitive.

Data analysis

All IDIs and FGDs were conducted in Pashto or Urdu and transcribed verbatim into English by trained bilingual members of the research team. Transcripts were checked for accuracy and completeness before analysis. For FGDs, institutional stakeholders were offered the opportunity to review their transcripts, although none requested changes. As some informal sector participants had limited literacy, transcripts were not returned for review. Instead, interviewers provided verbal summaries at the end of each session, inviting participants to clarify or expand on their views.

A qualitative thematic analysis was undertaken within a descriptive phenomenological orientation. We followed Sundler et al. (2019), who outline qualitative thematic analysis based on descriptive phenomenology, with emphasis on openness to lived experience, reflexivity, and questioning of researchers’ pre-understandings and presuppositions [66]. ATLAS.ti version 1.8 was used to support data organisation, coding, retrieval and comparison [67].

The analysis began with repeated reading of the transcripts by two researchers (SSB and SIK) to develop familiarity with the whole dataset and to gain an initial understanding of participants’ lived experiences. During this stage, the researchers moved back and forth between complete transcripts and specific accounts to understand the context in which meanings were expressed. Field notes and reflective notes were also reviewed to retain contextual detail from the interviews and focus group discussions.

Meaning units were then identified by two researchers (SSB and SIK) from words, phrases, sentences and longer sections of text that captured important aspects of participants’ experiences. These meaning units related to climate-related livelihood disruption, access to BISP and emergency cash assistance, adequacy and timing of support, digital and bureaucratic barriers, gendered constraints, local power relations, informal coping strategies and suggestions for climate-sensitive social protection. The meaning units were coded inductively and kept close to participants’ accounts to preserve the meanings expressed in the data.

Three researchers (HSS, SSB and SIK) compared the coded meaning units across transcripts and grouped related codes into broader clusters of meaning. They moved iteratively between individual coded extracts and the whole dataset to ensure that emerging understandings remained grounded in participants’ accounts.

Preliminary themes were developed from these clusters of meaning by three researchers (HSS, SSB and SIK). These themes were reviewed, questioned and refined through repeated engagement with the data. The analysis considered both similarities and differences across rural and urban participants, climatic zones and participant groups, including informal workers and institutional stakeholders.

The preliminary themes were discussed within the wider research team (MIK, ZUH, SIK, HSS, SSB and KR). During these discussions, the team considered whether the themes captured the meanings expressed in the data, whether they were distinct from one another, and whether they adequately reflected participants’ lived experiences. The final themes were then defined, named and integrated into a descriptive analytical narrative supported by illustrative quotations.

To enhance rigour, trustworthiness was considered in line with Lincoln and Guba’s criteria of credibility, dependability, confirmability and transferability [68]. Credibility was supported through repeated reading and initial coding by two researchers, comparison of coded meaning units by three researchers, wider team discussion, comparison across IDIs and FGDs, and use of illustrative quotations. Dependability was strengthened through systematic coding procedures and documentation of analytical decisions. Confirmability was supported through reflective notes and team-based discussions of emerging understandings. Transferability was enhanced by providing contextual detail about the study setting, participant groups and climate vulnerability across the three regions. The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) [69].

Results

A total of 30 informal sector workers participated in the study, with equal representation from the northern (n = 10), central (n = 10), and southern (n = 10) climatic zones, as summarised in Table 1. The sample comprised more women (n = 16, 53.3%) than men (n = 14, 46.7%). Participants were aged between 25 and 55 years. Educational attainment was generally low, with 19 participants (63.3%) having completed primary-level education and 11 participants (36.7%) having reached secondary level. Housing conditions reflected socio-economic precarity, with nine participants (30.0%) residing in mud houses, six (20.0%) in semi-permanent structures, five (16.7%) in concrete houses, six (20.0%) in rented rooms or flats, two (6.7%) in brick houses and two (6.7%) in informal shelters. Occupations varied, highlighting the heterogeneity of informal work. The main occupation categories were farming or seasonal farming (n = 6, 20.0%), domestic or service work (n = 6, 20.0%), home-based business or tailoring (n = 6, 20.0%), daily wage or manual labour (n = 6, 20.0%), street vending or shopkeeping (n = 4, 13.3%) and other skilled work (n = 2, 6.7%). Household dependency levels were high, with 11 participants (36.7%) reporting high dependency, 15 (50.0%) reporting medium dependency and four (13.3%) reporting low dependency.

Table 1.

