WHO pilots first-ever programme leadership and management training for RMNCAH in Somalia
Participants during a group work exercise developing an annual plan for rolling out the national RMNCAH strategy with key deliverables, indicators and budget lines during the 5-day workshop on programme management in Mogadishu, Somalia. Credit: WHO Somalia.
Mogadishu, 1 January 2023 – The ongoing drought and the COVID-19 pandemic has highlighted the gaps in basic service delivery for health and the weaknesses in the health system that prevent it from serving the vulnerable population with good quality care, even in the challenging circumstances. Women and children from marginalized rural communities and camps for internally displaced persons (IDPs) have been significantly impacted by the drought and COVID-19 pandemic, resulting in major inequities and inequalities in the health status of women and children in the country, including in their access to basic health services. Though certain health indicators have shown some progress over the past few years in Somalia, with neonatal mortality and stillbirth rates of 38.5 per 1000 live births and 35.5 per 1000 total births, respectively, and the highest under-5 mortality rate in WHO’s Eastern Mediterranean Region, Somalia is still one of the most dangerous countries for women to give birth and children to be born in.
WHO has been supporting the federal and state ministries of health in strengthening service delivery, especially for women, children and vulnerable populations. To improve reproductive, maternal and child health outcomes, WHO, together with the Ministry of Health, other United Nations agencies and key partners, has developed a national reproductive, maternal, newborn, child and adolescents health (RMNCAH) strategy that sets out priorities and targets for tackling the high maternal and child mortality and morbidity in the country. However, implementing the strategy has proven challenging, requiring various operational considerations.
The challenge, as identified by WHO through several rounds of consultations and field missions, was that the Ministry lacked both the human resources needed to implement the national strategy and the required skills and knowledge to understand the programme management cycle, including planning, budgeting, implementation and monitoring, to make the strategy more results-oriented, accountable and beneficial for the targeted population.
To meet this request from the Federal Ministry of Health, the WHO country office in Somalia, together regional experts, designed a training package, entitled “Managing programmes to improve reproductive, maternal, newborn, child and adolescent health,” based on regional recommendations and evidence-based interventions. The training package builds on the WHO’s established “Managing programmes to improve child health” (2009) package, developed specifically to address the targets and global strategies developed for the Sustainable Development Goals (SDGs), which has not yet been adopted in any of the countries of the WHO Eastern Mediterranean Region. The training package was customized to align with WHO’s country cooperation strategy (2021–2025) and Somalia’s essential package of health services through a series of consultations with the ministry and regional experts.
Enhanced leadership skills for better implementation of evidence-based interventions
WHO piloted the 5-day training package with 17 (including 9 female) directors and public health managers responsible for implementing the RMNCAH strategy at national and subnational levels across Somalia. The training was held in Mogadishu, Somalia, from 18 to 22 December 2022, with 2 core facilitators from the WHO Regional Office for the Eastern Mediterranean and two co-facilitators from the WHO country office for Somalia. To ensure equal participation from all states in the training, the various ministries of health (at both federal and state level) nominated 2 senior health officials from each state and 1 from Banadir Regional Authority (Mogadishu).
The training aimed to build the leadership and programme management capacities of senior health officials to help them translate their technical knowledge about RMNCAH into evidence-based, results-oriented, cost-effective interventions. It is expected that this leadership training will enhance planning, implementation, monitoring and evaluation capacities at the national and subnational levels.
Following the successful pilot training, which received overwhelmingly positive feedback from participants, the training will now be rolled out across the country, incorporating lessons learned and recommendations proposed by the ministry officials and facilitators.
After attending the extensive and interactive training sessions, Dr Ubah Farah Ahmed, Director of Family Health at the Federal Ministry of Health, remarked, “The training provided me with the best cost-effective way of planning, managing and monitoring maternal and child health programmes. The training certainly helped to demystify many of the areas related to management and leadership required to make a national strategy work. I would like to thank WHO for clearly making an informed effort to customize the training to reflect the Somali context. We would certainly make it a mandatory course for all the managers at the subnational level to ensure that we plan with clear objectives and measurable goals.”
