Health Care Services in Transitional Somalia: Challenges and Recommendations

By Mohamed Gedi Qayad

I. Introduction

Universal access to health care is an ideal goal for all nations. Nations often base their health care development plans on this principle. In Somalia, provision of health care services was also driven by this principle, and delivery of services was publicly funded like other social services, such as education. However, that goal was never achieved and the health status indicators for Somalia, even before the collapse of the central government, showed grim statistics.1

Health care services in Somalia were shaped by various administrations that adopted different policies, priorities, and health care service approaches, often influenced by local and international paradigms and
resolutions. The parliamentary government in the 1960s and the military government in the 1970s to 1990s shared common deficiencies in their national plans. Development plans were driven by institutional history, political interest, and personal desires, instead of need and resource capacities based on empirical evidence. Both administrations failed to maintain established health care delivery infrastructures or sustain their core operations, let alone expand services to the rural population and other vulnerable groups or modernize the system and improve its quality. As a result, health care facilities in many districts collapsed and were unable to provide even the minimum required clinical and preventive services.

In addition, high population growth, environmental degradation, desertification, frequent droughts and famines, urbanization and hap-hazard settlement, poverty and a weak economy, and poor governance created an unbearable burden of health problems that overwhelmed the nation’s staggering health care system and its coping mechanisms.

These problems stifled the health care system and contributed to the poor health status of the Somali people.

The Ministry of Health (MOH) never developed a core health care services package nor gauged the extent of resources and infrastructure mneeded to deliver them. It could have saved wasted resources and eased its management burden if sound leadership had been practiced.

As a result of poor leadership, the needs of the health care system and its effective operation were misconceptualized. Furthermore, the type and competencies of health manpower for the provision of a core health care services package, at different levels of delivery points, were never determined. Development of a national health plan with such attributes could have traced an efficient and progressive path for the Somali health care system.

A prominent weakness of the Somali health care system was the lack of a strong regulatory body on drug importation and utilization.

Disappointing outcomes of treatable diseases, such as tuberculosis, malaria, typhoid, and dysentery, were mainly attributed to the poor quality of imported drugs. As a result, many patients succumbed, in addition to those who fell victim to provider negligence and ignorance.

The currently flourishing drugstores across the country could dangerously worsen an already dire health situation.

There were several milestones in the history of health care services in Somalia. In 1966, a nursing school was established in Hargeisa, and another one in Mogadishu in 1970. In 1973, a faculty of medicine and surgery was set up in Mogadishu. These training institutions boosted the human resources for health. The smallpox eradication campaign in the mid-1970s, and introduction to primary health care (PHC) and new tuberculosis (TB) treatment regimens by the Finnish International Development Agency (FINIDA) in the 1980s, brought in massive external assistance. It established PHC training institutions and opened the door for medical specialty training in TB and lung diseases.

These inputs expanded access to health care services and improved the quality of care, particularly with regard to TB. However, the massive resources injected into the health care system were not used properly and their contributions faded soon. Another landmark was the formation of a semi-autonomous refugee health unit (RHU) in the Ministry of Health to serve the refugees from Ethiopia in 1977, which attracted massive foreign aid and expatriate health professionals. The RHU introduced sound health care planning and effective operations, which positively influenced the overall MOH functions and operations. The RHU staff gained valuable experience and knowledge about public health concepts and practices. This produced competent public health professionals and raised the awareness and practice of public health in Somalia. Also in the 1980s, research in medical sciences was initiated by the faculty of medicine, in collaboration with several universities in Sweden, through the National Academy of Science and Arts in Mogadishu. This was a new dawn for research in medical sciences and other fields in Somalia. This initiative and the others mentioned earlier mainly contributed to health manpower production and development.

However, these gains were reversed by the economic downturn and political turmoil of the 1980s and civil war of the 1990s.

All in all, the health status indicators in Somalia remained at the bottom among the developing countries.2

Currently, in the absence of a central government, health care services have become a local initiative, and with mixed success. Therefore, to avoid misguided national health development plans and policy, it is essential to examine the deficiencies and gaps in the operation of the past health care systems, and to provide a basic framework to ensure a functional and sustainable health care system in the future.

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Source: macalester.edu