Socio-demographic and household characteristics of informal sector worker participants (n = 30)

Characteristic	Category	n (%)
Region	North	10 (33.3)
	Central	10 (33.3)
	South	10 (33.3)
Location	Rural	15 (50.0)
	Urban	15 (50.0)
Gender	Female	16 (53.3)
	Male	14 (46.7)
Age group	25–34 years	13 (43.3)
	35–44 years	11 (36.7)
	45–54 years	4 (13.3)
	55 years and above	2 (6.7)
Education level	Primary	19 (63.3)
	Secondary	11 (36.7)
Type of housing	Mud house	9 (30.0)
	Semi-permanent	6 (20.0)
	Concrete house	5 (16.7)
	Rented room/flat	6 (20.0)
	Brick house	2 (6.7)
	Informal shelter	2 (6.7)
Occupation category	Farming/seasonal farming	6 (20.0)
	Domestic/service work	6 (20.0)
	Home-based business/tailoring	6 (20.0)
	Daily wage/manual labour	6 (20.0)
	Street vending/shopkeeping	4 (13.3)
	Other skilled work	2 (6.7)
Dependents level	Low	4 (13.3)
	Medium	15 (50.0)
	High	11 (36.7)

A total of 36 institutional stakeholders participated in the study, as summarised in Table 2. The majority were male (n = 25, 69.4%), while females comprised 11 participants (30.6%). Regional representation was evenly distributed, with 12 participants drawn from each of the central, northern and southern climatic zones. Participants were aged between 26 and 59 years, with a mean age of 42.8 years (SD = 9.3); the mean age was 44.0 years for males and 40.3 years for females. With respect to education, most stakeholders had attained tertiary-level qualifications (n = 26, 72.2%), while the remainder had completed education up to secondary level (n = 10, 27.8%). Years of professional experience ranged from 4 to 25 years, with an overall mean of 11.1 years. Stakeholders from the southern zone reported the highest mean work experience (13.3 years), followed by those in the central (10.3 years) and northern (9.8 years) zones.

Table 2.

Socio-demographic and professional characteristics of institutional stakeholder participants (n = 36)

Characteristic	Category	n (%)
Region	Central	12 (33.3)
	North	12 (33.3)
	South	12 (33.3)
Location	Rural	19 (52.8)
	Urban	17 (47.2)
Gender	Male	25 (69.4)
	Female	11 (30.6)
Age group	25–34 years	8 (22.2)
	35–44 years	11 (30.6)
	45–54 years	13 (36.1)
	55 years and above	4 (11.1)
Education level	Secondary	10 (27.8)
	Tertiary	26 (72.2)
Professional sector	Environment/environmental protection	9 (25.0)
	Disaster management/rescue	9 (25.0)
	Social protection/social welfare	6 (16.7)
	Health/emergency medicine/healthcare commission	8 (22.2)
	Climate finance/agriculture/forestry	4 (11.1)
Work experience	4–5 years	4 (11.1)
	6–10 years	15 (41.7)
	11–15 years	9 (25.0)
	16 years and above	8 (22.2)

Analysis of the interviews and focus group discussions generated five overarching themes and ten related sub-themes, these are summarised in Table 3, which presents the themes and associated sub-themes.

Table 3.

Overview of themes and sub-themes

Themes	Sub-themes
1. Inadequate and inflexible financial support	1.1 Static assistance amid dynamic crises 1.2 Debt, instability, and recovery fatigue
2. Barriers to accessing social protection	2.1 Digital gaps and bureaucratic complexity 2.2 Cultural and logistical barriers
3. Gendered constraints and local power structures	3.1 Aid without autonomy 3.2 Gatekeeping and informal exploitation
4. Everyday adaptation and informal resilience	4.1 Social networks and mutual aid 4.2 Flexible routines and low-cost innovations
5. Towards responsive and climate-sensitive aid	5.1 Disaster-specific, localised relief 5.2 Early warning and infrastructure gaps

Theme 1. Inadequate and inflexible financial support

Subtheme 1.1. Static assistance amid dynamic crises

Participants across rural and urban settings emphasised that although social safety nets and one-time grants provided short-term relief, the fixed amounts and quarterly disbursements were inadequate to meet the scale and duration of climate-related crises. Rural households, particularly those dependent on farming and livestock, described a mismatch between seasonal vulnerabilities and rigid support structures.

“The cash from the social programme and one-time grants provided immediate help, which we used for food and some crop medicines. However, the funds were quickly depleted since support comes only every three months. As we depend on farming for income, I invested part of it in hopes of a good harvest. Unfortunately, the limited and infrequent support does not address larger issues, especially during floods or bad weather, and it doesn't help us prepare for the long term or recover from major losses.” (ID-9, Farmer).

Urban informal workers similarly reported that support was mainly used to cover immediate needs such as rent, utilities, and food, but did not compensate for lost income or broader economic disruption. A few participants attempted to invest the assistance in small-scale livelihood activities, though these efforts were frequently undermined by subsequent climate shocks.

