Defriani Dwiyanti, Eri Barlian, Abdul Razak, Indang Dewata, Nurhasan Syah, Dewi Rahmadani Siregar
This study aims to prioritise leverage points across the Independent, Linkage, and Dependent quadrants and their hierarchies, and to synthesise a prioritised adaptation sequence that culminates in improved essential health service utilisation, food and nutrition quality, and policy integrity with IT-enabled cross-sector coordination. Interpretive Structural Modelling (ISM) combined with Matrice d’Impacts Croisés Multiplication Appliquée à un Classement (MICMAC) was used to build a directed influence hierarchy among elements (drivers to outcomes) and to map Driver Power (DP) and Dependence (DE). Climate-vulnerable West Sumatra is defined as very-high/high exposure tiers in the Regional Spatial Plan (RSP) West Sumatra 2025–2045. In the constraints set, the highest DP drivers (DP = 11) were hazard exposure, environment-based diseases, poor clean and healthy living behaviour, and weak community adaptation. Consumption and food security were Linkage, while workforce support, trust, information access, gender inequality, and health service utilisation were Dependent. In the programmes set, the highest DP levers (DP = 10) were climate-resilient food systems, mitigation and sanitation, and community education/training, a sustainable economy was a secondary independent buffer (DP = 7). Improving food and nutrition quality, strengthening health/nutrition services, and risk-area mapping for climate–disease–malnutrition were Linkage programmes, while essential service access, IT-enabled coordination, and gender-responsive protection were Dependent outcomes. In the institutions set, the Regional Development Planning Agency (BAPPEDA) was the core driver (DP = 8), and the Health Office and Food Security Service were drivers (DP = 7), with disaster management, family planning, and health centres as Linkage nodes, while social services and community institutions were Dependent. Overall, priorities for climate-vulnerable West Sumatra are to reduce hazard and infection risks, strengthen clean-living and adaptation behaviours, then stabilise consumption and food security, while improving enabling conditions (information, trust, gender equity, workforce support) and using IT-enabled coordination to support planning, budgeting, and climate-shock response monitoring. © The Author(s) 2026.
Health Polytechnic, Ministry of Health, West Sumatra, Padang, Indonesia; Doctoral Program in Environmental Sciences, Postgraduate School, Universitas Negeri Padang, West Sumatra, Padang, Indonesia; Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, West Sumatra, Padang, Indonesia; Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, West Sumatra, Padang, Indonesia; Department of Civil Engineering, Faculty of Engineering, Universitas Negeri Padang, West Sumatra, Padang, Indonesia
