Improving Access to Healthcare in Somalia

MOGADISHU, Somalia — The last several decades have been very difficult for the country of Somalia. After a military coup in 1969 and a subsequent civil war in 1991, the country has been plagued by famine and civil disorder. Due to these conflicts, Somalia is the world’s third-largest source of refugees, behind only Iraq and Afghanistan. Healthcare has suffered greatly. However, there are several organizations that are working the improve healthcare in Somalia.

The crises in Somalia have also led to significant disparities in health for Somali citizens. Diseases such as hepatitis, typhoid fever and malaria pose significant health risks. Only one in three Somali citizens has access to a safe source of drinking water. 

In 2015, only 46 percent of the country was vaccinated for measles. This is not for lack of trying by the international community. In 1992, the International Committee of the Red Cross spent one-third of its budget on Somalia alone. The root cause of the problem is a lack of medical professionals in the country, many of whom fled the wars and have yet to return. About two-thirds of Somali doctors currently live abroad.

Improving Healthcare in Somalia

In 2015, MATTER, a global nonprofit that focuses on “eliminating barriers to a healthier life,” partnered with the Minnesota Association of People with Disabilities to supply a 60-bed hospital in Mogadishu with all the necessary equipment for a functioning hospital. 

The equipment was shipped in 40-foot containers that contained everything “from hospital beds to full x-ray rooms.” The hospital is expected to be able to help 200 patients on a daily basis. This may seem like a small impact on Somalia as a whole, but it makes a huge difference to the patients who previously would have gone untreated.

Larger organizations are also taking steps to address the health crisis in Somalia. UNICEF started a program in Somalia called the Joint Health and Nutrition Program (JHNP). Several countries contributed more than $236 million to the program. It was scheduled to last from 2012-2016. Through the JHNP, 3.4 million Somalis now have access to nutrition services and healthcare coverage. The program also successfully opened 16 new midwifery schools and helped train more than 800 midwives to reduce maternal and infant mortality rates.

Improving Mental Health by Video

For those living in Somalia, mental health is just as much of a crisis as physical health. The stresses of living in a country torn by war and famine have increased pressure on the mental states of many Somalis. The World Health Organization reports that “one in three Somali citizens has some sort of mental illness.” Due to a large number of medical professionals that have fled the country, the mentally ill often are unable to get the help that they need.

Furthermore, the country has a tremendous stigma against people with mental illness, which is often reflected in poor treatment practices. Between 2000 and 2010, 90 percent of mentally ill Somalis had been restrained using chains at least once. To address this, therapists with the Mersey Care National Health Service Foundation Trust (MCFT) partnered with the Somali government and other nonprofits. The hope is to offer an innovative new program that would address mental health issues in Somalia as well as the country’s lack of infrastructure for mental health practice.

In this program, mental health professionals from MCFT trained 35 Somali medical professionals on good mental health practice via video-call. At the beginning of the program, most of these doctors had said that they had low confidence in their ability to treat patients with mental illness. By the end, however, most of the medical staff who participated felt like they had significantly improved their knowledge of caring for mentally ill patients. This study, although small, paves the way for further development of mental healthcare in the developing world, particularly in areas experiencing a significant dearth of medical professionals.

Somalia has been through some very difficult times with consequences that have been devastating to Somali citizens’ access to healthcare. However, programs such as those listed here have been able to revitalize the country’s healthcare industry. As they continue to grow and develop, Somali citizens will soon have better access to the coverage that they need to survive.

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UN agencies ramp up Somalia measles and polio campaign

A campaign to vaccinate some 1.7 million children in Somalia was launched on Sunday by the country’s government, in partnership with the World Health Organization (WHO) and the UN Children’s Fund (UNICEF).

Children under the age of five are being targeted with polio vaccines, and measles vaccines will be administered to children aged between 6 and 59 months. The campaign also includes a vitamin A supplement for children under 5 to boost their immunity as well as de-worming tablets.

UN Photo/Tobin JonesTwo children play in the surf on Mogadishu's Lido beach (file)

Over five days, until November 29, health workers will focus their efforts in the regions of  Benaadir, Galguduud, Hirshabelle, Jubaland and South West State, and on children in districts with high concentrations of internally displaced persons (IDPs). 

IDP camps often breed disease, and children living in such sites are also more likely to be living in crowded living conditions, and suffering from malnutrition, and limited access to water and sanitation. Children in nomadic communities are at a higher risk of contracting measles and polio due to the higher mobility of these population groups.

So far this year 3,616 suspected measles cases have been reported in Somalia: The virus, which is spread by respiratory transmission, is highly contagious: up to 90% of people without immunity, who are sharing a house with an infected person, will catch it.