“I can't really say that the support has boosted my income since I still rely on selling flowers, seeds, and plants from my garden to help my family. However, it did provide me with some extra cash to grow my business. I used some of that money to buy essential tools and cover transport costs to local markets. The weather, though, is a real challenge. Heavy rains and heatwaves frequently ruin my plants or hinder my ability to reach customers. Sometimes, roads get blocked, making it tough to deliver orders or bring in supplies on time. The assistance is helpful to some extent, but it doesn't fully address the actual costs of these setbacks. As a gardener, I really need steady support that can safeguard my work and income when the weather doesn't cooperate.” (ID-4, Gardener).

Stakeholders echoed these views, noting that BISP is primarily oriented towards poverty alleviation and maternal health rather than climate resilience. While it has the capacity to offer one-time cash grants during climate events or emergencies, it was regarded as insufficiently flexible or responsive to the acute and evolving challenges posed by climate-induced shocks.

“In the floods of 2022, the government handed out an extra Rs. 12,000, but honestly, that was just a tiny fraction of the massive losses. Whole crops were destroyed, livestock died, and families had to start over from scratch. The truth is, programme like BISP and unconditional cash transfers weren’t really set up with climate resilience in mind. They overlook areas and people that are frequently hit by floods, droughts, and other disasters. These payments aim to help with women’s education, health, and reducing poverty but they really don’t cut it when it comes to ongoing climate crises.” (FGD South, P25).

Subtheme 1.2. Debt, instability, and recovery fatigue

The fragile nature of informal work made participants particularly vulnerable during climate events, often pushing them into debt. Rural workers described being caught in cycles of borrowing to offset agricultural and livestock losses, while urban workers reported taking loans to survive when floods or storms disrupted customer flows and reduced their earnings.

“However, when heavy rains flooded the streets, customers stopped coming. That’s when things got really tough. We receive Rs. 12,500 every three months, which is helpful, but it’s not sufficient especially during emergencies. If the money came in monthly, it would really make a difference. Even during normal times, we find it hard to make ends meet, and when a flood or heatwave strikes, everything goes downhill. I had to borrow from family just to keep afloat. Once you get into debt like that, it’s really difficult to bounce back.” (ID-12, Casual Labourer).

Stakeholders observed that successive disasters had created a sense of “recovery fatigue,” as households struggled to rebuild before the next crisis. They noted that the increasing frequency and intensity of climate events, together with limited support systems, hindered households’ ability to recover.

“In Khyber Pakhtunkhwa, communities are stuck in a constant loop of rebuilding. Every flood or heatwave brings new losses, whether it’s crops, livestock, homes, or health. Recovery rarely finishes before another disaster strikes, and we find ourselves scrambling to tackle the next problem. There’s no solid prevention strategy in place, neither financially nor in terms of climate.” (FGD Central, P-2).

Theme 2. Barriers to accessing social protection

Subtheme 2.1. Digital gaps and bureaucratic complexity

Participants reported that limited literacy and lack of digital access posed major barriers to engaging with social protection services, especially in rural areas and among women. Older adults, in particular, described challenges with reading, writing, and using mobile technologies. The absence of smartphones, unfamiliarity with SMS-based systems, and confusion about registration procedures further constrained their ability to access available support.

“My wife and I struggle to grasp mobile apps and point-of-sale systems, which complicates things for us. The SMS notifications we get are also puzzling and hard to make sense of. All of this just adds to the confusion and stress we deal with during the whole process.” (ID-7, Electrician).

Stakeholders acknowledged that while digitalisation enhanced programme efficiency, it also created new barriers that excluded vulnerable groups.

“Since our launch in 2008–2009, we’ve seen a big digital shift. Initially, we operated as a paper-based transfer programme, but by 2015, we teamed up with NADRA to transition to ATM cards. Then in 2018, we collaborated with various banks for mobile cash transfers, which has improved our data management. However, this shift has also left many people behind, particularly women in rural or low-literacy areas. They often don’t know where to go or how to sign up. If we don’t address this gap, even the most well-designed programme will fail to reach those who need assistance the most.” (FGD Central, P6).

By contrast, urban workers with smartphones and workplace connectivity reported smoother access to services. However, in both urban and rural settings, misinformation, missed announcements, and bureaucratic hurdles continued to restrict engagement. Rural residents were especially disadvantaged by the long travel required to reach distant service centres.

“Whether you’re in the village or the city, many of us face the same problems. At first, I didn’t know how to apply and had to ask around. Some shops turned me away, saying only certain ones handled applications. When I finally found the right place, they said my wife wasn’t eligible, so we had to go to NADRA to prove otherwise, which caused further delays. In cities, people may also deal with paperwork issues, but they can usually reach offices more easily. In rural areas, it means long trips on broken roads and multiple visits, especially when documents are missing. Many people, like us, miss out on aid or deadlines simply because the process isn’t clearly explained. The system may be simple, but the confusion makes it much harder than it should be.” (ID-19, Seasonal Farmer).

