Essential medicines and pharmaceutical policies

Promoting access to safe, life-saving, affordable medicines

Our mission is to promote the rational use of medicines by improving access to safe, effective and affordable medicines and other health products of assured quality across the country to ensure universal health coverage while also developing the capacity of the health authorities and workforce to effectively manage the pharmaceutical supply chain system.

Who we are

The Essential Medicines and Pharmaceutical Policies Programme of the WHO country office works to strengthen equitable access to safe, effective and high-quality essential medicines, vaccines and other health products at an affordable price as part of the effort to achieve universal health coverage and ensure protection of public health.

The programme works with national and local health authorities at all levels in the pharmaceutical section to support the development of policies, plans and strategies and promote access to essential medicines at all service delivery points.

What we do

In collaboration with health authorities, we work to promote equitable access to safe, effective and high-quality essential medicines, vaccines and other health products primarily through the following actions:

Establish national supply chain management

We help establish and maintain a safe supply chain of essential medicines in the country.

Support the management of essential medicines

We support the management and safe storage of essential medicines and other pharmaceutical products.

Assess quality problems of medicines

We assess problems related to the quality of medicines and tackle problems related to the availability and accessibility of good-quality medicines for delivery of safe health care.

Our impact

Working with the Somali Ministry of Health and partners

  • The Somali National Medicines Policy and other pharmaceutical policies developed to improve access to medicines of good quality and rational use of medicines and health products
  • National supply chain established
  • National medicines regulatory authority established
  • Developed policies and guidelines to support rational use of medicines
  • Empowered policy- makers to develop strategies and guidelines to ensure equitable and affordable access to essential medicines

What we have achieved

  • Supported the establishment of the Medicines’ Regulatory Authority in 2016 and subsequently conducted a rapid benchmarking assessment for the authority.
  • Finalized the report on the benchmarking assessment, including the Institutional Development Plan for the pharmaceutical sector in the country (2017).
  • Provided technical support for the establishment of the pharmacovigilance unit in the Federal Ministry of Health in Somalia, and a system for reporting of adverse drugs reactions (2019).
  • Supported the development of the Somalia National Medicines Policy (2014) and updated the Somali Essential Medicines List (2019).
  • Supported the launch of the standard treatment guidelines for hospitals, health centres and health units, which are easy reference guides on the correct use of medicines based on current evidence-based prescribing practices from WHO.
  • Initiated the development of the national action programme on antimicrobial resistance.
  • Provided technical support for the development of the Somali Medicines Law and Drug Act (2019).
  • Built national pharmaceutical capacity of more than 1000 national staff in different components of the national medicines policies.

What is next

The Essential Medicines and Pharmaceutical Policies Programme will continue working with health authorities and national regulatory authorities to strengthen the medicines regulatory authorities and the supply chain system to promote sustainable and equitable access to these supplies, including to vulnerable communities in the society. In addition, the programme will support the following activities:

  • Conduct a pharmaceutical sector assessment survey to collect data on the availability, quality, and rational use of medicines from 65 public and private pharmaceutical facilities in the country.
  • Provide technical support for finalization of the Somalia Medicines Law and Drug Act: to provide legal and regulatory support for the Somali Essential Drug List.
  • Develop an antimicrobial resistance programme to collect data on the threat of antimicrobial resistance and develop a national action plan for combatting antimicrobial resistance.
  • Develop standard treatment guidelines to support the launch of the essential package of health services.
  • Improve the efficiency of the pharmaceutical supply-chain system to ensure sustainable and equitable access to and availability of affordable and good-quality essential medicines.

Polio eradication

Reaching every last child

Our mission is to maintain a polio-free status by boosting immunity in children under 5 years of age and improving coverage of oral polio vaccines in the routine immunization programme, while continuing to search for polioviruses circulating in the human population and the environment.

Who we are

The Polio Eradication Programme is a partnership that brings together the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF) and the Ministry of Health (at all levels) with the aim of protecting every child from polio and eradicating the disease from the country. These partners are supported internationally by of the Global Polio Eradication Initiative, including the Bill and Melinda Gates Foundation, United States Centers for Disease Control and Prevention and Rotary International, who are committed to eradicating poliomyelitis globally.

As the technical lead, the WHO country office is involved in the following areas: mass vaccination campaigns; nationwide surveillance for acute flaccid paralysis in children under 15 years; capacity development of field staff; containment (during collection, handling and storage) of potentially infectious polio materials; promotion of childhood vaccination provided under the Expanded Programme on Immunization (EPI); and support of the Somali Government for implementation of policies on poliomyelitis in the International Health Regulations (2005).