One among 7 Somali children dies before their fifth birthday and many of these deaths are preventable by use of vaccines Dr. Mamunur Malik, WHO Representative, Somalia

“One among 7 Somali children dies before their fifth birthday and many of these deaths are preventable by use of vaccines”, Dr. Mamunur Malik, WHO Representative in Somalia, said on Sunday. “Although we have made progress over the years to improve routine immunization coverage in the country, there is an urgent need to further scale up the vaccination coverage, especially for measles and polio, by working together with partners, communities and grass-root level organizations”. 

The aim of the mass vaccination programme is to stem the transmission of measles infection, and reduce the likelihood of future outbreaks in Somalia. The addition of the polio vaccine to the campaign will also help to bolster protection against polio virus type 1 and 3 among all Somali children.

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From malnutrition to tuberculosis: responding to needs in North Galkayo

Southern and central parts of Somalia are currently affected by floods that have forced hundreds of thousands of people from their homes and triggered a humanitarian crisis. But even before the floods, people in Somalia were very vulnerable following decades of protracted conflict.

Galkayo, a town in central Somalia, hosts a large number of internally displaced people who have fled violence, drought and other climate hazards within the country. It also hosts migrants and refugees, as well as people from the neighbouring Somali region of Ethiopia seeking better healthcare.

A male nurse prepares milk for malnourished children in the therapeutic feeding centre of Mudug Regional Hospital in Galkayo city, Somalia. July 2019.

Mudug Regional Hospital is the city´s main referral hospital, serving some half a million people. MSF has supported this facility since May 2017. Today, we work in the emergency room, care for malnourished children, treat people with tuberculosis and assist women with complicated pregnancies. We also run mobile clinics. These are some of the stories of MSF’s patients in Galkayo.

My daughter Farhiya was very weak and wasn’t responding – it was as if she had fainted,” says Khadro Ahmed Abdi, 28. “When we arrived at the hospital at around 3 pm, I was extremely worried. The nurses took her to the emergency room straight away.

When her 11-month-old daughter fell sick, Khadro’s neighbours advised her to go to Mudug Regional Hospital, a five-hour journey from their village of Jira’le, in the Somali region of Ethiopia. She left her eight older children in the care of her husband. The family, who are traditional herders, live in a drought-stricken region and survive on a single meal a day. Farhiya was severely malnourished and, by the time she arrived in Galkayo, she was unconscious. The nurses wasted no time in admitting her to the hospital’s inpatient therapeutic feeding centre.

After receiving proper medical care and nutritious milk and biscuits [Plumpy’Nut, a therapeutic and highly calorific peanut-based paste], my daughter got better and two days later we were able to return home, says Khadro. Without medical care, she says, many children like her daughter would simply not survive.

Drought and violence

High rates of malnutrition in children are common across Somalia, especially among displaced families forced from their homes by violence and drought who often settle in poor urban areas. Between January and August this year, MSF treated nearly 2,000 malnourished children at this hospital.

The poor rainy seasons of recent years, exacerbated by poverty and harsh living conditions, have contributed to rising rates of malnutrition. This year in Somalia, an estimated 903,000 children under five are acutely malnourished, including 138,000 suffering from severe malnutrition, according to UNICEF.

Eight-month-old Bilal lies next to his mother on a bed in the hospital’s paediatric ward. Brought to the hospital by MSF’s mobile medical team from his home in Bulo Ba’ley camp for displaced people, Bilal is recovering from acute watery diarrhoea.

Bilal had diarrhoea for three days and was severely dehydrated,” says his mother, Kawsar Ibrahim, 25, whose three older children are at home with her husband, a casual labourer. “He was put on medication immediately after we arrived. The diarrhoea has now stopped and my son is doing well. I am so glad Bilal is well and will be able to play at home again soon.

Five days after he was admitted for treatment, Bilal is ready to return home.

Dr Abdullahi Mohamed Muse checks the condition of a patient who had a caesarean section in the maternity ward of Mudug Regional Hospital. Galkayo city, Somalia, July 2019.

Poor living conditions and new arrivals

Galkayo town is split in two by an administrative boundary, with north and south each part of a different state: Puntland and Galmudug respectively. The town’s population is boosted by more than 100,000 internally displaced people from across Somalia, who live in camps with few resources. Some have been displaced for years. The MSF supported hospital provides free healthcare to displaced people, refugees and local communities coming from both sides of the city.

“Galkayo now has more than 70 camps  for displaced people, with more people arriving every week from conflict and drought-crippled regions of the country,” says Bashir Muse Hassan, MSF’s deputy medical activity manager in Mudug Regional Hospital.

“Our mobile health teams visit 23 of the camps almost every day, providing basic healthcare and referring patients with critical health needs to the hospital. The displaced people do not have enough water or food so there are large numbers of malnourished children.”

Complicated deliveries

Children are not the only vulnerable group in Galkayo. In Somalia, maternal mortality rates are among the highest in the world. For medical staff, as well as for families of pregnant women, managing complications during pregnancy and childbirth is a massive challenge.  