The majority of the participants echoed these sentiments, promising to cascade the learning among their peers at the subnational level. Towards the end of the training, the Federal Ministry of Health had already announced its intention to scale up the training by cascading it to the district level to improve implementation of the RMNCAH strategy at all levels.
Additionally, the timing of the training coincided with the annual planning process of both the federal and state ministries of health.
“After this timely and much-required training, we will be able to look at the rollout of the national RMNCAH strategy at the state level in a totally different, well-calculated and measured manner. WHO has been helpful to us in many other ways, but this specific intervention will surely help us realize our objectives of empowering our knowledge capacity, improving our programme management skills and achieving our goals,” said Dr Mohamoud Garun Gas, Director of Family Health for the Jubaland State of Somalia.
Dr Ubah receiving her certificate. Credit: WHO Somalia.
Accelerating RMNCAH to achieve universal health coverage and the SDGs
RMNCAH is fundamental for achieving universal health coverage and is a key driver of the SDGs. In Somalia, maternal mortality ratio is estimated at 692 maternal deaths per 100 000 live births, and 1 in 20 women is expected to die from pregnancy-related causes during their reproductive lifetime.
"We are working in one of the most challenging environments, but we are grateful to the ministries of health (at both federal and state level) and our colleagues at the WHO Regional Office, for making RMNCAH a priority in this country. We feel pride in supporting the willingness of health professionals in the country to learn these skills and cascade them at all levels. Still, we know that by no means is our job done because we have to cover lots of miles to make Somalia a comparatively safe place for mothers and newborns as per the stated SDG 3 and universal health coverage goals. For this, we certainly will need support from all quarters, including our worthy donors, our partners and, more importantly, from the communities,” commented Dr Al-Umra Umar, Programme Lead for RMNCAH at the WHO Somalia country office, while addressing the concluding session of the workshop in Mogadishu.
The Global Strategy for Women’s, Children’s and Adolescents’ Health (2016–2030) aims to keep RMNCAH at the centre of the SDG agenda by providing strategic and concrete guidance on accelerating progress toward ending all preventable maternal, newborn and child deaths, including stillbirths, by 2030. It aims to support countries in improving the overall health and well-being of women, children and adolescents through transformative action. WHO has been supporting Somalia in achieving its SDG targets and improving the health and well-being of all its women and children.
For additional information, please contact:
Kyle DeFreitas, External Relations Officer,
Fouzia Bano, Communications Officer,
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Note to editors
Please see the links below for additional information on recent support:
Creating a safe environment for mothers and newborns in Somalia
Universal Health Coverage Day: Building the World We Want to Deliver A Healthy Future for All
Health workers prepared to visit a camp for internally displaced persons in Kismayo, Somalia. Credit: WHO/Ismail Taxte
Mogadishu, 12 December 2022 – Since 2014, 12 December has been commemorated as Universal Health Coverage Day, marking the day in 2012 when the United Nations unanimously endorsed a resolution urging all countries to accelerate progress toward universal health coverage (UHC). The theme for 2022 is “Build the World We Want: A Healthy Future for All.”
UHC means that all people everywhere can access the quality health services they need, without suffering financial hardship. It is rooted in 3 principles: equity of access, quality of services and financial protection. With the impact of COVID-19 which is estimated to have rolled-back 2 decades of global progress towards UHC and with humanitarian crises increasing around the world, advancing access to health for all remains crucial.
In Somalia, decades of conflict, recurrent climatic shocks and the COVID-19 pandemic have weakened the already-fragile health system and further exacerbated widespread poverty, underdevelopment and social and gender inequality. Currently, the country sits at the bottom of the UHC index, indicating that it has the lowest level of UHC in the world.