Subtheme 2.2. Cultural and logistical barriers

Participants explained that in rural areas, cultural norms surrounding female modesty and family honour constrained women’s mobility. Women were often required to travel with male relatives, leading to delays or missed appointments when escorts were unavailable. This dependence on male family members limited timely access to services, particularly during emergencies.

“For women in our Pashtoon culture, things are even harder. They’re not allowed to travel alone and always need a male family member to go with them for safety and respect. But we're often busy or not around, so they end up missing appointments or deadlines just because they can’t go on their own. These restrictions keep them dependent and make it hard for them to speak up or do things for themselves. In the end, it’s not just the women who are affected, this holds back progress for the whole community.” (ID30, Farmer).

In urban contexts, women reported comparatively greater autonomy, facilitated by access to transport and digital technologies. By contrast, travel infrastructure posed a substantial barrier in rural areas, where poor road conditions and distant service centres made aid collection highly burdensome. Stakeholders further noted that cultural constraints, compounded by infrastructure breakdowns, disproportionately disadvantaged women, children, and persons with disabilities.

“During disasters, people often struggle to access any kind of facilities, whether it's healthcare or social funds, especially in rural areas. Women are particularly affected due to cultural and religious practices. On top of these cultural barriers, groups like pregnant women, children, and individuals with congenital disabilities face even greater challenges because of physical limitations. For them, the impact is intensified by both physical and cultural obstacles.” (FGD North, P23).

Theme 3. Gendered constraints and local power structures

Subtheme 3.1. Aid without autonomy

Participants reported that gendered constraints shaped women’s access to support in both rural and urban settings, with rural women facing stricter enforcement of patriarchal norms and fewer opportunities to contest them. Although women were frequently registered as beneficiaries of programme such as BISP and one-time cash grants, many described having little control over how these funds were used. In rural households, financial decisions were typically managed by men, with husbands or other male relatives determining spending priorities. In urban areas, some women noted slightly more space to exercise decision-making, particularly those with independent incomes or digital literacy, yet patriarchal expectations and family oversight continued to limit their agency.

“The money is in my name, I go and collect it, and I get to decide how to use it. But sometimes my husband asks for it, claiming he’s low on cash for his work, and I feel like I have no choice but to hand it over. I have to live with him and we have kids together. There have even been times when I’ve had to use this social support to help pay off his debts.” (ID-5, Home Tutor).

Stakeholders further emphasised that social protection programme should extend beyond cash disbursement to actively promote women’s empowerment and address restrictive gender norms.

“But the programme needs to go beyond just giving out cash every few months. Real empowerment for women requires teamwork across different sectors like health, education, disaster management, and gender equality. We really need to move from just keeping an eye on cash distributions to looking at real empowerment results. Are women seeing significant changes in their homes, communities, and lives? Just cash isn't sufficient; true impact comes from changing norms, creating more opportunities, and making sure that support leads to lasting independence and respect.” (FGD South, P32).

Subtheme 3.2. Gatekeeping and informal exploitation

Participants in both rural and urban areas recounted experiences of gatekeeping, corruption, and informal exploitation when attempting to access social safety nets. Rural women, constrained by limited mobility and weaker social networks, were particularly disadvantaged. Urban participants described managing these obstacles through persistence, personal connections, or digital literacy; however, demands for informal payments and unresponsive officials remained widespread.

“My family had gone through the application process before, so they filled me in on what to expect, which really helped. But the officials I dealt with for registration were totally unhelpful; they kept asking for money to process my application. They didn't even bother to say hello properly and wanted to know if I was ready to hand over a part of the money I’d get from the Benazir programme or any other social aid, whether it was regular or for disasters. When I said no, they claimed I wasn't eligible. Luckily, a relative stepped in and guided me through the application at a different centre, where the staff were way more supportive thanks to our social ties.” (ID-15, Waste picker).

Stakeholders acknowledged these challenges, noting persistent issues of leakage and corruption, but also highlighted recent reforms introduced to strengthen transparency and accountability.

“Back in 2020, we saw investigations into fund skimming, with reports of people who weren't beneficiaries receiving funds, including some government officials. Most of the issues reported involved local retail outlets taking money from beneficiaries. Even a World Bank impact evaluation pointed out that women beneficiaries were less satisfied because of fund leakage through human agents. Some solutions are already in the works; the programme is focusing on third-party monitoring, audits, grievance support, strict penalties for those caught embezzling, and increasing the number of female staff in the programme.” (FGD North, P4).