Deqa Awil Hassan, a 32-year-old mother of seven, recently gave birth by caesarean, with the agreement of her family, after doctors informed her that she would not be able to deliver normally.

“I was in my twenty-fifth week of pregnancy when my uterus started to bleed. First, I was taken to Galdogob hospital (Somali town next to the Ethiopian border) and then doctors referred me to this hospital,” says Deqa, who comes from Bokh district, in the Somali region of Ethiopia.

“This was my seventh pregnancy and I was a bit scared. Fortunately, I delivered a healthy baby boy. I am so glad that both my baby and I are well. I want to name him ‘Abdi Nasib’ because he was lucky to be born alive [the names means literally ‘servant of the fate’].”

In June 2019, the MSF team at Mudug Regional Hospital received more than 170 women experiencing complications in labour, and 19 others who needed an emergency caesarean.

“From that number, you can estimate how vital these services are for the local community,” says Bashir.

Internal bleeding of the uterus is relatively common in pregnancy, explains the obstetrician Abdullahi Mohamed Muse, and only 30 per cent of women with this condition need a caesarean.

“We observe and monitor the condition to decide what intervention to do to save the life of the pregnant mothers and their unborn babies,” says Abdullahi. “Such operations [emergency caesareans] are only needed when the life of the pregnant mother is at risk. We try to explain that and convince families of the importance of saving the mother’s life. This may help reduce the high maternal mortality rate in Somalia.”

Tuberculosis

MSF teams in Mudug hospital are also working to reduce the burden of tuberculosis (TB), a disease that spreads easily in overcrowded living conditions, such as in the camps for displaced people in Galkayo. In Somalia, the diagnosis and treatment of TB is often unavailable or is prone to interruption, which can cause drug-resistance.

Currently 172 drug-susceptible and drug-resistant TB patients are enrolled in the treatment programme, while in the first half of 2019, almost 100 patients successfully completed their treatment. Despite the achievements, there are challenges. Nur Ahmed Nur, who has managed the TB ward since its inception, says patients defaulting on medication can be a problem. To help prevent this, the team works with the community and encourages patients to bring a relative with them to support them throughout the treatment.

“Following them up will help us ensure that all patients receive their drugs every single day,” says Nur. “This, in turn, helps avoid the development of drug-resistant TB.”  

Fardowsa Hussein Hassan, 40, from north Galkayo, caught pulmonary TB. She successfully completed her treatment in June, but returns to the hospital for regular check-ups.

Nurse Hawo talks to a pregnant woman and two patients who have come to receive antenatal care at Mudug Regional Hospital. Galkayo city, Somalia, July 2019.

“I was very weak and sick when I was brought to the hospital in January,” says Fardowsa. “I was coughing for weeks and, when doctors took my sputum to the laboratory, I tested positive for TB. I was immediately put on medication. Six months later, I have now tested negative. I thank the hospital management and all those who support the TB department.”

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Twin Cities hospital introduces line of hijabs for patients and staff

Park Nicollet Methodist Hospital in St. Louis Park took a major step toward inclusivity and added a brand new line of hijabs to its gift shop on Thursday. 

The hospital partnered with a local business called Henna and Hijabs (H&H) to make comfortable headscarves available to patients and staff. According to a Facebook post, the owner of H&H is a longtime volunteer and colleague at Park Nicollet. 

Hilal Ibrahim of Henna and Hijabs

Park Nicollet Methodist Hospital, Facebook

"Since I began volunteering at Park Nicollet Methodist Hospital 10 years ago, they've always been receptive to diverse viewpoints," said Hilal Ibrahim, founder of H&H. 

Ibrahim told KSTP she noticed patients trying to wear hospital blankets on their heads and Muslim nurses struggling to secure their hijabs while working. That's when she decided to share her ideas about medical headscarves. 

The line of medical hijabs includes 10 different designs. They are made of soft, breathable fabric and are designed to be comfortable for both patients and staff. 

The hospital says it is the first in the U.S. to offer a hijab product.

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Park Nicollet Methodist Hospital

on Thursday

Help us celebrate a historic moment in health care! Today, our Gift Shoppe introduces a new product line of locally made H&H hijabs 🧕🏾🧕🏼🧕🏿 – and by doing so, we take an important step in inclusivity that no other U.S. health care organization has taken before.

“To come in and see a collection of hijabs for sale at your hospital, right alongside the t-shirts and sweatshirts that have been sold there for years, means so much to my community,” says Hilal Ibrahim, the longtime M...

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Project Management in Global Health Course run by University of Washington (Online)

So much of your work in global health is project based, whether you’re training, implementing, or evaluating. Good project management is crucial for the success of these endeavors.