Building the world we want
To rectify the dire situation, the Somali Federal Government has started to implement a transformative agenda through its Essential Package of Health Services 2020 (EPHS), aimed at rebuilding its health system towards achieving UHC using primary health care services as the main entry point. In this regard, WHO has been supporting the strengthening of access to medical oxygen, by having procured pressure swing adsorption oxygen plants and installing solar-powered oxygen concentrators at hospitals across the country; improving surveillance activities, including through the deployment of community health workers and rapid response teams, as well as by enhancing the capacities of laboratories to test for epidemic-prone diseases; the procurement and distribution of essential medicines and supplies and developing infrastructure to ensure that health services are available to those who need them most.
The roll out of large vaccination campaigns across the country, integrated with other basic services, provide the opportunity to reach “zero dose children” and their underserved communities, with expansion of coverage of essential services – one step forward to deliver the EPHS.
Working in partnership with the government, United Nations sister agencies, donors and other stakeholders to deliver essential services in the short-term and build the capacity of the Somali health service in the longer term, the goal of ensuring that every family is able to access quality health care without falling into poverty is possible.
Leaving no one behind
Despite the above gains, Somalia is now in the grip of one of the worst droughts the country has seen in decades, putting further strain on the fragile health system. It is currently affecting 7.8 million people, 1.1 million of whom have been displaced from their homes, on top of the 2.5 million people already displaced.
The need for quality, accessible health services does not stop in emergency contexts – in fact, it increases. Not only are children missing out on essential lifesaving vaccinations, but a lack of access to health services can allow epidemic-prone diseases to rapidly circulate, with long-lasting consequences for individuals, communities and for the health of Somalia as a whole.
To overcome this challenge, WHO is working with Federal and State Ministries of Health as well as frontline health workers in an effort to ensure that no one is left behind and that progress made towards UHC is not lost. To achieve this, WHO has deployed community health workers and rapid response teams for community-based surveillance of epidemic-prone diseases, the provision of basic services, referring patients to health facilities, and risk communication and community engagement.
“A child born today in Somalia is about 16.5 times more likely to die before the age of 5, than a child born elsewhere,” said Dr Sk Md Mamunur Rahman Malik, WHO Representative and Head of Mission to Somalia. “Evidence shows that it is the most vulnerable and marginalized families who have the least access to health care. Universal health coverage is key to correcting this injustice. Moreover, fragile contexts like Somalia face multiple challenges in achieving UHC but the progress made in recent years show that it is possible. By strengthening the health system to withstand shocks and identify and respond to emerging health risks, as well as supporting the delivery of basic services including to the most vulnerable, we can build a healthy future for all.”
For additional information, please contact:
Kyle DeFreitas
External Relations Officer
Fouzia Bano
Communications Officer
Related links
WHO EMRO | Universal health coverage | Priority areas | Somalia site
Essential Package of Health Services (EPHS) Somalia, 2020 - Somalia | ReliefWeb
UK and WHO partner to fight against diseases and protect health of drought-affected communities across Somalia
WHO-supported health worker administering vaccine to a child at a primary health care centre in Galkayo, Puntland. WHO/Fouzia Bano
Mogadishu, 11 December 2022 – The Government of the United Kingdom of Great Britain and Northern Ireland (UK) and the World Health Organization country office in Somalia have recently signed an agreement to support WHO’s emergency health response to the current drought in the country.
In support of Federal and State Ministries of Health in Somalia, this important contribution will enable WHO to prevent and mitigate the adverse impacts of drought on health of the women, children and other vulnerable populations impacted by the ongoing drought, one of the worst in recent history.
The contribution received from the UK Government will enable WHO to scale up and sustain its integrated health and nutrition interventions in some of the worst affected, hard-to-reach and inaccessible areas where the people have been devoid of basic health and nutrition services for decades. The delivery of these interventions will support the “First-line Integrated Response Framework” endorsed by the Humanitarian Country Team (HCT) of Somalia. Under the rapid response mechanism of this framework, 4 life-saving sectors – health, nutrition, WASH and food security are delivering a set of life-saving interventions in an integrated manner as part of these sector’s ongoing relief assistance close to locations where these vulnerable populations are currently living. The delivery of these interventions has targeted women and children, among other vulnerable groups, as they have been the worst affected in this drought.