Theme 4. Everyday adaptation and informal resilience

Subtheme 4.1. Social networks and mutual aid

Participants described resilience in rural areas as being rooted in kinship systems and informal social networks that provided crucial support during crises such as floods, heatwaves, and prolonged power outages. In the absence of robust formal safety nets, family ties, neighbourly relations, and shared experiences offered shelter, food, labour, and emotional reassurance. These community-based mechanisms were viewed as critical in enabling households to cope, adapt, and recover from recurring climate shocks. In urban settings, participants noted that social networks were present but weaker, often taking the form of short-term, charity-like assistance. While such support offered immediate relief during emergencies, it seldom contributed to sustained recovery.

“In our neighbourhood, during climate-related emergencies, people occasionally help each other out, but it's usually just a one-time gesture. In big cities, the assistance during such events often follows a predictable pattern. Wealthier individuals tend to provide clothing, food, or shelter, but it often feels more like charity rather than genuine support for long-term recovery. In times of crisis, affluent families may help those in need, but they typically don't invest the time or effort to help rebuild lives; they simply lack the capacity for that.” (ID-11, Service Worker).

Stakeholders reinforced these perspectives, emphasising the importance of informal networks in providing food, shelter, rescue, and communication during disasters, and recognising them as a vital complement to formal support systems.

“Communities often rely on informal networks, like neighbours helping each other out during bad weather. In Khyber Pakhtunkhwa, this culture of helping one another is well-rooted, covering shelter, transport, rescue, food sharing, financial aid, and even local early warning systems. Many families welcome those who have lost their homes, while others use local resources like tractors or boats to transport at-risk families to safer areas. Community members frequently share basic food items or organise group meals funded by mosques. Plus, word-of-mouth alerts and announcements from mosques serve as common early warning systems, emphasizing the crucial role of community unity, which is built on social ties and mutual support in times of crisis.” (FGD Central, P3).

Subtheme 4.2. Flexible routines and low-tech innovation

Both rural and urban participants described adopting locally driven strategies to cope with climate extremes. In rural areas, adaptations included adjusting work schedules and introducing low-cost innovations to support daily survival. Rural participants stressed that these practices were grounded in practical knowledge, traditional methods, and a deep familiarity with their environment.

“When flooding is expected, we design makeshift boats to transport our livestock and families to safer areas. We're familiar with local rainfall patterns and try to align our planting cycles with the weather to improve crop yields. Rainwater harvesting is important to us; we store water in barrels and underground tanks because our region experiences unpredictable shifts from droughts to heavy rainfall. We’ve seen it all.” (ID-19, Seasonal Farmer).

Urban participants, by contrast, reported relying more on market-based solutions, including the use of solar energy, refrigeration, and adjustments to work schedules. Stakeholders confirmed that communities in both rural and urban settings adapted their routines, tools, and practices to manage risks during extreme weather events, drawing on a combination of indigenous knowledge and emerging technologies.

“As summer’s heat up, they’re moving their work to the cooler early mornings or evenings. Weather changes are affecting school attendance, leading to more home-based schooling, and altering how people collect water for cooking. There’s a noticeable shift towards using solar-powered batteries, fans, lights, and direct current systems. Whether you’re in the village or the city, you can see this change. Through traditional practices, people are relying on old methods like using woven beds outside or on rooftops, and mud walls provide better natural ventilation compared to concrete houses. Farmers are quite skilled at observing river flows and animal behaviour to develop early warning systems.” (FGD South, P 36).

Theme 5. Towards responsive and climate-sensitive aid

Subtheme 5.1. Disaster-specific, localised relief

Participants emphasised the limitations of static, poverty-focused initiatives such as BISP in addressing disaster-related needs. One-time cash grants were regarded as insufficient and poorly aligned with local priorities. Urban participants, in particular, called for reforms to make aid more responsive, suggesting mechanisms such as mobile cash transfers, tailored recovery packages, and support for livelihood diversification.

“People who live in areas prone to floods, droughts, or heatwaves should definitely be on a list to receive assistance, and this list needs to be reviewed and updated at least once a year. When a disaster strikes, they should receive emergency funds immediately through mobile apps like Jazz Cash or Easypaisa, no waiting around. However, this support shouldn’t just last a few days. It should also help people rebuild their lives. For instance, if someone lost their livestock in a flood, they should be provided with new goats or chickens. If their crops were ruined, they should receive seeds and farming equipment. If heatwaves damaged their sewing machine or handcart, they should get help to replace those items. The programme should also focus on teaching people new skills and assisting them in starting small businesses such as mobile repair, sewing, or farming that can adapt to changing weather so they can earn money again and truly recover.” (ID-5, Home Tutor).