Faculty/Lecturer: 

Ann Downer, EdD, MPH

            Professor, Global Health

           Adjunct Professor, Health Services

           Executive Director, I-TECH

Overview

So much of your work in global health is project based, whether you’re training healthcare workers implementing an intervention, adopting a health information system or evaluating for quality improvement. Good project management is crucial for the success of these endeavors.

By the end of the Project Management in Global Health course, you’ll learn the fundamentals of project management, including conducting needs assessments, creating planning and implementation documents, managing project resources, transitioning the project to local agencies, and evaluating the project.

Unfortunately, projects don’t always go as planned. Funding may be cut, the scope may grow, priorities may shift, key team members may leave, or a host of other unexpected changes. This course gives practical tips, tools, and techniques for how to address unexpected challenges that inevitably arise. These come from experts from all over the world who have spent years managing global health projects and share lessons they have learned. 

Format

This online, graduate-level course has video lectures, case studies, readings, discussion forums, quizzes, and practical assignments accessible with username and password provided by the UW after full registration. The course is taught in English. 

You can participate in this course as an independent participant or as part of a site. We encourage participation as a group because it provides a forum for discussing course concepts and applying them to the local context. If you can’t join a group, the discussion boards can provide that forum. 

Eligibility

The course is most useful for public health and healthcare professionals who have some experience in management and who wish to enhance their skills working with people and organizational resources. The course is less well suited to individuals in entry-level positions.

Syllabus: Topics to be covered

1)      Introduction to Project Management Framework

• Challenges of project management
• Essentials of project management
• Overview of approach
• Role of project managers

2)      Gathering and Using Data

• Data cycle
• Types/sources of data
• Data collection
• Analyzing data
• Data management

3)      Needs Assessment

• Identifying project needs
• IDEO
• Prioritizing needs

4)      Planning: Overview

• Establishing governance structure
• Authorizing start of the project (charters, roles matrix)
• Creating a logic model

5)      Planning: Developing a Roadmap

• Developing a project plan

6)      Planning: Beyond Implementation

• Transition planning
• Sustainability
• Capacity building

7)      Keys to Project Success

• HR/managing people
• Team building
• Involving/engaging stakeholders
• Effective meetings
• Communication
• Working across cultures
• Scope management
• Financial management
• Time management
• Monitoring/issue management

8)      Monitoring and Evaluation

• Project M&E plan

9)      Transition

• Closing out projects

Certification

For those who are successfully completed the course will receive a formal printed Certificate of Completion on vellum paper with University of Washington seal mailed to them. We will ship them all together to your Site Coordinator.

More information

You can contact Dr. Mohamed Y. Dualeh, Somalia’s HeSMA SOM site coordinator for further details and guidance for your enrollment process in this phone number 00252-63-4417945 with preferable in WattsApp texting or drop an E-mail to drdualeh@hesma.or.ke 

Women in Central Somalia Thankful for free Maternity Services at Abduwak General Hospital

Pregnant women in Abudwak, central Somalia, are thankful to be receiving free delivery services at a private hospital in the town, following closure of the only public health facility that had been providing free maternity care. 

Nasra Bishaar Ismail, 23, gave birth to her first child by caesarean delivery at the private Abduwak general hospital five days ago, after a 32–hour labour.  

She had been getting ante-natal care at the hospital but feared she might be able to afford professional help for delivery.   

I was so worried about what would happen to me because I had no money and would not have been in a position to seek help from private hospitals, Nasra said. 

 “The baby and I are recovering very well, though with some bruises caused by the birth complications,” she said. 

Another mother, Hamdi Mohamed Ahmed, underwent prolonged labour in her village of Yamaarugley for six days. She was finally transported to Abudwak by her family. 

“I was informed of the free delivery services offered by the hospital but when I went into labour, I opted to stay at home. But that did not work out and so I was brought here,” she said. 

Hamdi also had financial problems, as her family lost 140 goats during drought over the last three years, and would not have been able to pay for private delivery. 

“I failed to deliver the baby naturally as I was suffering from anemia. Then I was brought to these doctors,” she said.  She was very weak and needed blood and intravenous fluids on arrival. 

Dr Mustafe Mohamed Hassan, head of the maternity department at the privately run Abudwak general hospital, told Radio Ergo they were offering free delivery services to fill the gap left by the only public health centre in Abudwak that closed several months ago due to lack of funding.  

“Before we started offering this free service, people used to go seeking medical help in Galkayo, Dhusamareb and Adado towns.  But now people know about the services we are offering.  

Only minutes ago, we helped a mother through a stillbirth, she was from a remote area,” he said. “People pay nothing. Since we began this free service, we have assisted 30 mothers.” 

The public health centre that had been providing free maternity services in Abudwak was Ibado hospital. It was run by the International Medical Corps (IMC), which ceased its support in June due to lack of funding for its programmes in Galmudug. 

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