SOMALIA’S HEALTH SYSTEM: challenges and opportunities.
Introduction:
Somalia is seriously off track in reaching the Millennium Development Goals. Over the past three decades, Somalia has become one of the world’s most enduring humanitarian crises causing enormous damage to health and development. After a prolonged civil war, the health of the Somali people has suffered tremendously. Armed conflict has destroyed health infrastructure, resulting in reduced access to essential health services, exposing an already vulnerable population to high disease burden and malnutrition.
Somalia’s health system ranks as one of the world’s weakest.[1] There is an estimated total of 846 health facilities in Somalia, including seven referral hospitals, 27 district hospitals, 248 maternal and child health clinics and 544 health posts.[2] However, most of these healthcare facilities are poorly staffed and inadequately distributed, mostly due in large part to the historical concentration of the majority of health services in urban areas. This is despite only 42% of the 12.3 million Somalis being urban dwellers, with the remainder comprising of rural dwellers, nomads and internally displaced persons (IDPs). The Somali public health system has been dysfunctional for over 20 years with development, and humanitarian NGOs have played a vital role in bridging gaps in healthcare services in a sector that is almost entirely private.[3]
The Ministry of Health developed the Health Sector Strategic Plans (HSSPs ) a national health system that aims to provide universal primary healthcare and public safety to all citizens of Somalia’s government. There are significant variations between the zones as far as the implementation of the strategic plans is concerned.
The burden of disease is heavily dominated by communicable diseases, reproductive health problems and undernutrition issues. The outbreak of the Covid-19 pandemic like most countries in the world, Somalia is facing the unique challenge of the virus, and the Somali Medical Association stands shoulder to shoulder with the people during this testing time and the likely colossal death toll due to poor working relations in the public health system of Somalia. Thus Somalia has established an Early Warning Alert and Response Network (EWARN) in over 500 sentinel facilities in all states to report alert of epidemic-prone diseases.
The key challenges facing the Somali health system as asserted by WHO in line with the Ministry of Health of Somalia:
- Persistently high burden of disease;
- Limited institutional capacity and stewardship role of ministries of health;
- Inadequate, unpredictable and unsustainable level of financing, with a high share of out‐of‐pocket spending on health;
- Absence of balanced, motivated, well‐distributed and well‐managed health workforce with the appropriate skills mix;
- Limited and unequal access to essential health services, and poor quality and safety of services across all levels of care;
- Inadequate procurement/supply system and irrational use of essential technologies and medicines;
- Absence of national surveys and census, weak births and deaths registration, limited operational research and disease surveillance;
- Lack of synergy of the humanitarian response to health; and
- Inadequate action on social determinants of health.
- Views on Covid-19 revealed that lack of hygiene facilities, community overcrowding, low awareness levels about the virus and lack of access to testing and treatment services as well as lack of water for handwashing are of primary concerns.
Strengths of the Health System:
Strategic priorities have been proposed by WHO together with the Ministry of the health of Somalia for reform of the Somalia health system and eradication of disease outbreak and healthcare provision; for each, there are well‐defined action points as follows:[4]
- Improving synergy between developmental and humanitarian assistance through enhanced coordination among development partners and the government.
- Improving the stewardship and governance capacities of ministries of the heath for evidence‐based policies and plans, engagement with non‐state actors and better partner coordination.
- Developing a medium‐term strategy and a business plan that provides for a sustainable approach to health sector financing.
- Scaling up essential health workforce cadres to ensure improved access to health services in the short term.
- The rapid expansion of the Essential Package of Health Services (EPHS) and community‐based health services of acceptable quality through innovative approaches, including training of community‐based health workers and outsourcing of service delivery to nongovernmental organizations.
- Improving the availability and use of information by strengthening management information systems, implementing household surveys and improving civil registration and vital statistics.
- Improving access to and rational use of medicines and essential technologies.
- Strengthening public health preparedness and response capacity to confront and tackle health emergencies effectively.
- Providing technical expertise and logistics, training health workers, providing equipment for isolation centres and scaling up hygiene responses to support the Covid-19 response plan.
- Maintaining its scaled-up operational readiness and response, including by supporting a testing mechanism and isolating suspected cases of Covid-19 tp prevent onward transmission of the virus.
- Appeal to everyone to come together in the fight against Covid-19 pandemic by calling for an immediate ceasefire to put aside violence, mistrust, hostilities and animosity and to focus on battling the virus, not each other so that all resources and support can be channelled to fight the Covid-19 pandemic.
- Government agencies with support from humanitarian and development actors to undertake considerable efforts to contain the risk of the virus spread in the country. These include border closures, curfews, restricted public gatherings and quarantine measures as well as encouraging hand washing and social distancing practices.
REFERENCES:
- Somalia: Country Cooperation at a glance. 2014. Geneva: World Health Organization; 2014.
- Maalim AM, Zachariah R, Khogali M et al. Supporting ‘medicine at a distance’ for delivery of hospital services in war-torn Somalia: how well are we doing? Int Health, 2014;6:70–3.
- Warsame A. Opportunity for health systems strengthening in Somalia.Lancet Glob Health 2014:2:e197–8.
- African Development Bank Group. Somalia Country Brief, 2013–2015.Tunisia: African Development Bank; 2013.
- The Federal Government of Somali Republic. Somalia Health Sector Strategic Plan January 2013 – December 2016.
- Puntland, Wasaarada Caafimaadka, Ministry of Health. Health Sector Strategic Plan, January 2013-December, 2016.
@Ahmed Shiekh Doon is doing master’s program on child health at Makerere University, Uganda.
[1] WHO. Somalia: Country Cooperation at a glance. 2014. Geneva: World Health Organization; 2014.
[2] WHO. Somalia: Country Cooperation at a glance. 2014. Geneva: World Health Organization; 2014.
[3] Maalim AM, Zachariah R, Khogali M et al. Supporting ‘medicine at a distance’ for delivery of hospital services in war-torn Somalia: how well are we doing? Int Health 2014;6:70–3.
[4] WHO. Everybody’s business: Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: World Health Organization.
