Fast facts: Tackling inequality in developing countries
- One in 12 women die every year from causes related to pregnancy and childbirth (UNICEF, 2019).
- The prevalence of any contraceptive methods was just 14.9% in Somalia in 2019 – one of the lowest rates in the world.
- Four in 100 Somali children die during the first month of life, eight in 100 before their first birthday, and 1 in 8 before they turn five (UNICEF, 2019)
Challenge
The 35-year conflict that has engulfed Somalia and Somaliland has had a disproportionate impact on women, adolescent girls and children, who together number among the most vulnerable people. While their reproductive healthcare demands have increased, the services available have often decreased, resulting in a lack of family planning options, as well as urgent antenatal, postnatal and child health care.
Low numbers of trained midwives and poor-quality antenatal care contribute to a high maternal mortality ratio, with over nearly one of every 22 mothers dying from pregnancy-related complications. More than 350,000 Somalis are refugees and a further 400,000 are internally displaced. Unintended pregnancies mean that women and adolescent girls are caught in a continuous pregnancy cycle, which reduces their ability to engage in economic activities. Many communities are trapped in poverty as a result, which has further health implications for women and their children.
Approach
The Somali Health and Nutrition Programme (SHINE) in Somalia, funded by UK aid, works to improve the health and nutrition status of Somalis, with a particular focus on women and children. The programme is delivering health services to meet the critical needs of the Somali population and empower vulnerable groups to overcome barriers in accessing health services in hard to reach areas.
Mott MacDonald is managing SHINE Supply, a sub-programme within the SHINE umbrella, which aims to provide essential healthcare services and improve the capacity of officials within the Ministries of Health. SHINE Supply is being implemented in the regions of Awdal and Togdheer in Somaliland and Galgaduud and Banadir in the Federal Republic of Somalia.
The programme is working closely with the Somali Health Authorities to achieve the following two broad objectives:
1. Deliver an Essential Package of Health Services (EPHS) to two million people, by increasing access, utilisation and quality of health services across all levels especially for women, children and vulnerable populations. Our focus is on maternal, reproductive and neonatal health, child health, communicable disease surveillance and control, first aid care of critically ill and injured, and treatment of common illnesses.
2. Health Systems Strengthening (HSS), under the stewardship of the Somali Health Authorities (SHAs). We are supporting the development of robust support systems in the areas of supply chain management, human resources for health, decentralised health services management and planning, coordination and monitoring and evaluation.
SHINE Supply is shifting the focus of support from a humanitarian to a development approach. That means building capacities of state institutions and the Ministry of Health itself, as well as improving expertise around collection, analysis and use of data in proactive decision making.
This approach aims to help government officials – and health workers in the field – to gain greater sight on the current status of the health of the population, as well as health services necessary for responding to health risks. Authorities have traditionally taken a reactive rather than a proactive approach to health. Better harvesting and processing of data will help them to understand why things are currently happening and also to predict what will happen in the future. For example, why has a certain region suffered a surge in malaria cases? Will that happen again next year? Better data can expose reasons such as seasonal changes or reveal correlation with other diseases such as TB.
Progress
SHINE Supply is supporting the implementation of the EPHS core programmes in five hospitals, three referral health centres, 63 health centres, two mobile clinics and 49 primary health units across 16 districts of Somalia and Somaliland.
The programme is still in early days of implementation; however field teams were sufficiently embedded to provide assistance for the response to the COVID-19 pandemic, helping Somalia and Somaliland limit the spread of the virus.
Transmission of COVID-19 had already been established in some communities. SHINE Supply’s community health workers’ network helped to control infections through surveillance, case management, and communication on prevention. SHINE Supply also helped to support the formal health care systems already impacted greatly by protracted crises. The response was developed in close collaboration with our development partners including the Ministries of Health, the UK government, UNICEF, WHO and PSI.
It addressed working conditions for frontline staff ensuring they had the correct Personal Protective Equipment (PPE) and training on infection control and prevention. Support to health facilities was refocused towards the response with additional handwashing points, creation of isolation zones and improved reporting, while posters in local languages helped share accurate information with the public. By building on existing community health worker initiatives, the most vulnerable groups could remain protected and maintain access to vital health care services. Activities also supported the deployment of ambulances to isolation centres and secure transportation of samples for testing.
By adapting to the challenges of the pandemic, the SHINE Supply team is helping prevent successive waves of COVID-19 while continuing to build stronger, more resilient health systems for the Somali people and contributing to the long-term stability and security of the region.