Stakeholders similarly acknowledged the structural limitations of existing systems, particularly the lack of climate-specific indicators to guide programme design and implementation. They proposed the introduction of adaptive mechanisms, such as pre-disaster cash transfers and microinsurance schemes, to strengthen anticipatory capacity and enhance resilience.

“BISP provides some relief… but it wasn't specifically created for disasters related to climate change. Genuine recovery calls for a comprehensive approach. We need to test an adaptive social protection system within BISP operations, targeting only those individuals who are at verified climate risk. Vulnerability mapping is crucial for pre-disaster payments, where high-risk households are identified in advance. Payments should be made through easy mobile cash transfers instead of just offering reactive support when a climate crisis hits. We also need microinsurance for small-scale farmers and climate resilience funds that link disaster-related public financing from government or international donor sources. We need a shock-responsive and forward-thinking adaptive system for BISP that not only focuses on reducing poverty but also on building climate resilience.” (FGD Central, P4).

Subtheme 5.2. Early warning and infrastructure gaps

Across both rural and urban settings, participants expressed dissatisfaction with weak early warning systems and inadequate infrastructure. Rural residents particularly highlighted delays in receiving alerts and challenges in accessing evacuation routes. Urban participants reported receiving warnings through multiple channels, yet noted inconsistencies and concerns regarding their reliability.

“I remember a time when we received a flood alert via an announcement at the mosque it had a significant impact. We require that type of local alert system in all communities. Sometimes we receive text messages or automated calls, and occasionally we find updates on social media, TV, or radio. However, these alerts can be unreliable. There is a pressing need to enhance the accessibility, frequency, and clarity of early warnings so that everyone, no matter their location, can prepare in a timely manner.” (ID-21, Home-based Business).

Stakeholders underscored the absence of localised forecasting mechanisms and recommended enhanced inter-agency coordination, greater investment in technology, and the establishment of community-based warning networks.

“It's not too tough to set up early warning systems in Pakistan. We could kick things off by bringing together platforms like NDMA and PDMA, along with real-time dashboards. We should invest in forecasting models and monitoring systems, especially in provinces that are prone to extreme weather. Plus, we can train local volunteers, like climate activists, to act as ambassadors for early warning systems and help build community-based initiatives. Improving communication is key, so we should use radio and SMS to send localized early alerts instead of the usual generic extreme weather warnings. For instance, we could notify people that a specific area is expected to have 4 feet of water in the next 24 h. Right now, we just get a standard voice message or text. International donor agencies could also help with capacity building for community training and evacuation drills. These are all basic yet essential steps for enhancing early warning systems.” (FGD North, P20).

Discussion

This study explored how socio-economic incentives particularly one-time cash grants and the Benazir Income Support Programme (BISP) shape the climate resilience of informal workers in Khyber Pakhtunkhwa. Participants identified five interconnected areas: inadequate and inflexible financial support; barriers to accessing programmes; gendered constraints and power dynamics; everyday adaptation strategies; and the need for climate-sensitive and responsive aid. Overall, while cash transfers offered short-term relief, they did not support long-term resilience, leaving workers to depend heavily on their own adaptive practices. Our findings highlight a persistent misalignment between existing social protection schemes and the recurrent, long-term nature of climate risks.

This reflects broader debates in resilience literature, where resilience is often framed as a short-term “bounce back” capacity [70, 71]. Cash transfers contributed to absorptive capacity, helping households manage immediate shocks consistent with evidence from Kenya’s HSNP, Ethiopia’s PSNP, and Mexico's programmes [71, 72]. Importantly, BISP’s stated objectives to support women and children, address undernutrition, and its ability to scale up transfers during crises indicate alignment with core principles of absorptive climate resilience [73]. However, as documented elsewhere, cash alone seldom enables sustained adaptation without complementary interventions such as credit, assets, or skills development [33]. Our findings highlighted that BISP’s perceived climate blindness reflects implementation gaps rather than programme intent, as poverty-based eligibility, uniform transfer values, and reactive disbursement mechanisms are poorly aligned with recurrent and localised climate risks. Limited integration with climate risk mapping, early warning systems, and livelihood protection mechanisms further constrained responsiveness in areas repeatedly affected by floods, droughts, and heatwaves. These gaps point to the need for social protection programmes to move beyond absorptive support and embed climate responsiveness to remain adequate amid ongoing climate crises.