WHO intends to deliver part of these preventive health interventions, such as risk communication, nutrition screening, referral and distribution of micronutrient supplements, including identifying children who are sick and have missed out on routine immunization through the community health workers who are mostly female and drawn from the same communities in which these services will be delivered.
In addition, with this new funding from the UK, WHO will support deployment of a number of mobile outreach teams in these areas for administering childhood vaccines, supporting antenatal care thorough the provision of iron and folic tablets to pregnant women, treatment and referral of sick and malnourished children, as well as treatment and care of women and children with common ailments. Improving access to health care and other preventive health and nutrition interventions for these vulnerable populations who have been devoid of basic health services for decades will mean that every vulnerable child and every woman of child bearing age, including pregnant and lactating women, living in these hard-to-reach and inaccessible areas will be protected from diseases that are preventable. With a focus on 16 operational priority-one districts, severely affected by the ongoing drought, WHO expects that approximately 2 million people will be reached through these integrated health and nutrition activities.
“The situation remains dire. Disease and lack of access to health care pose the biggest threat to millions of Somalis impacted by the drought. WHO’s unique expertise and emergency health response is critical. This new UK support to the WHO will save lives and avert famine and its consequences,” said UK’s Development Director for the Foreign Commonwealth and Development Office Somalia Damon Bristow.
In addition, with this funding support, WHO will support conducting prospective and real-time mortality surveillance through a national and international academic institution to estimate “excess death” from all causes attributed to drought, a measure which is often used to declare famine and also a proxy to better understand the effectiveness of the humanitarian operational response. Also, as part of this initiative, WHO will continue to collaborate with UNICEF and the World Food Programme in order to support the integrated response framework endorsed by the HCT.
Commending the support extended by the UK Government, WHO Representative to Somalia Dr Mamunur Rahman Malik said, “As the threat of famine is looming large, this timely contribution from the UK will help us to save lives among the most vulnerable populations affected by this drought, the scale of which is unprecedented. This support will ensure that we sustain our community-based health and nutrition interventions, including surveillance for early detection of epidemic-prone diseases in some of the most challenging and operating environment that our agency has worked in in recent time. I also thank the Foreign Commonwealth and Development Office for their support to our work in mortality estimates. This is the first time in this country that such work related to mortality has ever been undertaken. The data from such estimates will help us and other agencies to take evidence-based decisions on the basis of quality of our response and target areas and populations who are at most risk of dying from hunger, disease and malnutrition in the country. I take this opportunity to express our most sincere appreciation to the Foreign Commonwealth and Development Office for their partnership with us for advancing health in Somalia.”
For additional information, please contact:
Joy Odero
UK Foreign Commonwealth and Development Office
Head of Communications Kenya & Somalia
Kyle DeFreitas
External Relations Officer
Fouzia Bano
Communications Officer
Related links
/images/stories/somalia/weekly-cholera-report-week-43-2022.pdf?ua=1
Technical program update_May-Aug_2022 (who.int)
WHO supports nationwide integrated immunization campaign in the midst of drought: 2.61 million children vaccinated against measles and polio
A health worker inoculating a child in a nomadic settlement during the integrated immunization campaign in Hobyo district of Galmudug state. Credit: WHO/Fouzia Bano Mogadishu, 7 December 2022 – A complex humanitarian crisis caused by conflict, protracted drought and emanating displacements of populations in Somalia has put more than 3.6 million under-5 years children at risk as their immunity is running dangerously low and vulnerabilities are on the rise with each passing day.