Barriers to access were central to participants’ experiences. Digital exclusion, low literacy, and bureaucratic procedures disproportionately affected rural and marginalised groups. Women faced compounded disadvantages due to mobility restrictions, low digital literacy, and dependence on male relatives, echoing evidence that digital inclusion requires simplified tools, non-digital options, and local training [74]. Participants also reported corruption, gatekeeping, and informal deductions, consistent with independent evaluations documenting leakage and elite capture in BISP [43]. Gendered and cultural constraints identified in our study mirror broader LMIC evidence that weak attention to social norms and power relations limits social protection effectiveness and can perpetuate hidden forms of exploitation [75, 76].

Participants also described everyday adaptive strategies, including informal social support, adjustments to work routines, rainwater harvesting, and small-scale solar use, reflecting adaptive capacity as described in resilience frameworks. Viewed through this lens, adaptive and transformative capacities were largely sustained through individual and community agency rather than formal institutional support. Similar forms of community-based resilience have been reported in Nepal and Bangladesh [77, 78], and across Asia and Africa, where indigenous knowledge and community agency underpin climate adaptation [79].

Rather than proposing wide-ranging reforms, the findings point to two priority areas for strengthening climate-responsive social protection: climate-sensitive targeting and greater implementation flexibility. Participants stressed the need for flexible, rapid, and hazard-specific support, including mobile cash transfers and programme designs that reflect differential exposure to climate risks. These priorities align with global calls for shock-responsive and anticipatory social protection that integrates climate triggers, vulnerability mapping, and flexible delivery mechanisms in LMICs [80, 81]. Participants also noted weaknesses in Pakistan’s disaster governance, echoing wider critiques of fragmented early warning systems and limited local infrastructure [82–84]. Evidence from South Asia shows that community-embedded early warning systems can substantially reduce disaster losses [85, 86].

In addition to programme design limitations, the findings revealed important rural–urban distinctions in resilience pathways. Rural informal sector workers described recovery processes centred around agricultural rehabilitation, livestock protection, and kinship-based support systems, whereas urban workers experienced income volatility linked to market closures, infrastructure breakdowns, and disrupted daily wage opportunities. These spatially differentiated experiences illustrate that resilience capacities are territorially mediated and embedded within distinct livelihood ecologies and requires context-specific social protection responses rather than standardised national delivery models [70, 71, 87]. The study also underscores the significance of local knowledge and community-based networks in buffering climate shocks. Informal workers frequently relied on neighbour support, kinship borrowing, and informal collective coping mechanisms in the absence of institutional assistance. While these social cohesion mechanisms strengthened short-term absorptive capacity, their sustainability remains constrained without integration into formal governance and climate adaptation systems, consistent with emerging evidence on the need to align social protection with climate adaptation financing and governance frameworks [88].

Implications for practice, policy and research

The findings of this study indicate several ways to strengthen the contribution of social safety nets, including BISP and one-off cash grants, to the climate resilience of informal sector workers in Pakistan. First, social protection programmes should incorporate climate sensitivity into their design. BISP needs to move beyond a static poverty focus and adopt climate responsive mechanisms such as mobile cash transfers, rapid disbursement during emergencies, and disaster contingent top ups. Strengthening the links between climate change, humanitarian response, and long-term development would allow BISP to operate as a more transformative safety net rather than a minimal source of temporary relief. Second, supporting long-term resilience requires a shift from short-term absorptive assistance toward interventions that build adaptive and transformative capacities. Access to credit, skills training, livelihood diversification, and asset building would enable households to invest in climate resilient housing, livelihoods, and small enterprises, reducing recurring reliance on emergency transfers. Third, improving accessibility and eligibility is essential. Regularly updating beneficiary lists through poverty and climate vulnerability assessments, particularly in high-risk districts, would enhance programme responsiveness. Aligning BISP with disaster risk reduction frameworks, alongside training female community facilitators to support women with low literacy and limited mobility, would reduce digital exclusion and dependence on male intermediaries. Fourth, governance and accountability mechanisms require strengthening to address corruption, elite capture, and informal deductions. A hybrid accountability model that combines technology enabled transparency with community-based monitoring, local grievance redress systems, and citizen oversight can promote greater trust and ensure that both institutions and communities have meaningful roles in shaping programme delivery. Finally, improving interagency coordination is critical for climate resilience. Collaboration between BISP, the National Disaster Management Authority, and Provincial Disaster Management Authorities can support the development of climate smart safety nets. Practical measures include the establishment of trained community early warning ambassadors and investment in localised, actionable early warning systems that directly link with social protection delivery.

Strengths and weaknesses of the study

To our knowledge, this is the first qualitative study in Pakistan to examine the relationship between social safety nets and climate resilience among informal workers. A major strength of the study lies in its qualitative design, which enabled an in-depth exploration of lived experiences and institutional perspectives across multiple climatic zones, generating rich, contextually grounded insights that are difficult to capture through quantitative approaches. Methodological rigour was enhanced through qualitative thematic analysis within a descriptive phenomenological orientation, team-based interpretation, comparison across participant groups, and adherence to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Women’s participation, particularly among community members, was strong despite prevailing cultural norms and gendered power structures, facilitated by the predominantly female research team, which supported trust-building and inclusive engagement.