World Health Organization (WHO), in collaboration with the United Nations Children’s Fund (UNICEF), has helped the Federal and State Ministries of Health to immunize all eligible children under 5 in 2022 to protect them from vaccine-preventable diseases like measles and polio. Since January 2022, WHO has helped the ministries of health to conduct one integrated nationwide campaign (November 2022), 2 nationwide polio campaigns (February, October 2022) in addition to conducting one targeted measles and 3 polio campaigns across high-risk districts in vulnerable states.
A recent nationwide integrated campaign, which started from 12 November, lasted for 5 days across the country and managed to immunize 2.61 million children under 5 (0–59 months) with trivalent oral polio vaccine (tOPV). This is the first time Somalia used tOPV in campaign mode after its switch in 2016. The campaign also helped to vaccinate 2.31 million children aged between 6 and 59 months against measles, administered vitamin A and deworming tablets to about 2 million children under 5.
“We are thankful to all the partners and Gavi - the Vaccine Alliance for supporting the first ever national integrated campaign after 2019, which aimed exclusively to vaccinate children against tOPV along with measles and boost their immunity with supplements like vitamin A and deworming tablets across the country and is likely to help cut down mortality and morbidity rates across the country,” commented Dr Muhammad Farid the lead for WHO's immunization programme.
Integrated approach paying dividends
In a resource-starved and fragile health system, WHO's immunization programme in Somalia adopted a one-team multiple-goals approach to roll out an integrated immunization campaign across the country by collaborating with partners. A package of deliverables was finalized with partners to vaccinate around 2.6 million children under 5 in this first phase of a 5-day campaign, which began on 12 November 2022. This package included administering measles vaccine targeting children aged 6-59 months, tOPV targeting children aged 0-59 months, vitamin A supplements for children aged 6-59 months and deworming tablets (Albendazol) for children aged 12-59 Months.
A health worker prepares for a vaccination session at a camp for internally displaced persons (IDP) in Puntland State during the nationwide integrated immunization campaign. Credit: WHOSomalia/Mukhtar Sudani After several rounds of meetings with all the stakeholders (ministries of health) at the state, region and district level, a total of 4088 teams (each team comprising of 3 skilled persons, 2 recorders, one social mobilizer) were deployed across the country to roll out, record and report the campaign using an online digital platform. WHO also helped partners to establish the points of vaccine-administration by using the existing permanent health facilities in each district and setting up outreach posts at nearby accessible schools, mosques, bus stations, and camps for internally displaced persons (IDPs). Social mobilizers were deployed in advance of the campaigns to mobiles the communities, raise awareness about the vaccine uptake and familiarize the communities with available vaccination points in their proximity.
“Currently, these are one of the most vulnerable times for the children of Somalia and WHO is employing all its available resources and innovative approaches such as integrated campaigns, solarization of health facilities to maintain vaccine cold chain and engaging local communities to save the lives of millions of Somali children who deserve bright and healthier lives,” said Dr Mamunur Rahman Malik, WHO Representative for Somalia. He added that “WHO is thankful to all our partners and especially the donors like the Global Polio Eradication Initiative and Gavi - the Vaccine Alliance to help us roll out vaccine campaigns across the country with the single aim of protecting as many children as possible in some of the most fragile health and living conditions worldwide.”
Immunization status in Somalia
Somalia is currently facing one of the most severe droughts in its history, with a looming famine and possibility of severe loss of life due to hunger, malnutrition and disease. Currently, 7.8 million people are affected and 1.1 million are displaced (on top of 2.5 million which were already displaced) as they are in search of food, water, shelter, health care and any assistance available. As of October 2022, a total of 15 143 cases of measles, 4 cases of cVDPV2 in humans and 4 isolates in environment reported since January 2022. The administrative data coverage, as of August 2022 shows that only 88% of eligible children received one dose of measles while only 11% have received a second dose across the country. Combined these figures indicate low immunity of children against measles and polio and this risk is further aggravated by a complex humanitarian crisis caused by conflict and droughts, and related displacement.
For additional information, please contact:
Kyle DeFreitas, External Relations Officer,
Fouzia Bano, Communications Officer,
Related links