Several limitations should be acknowledged. As with all qualitative research, the findings are not statistically generalisable; however, they offer analytical and contextual transferability to similar settings. The study was conducted in Khyber Pakhtunkhwa, and experiences may differ in other provinces with distinct socio-economic and climatic conditions. Data were collected at a single point in time and therefore capture experiences at a particular stage of recurrent climate shocks, which may not reflect longer-term resilience trajectories. Reliance on self-reported experiences may have introduced recall bias, although this was mitigated through contextual probing and triangulation. The exclusion of individuals with significant cognitive or speech impairments is noted as a methodological limitation, reflecting the requirements of an interview-based qualitative design and may have modestly constrained the range of perspectives captured.

Conclusion

This study explored how poverty targeted social assistance, particularly the Benazir Income Support Programme and one-time emergency cash grants, shapes the climate resilience of informal workers in Khyber Pakhtunkhwa, Pakistan. Grounded in resilience theory, the study explored how absorptive, adaptive, and transformative capacities are supported or constrained within recurrent climate shock settings.

The findings demonstrate that while cash transfers provide essential short-term relief and contribute to absorptive capacity by stabilising consumption during crises, they do not adequately support adaptive or transformative resilience. Limited transfer amounts, uniform poverty-based targeting, reactive disbursement mechanisms, digital and bureaucratic barriers, and gendered power dynamics restrict the ability of social protection programmes to respond to the differentiated and recurring nature of climate risks faced by informal workers. As a result, adaptive and transformative capacities were largely sustained through individual agency, local knowledge, and community networks rather than institutional support.

The study highlights a structural misalignment between climate vulnerability and poverty-oriented safety nets. In contexts characterised by recurrent floods, droughts, and heatwaves, social protection systems that remain climate blind risk reinforcing existing inequalities and perpetuating cycles of vulnerability. Building genuine climate resilience requires moving beyond static poverty alleviation towards climate sensitive targeting, anticipatory financing, governance integration, and interventions that strengthen livelihood diversification, asset accumulation, and social cohesion.

By providing qualitative evidence from informal workers across multiple climatic zones, this study contributes to emerging evidence on adaptive social protection in LMIC countries. It underscores the importance of integrating equity, territorial differentiation, and institutional flexibility into climate resilience strategies. In doing so, it offers policy relevant insights for Pakistan and other climate vulnerable LMICs seeking to align social protection systems with the long-term realities of climate change.

Abbreviations

ATLAS.ti

Qualitative data analysis software

BISP

Benazir Income Support Programme

COREQ

Consolidated Criteria for Reporting Qualitative Research

FGDs

Focus group discussions

GDPC

Global Disaster Preparedness Center

GDP

Gross Domestic Product

IDIs

In-depth interviews

KP

Khyber Pakhtunkhwa

LMICs

Low- and middle-income countries

NAP

National Adaptation Plan

PKR

Pakistani Rupee

Authors’ contributions

The research team included MIK, the senior qualitative researcher and principal investigator; ZUH, the global health specialist and co-principal investigator; KR, the climate and health expert; SIK, the health data scientist; and SSB, the qualitative research associate. HMJ and AA contributed as experienced researchers in global health and public health.

Funding

This study was supported by a grant from the American Red Cross Global Disaster Preparedness Center (GDPC) Research Grants Program for Urban Climate Resilience. The funder had no involvement in the study’s design, data collection, analysis, interpretation of findings, decision to publish, or writing of the manuscript.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to their qualitative nature and the need to preserve the anonymity and confidentiality of research participants, but are available from the corresponding author on reasonable request. Requests for access to the data should be directed to Dr Maria Ishaq Khattak at maria.iph@kmu.edu.pk.

Declarations

Ethics approval and consent to participate

This study received approval from the Khyber Medical University Ethics Board (Reference: Dir/Ethics/KMU-EB/EC/00106). Informed consent to participate was obtained from all participants before data collection. Participants were informed about the aims of the research, the voluntary nature of their involvement, their right to withdraw at any time without any consequences, and the measures taken to ensure confidentiality. Consent was documented according to participant preference and literacy level, either through a signed consent form or thumb impression. All participants also provided consent for audio recording. To protect privacy, each participant was assigned a code, and any information that could reveal their identity was removed from all written records. All files were kept on secure, password-protected devices accessible only to the research team. Following university guidelines, the data will be kept for five years and then permanently deleted. The study was carried out in line with internationally accepted ethical standards, including those outlined in the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.