What we do

Conduct vaccination

In collaboration with health authorities and partners, we work to eradicate polio, primarily through the following actions: Respond to Polio Outbreaks by conducting vaccination campaigns. The last outbreak of wild poliovirus in Somalia was in 2014. However, since December 2017, two concurrent outbreaks of circulating vaccine-derived polio virus (cVDPV) have occurred, resulting in the detection of 19 children with paralysis. In order to interrupt the spread of polio virus and avoid additional infections and disabilities in vulnerable Somali children, we conduct nationwide and smaller, case- response immunization campaigns that aim to reach every child to boost their immunity.  Maintaining a high level of immunity in the entire population, including mobile populations and across borders, is essential to prevent future outbreaks.

Detect acute flaccid paralysis

We search for acute flaccid paralysis in children under 15 years to ensure that, if found, no cases of poliovirus spread any further. Polio teams visit health facilities included in the active surveillance network (793 of 1267 health facilities). As part of passive surveillance, polio teams also liaise with focal persons in 413 other health facilities to report (zero reporting) on any suspected cases. Village polio volunteers support house-to-house surveillance in hard-to-reach and insecure areas.

Detect polioviruses in the environment

We complement surveillance of acute flaccid paralysis by searching for polioviruses in the environment. Samples are collected from sewer systems at four sites in Banadir region, and analysed at the Kenya Medical Research Institute in Nairobi. This surveillance helps signal whether people are infected and are shedding virus in their stool.

Build capacity

We develop the capacity of field staff (including WHO, UNICEF and health ministry staff) in the areas of surveillance and outbreak response.

Support routine childhood immunization

We support routine immunization of children by sharing resources, such as staff, systems and infrastructure with country's EPI. We integrate activities during vaccination campaigns and help strengthen the capacity of the Somali EPI.

Raise awareness of immunization

We work with authorities, UNICEF and local media outlets to raise awareness of the benefits of vaccines and vaccination, the campaigns that are being conducted and vaccination schedules, and to encourage caregivers to vaccinate children. Health workers use Somali information, education and communication materials to raise awareness among caregivers. Manage information. We collect data from acute flaccid paralysis and disease surveillance, EPI and vaccination activities, and other work streams, including from partner agencies (such as mapping of internally displaced people from the International Organization for Migration). This information guides decision-making and allows us to assess the quality of work done across the country. We post the information collected and the high-quality maps produced on the website www.somaliapolio.org. Polio teams are progressively using real-time, electronic means of reporting for data management (Open Data Kit software).

Support other health interventions

We provide support to other health interventions by sharing resources and systems established by the polio eradication programme in the past 22 years. For example, our systems are used to improve surveillance for diseases (including measles) and outbreak control (such as cholera).

Our impact

Working with the Somali Ministry of Health and partners

  • Kept the free country of wild polioviruses since 2014
  • Spread of two outbreaks of circulating vaccine-derived polioviruses types 2 and 3 stopped through 19 intense polio vaccination campaigns
  • Environmental surveillance introduced in Banadir, which helped detect vaccine-derived polioviruses in sewer water samples
  • Strong partnerships with Kenya and Ethiopia forged to work jointly to eradicate polio from the Horn of Africa, which led to synchronized supplementary immunization and cross- notification of acute flaccid paralysis cases
  • More than 2.5 million children under 5 years reached with oral polio vaccines during nationwide campaigns
  • Circulation of cVDPV2 detected in Somaliland and Puntland after years of no cases in these states. Cross-notified 17 acute flaccid paralysis cases with Ethiopia
  • Polio and acute flaccid paralysis surveillance and response maintained across the country
  • Somali women empowered through employment as 65% of polio field staff are women

What we have achieved

  • Enhanced quality of immunization campaigns by improving planning and monitoring of immunization campaigns and improving quality of training offered to health workers. Campaign quality is monitored by independent third-party monitors.
  • Negotiated and gained access to insecure districts, which led to an estimated 50 000 children being vaccinated against polio in these areas for the first time. These areas have been inaccessible for many years.
  • Prioritized health facilities and liaised with health focal points to develop schedules for active visits and passive reporting, both of which search for children with acute flaccid paralysis, to detect the spread of any polioviruses.
  • Improved reporting and field supervision by using real-time, electronic means of reporting, including the Open Data Kit.
  • Developed the capacity of more than 200 national staff through training on surveillance and microplanning led by international experts. Training is done directly, hence eliminating the need for cascading.
  • Developed information, education and communication materials on acute flaccid paralysis surveillance to help health workers, Somali parents and caregivers and our partners understand how polio is spread, what acute flaccid paralysis is and what actions need to be taken when it is detected, and the benefits of vaccination.

What is next

  • The Polio Eradication Programme will intensify efforts to promote population immunity and strengthen surveillance to end the ongoing cVDPV outbreaks and to eventually certify the country free of polio through the following activities.
  • Target high-risk populations (nomadic people, internally displaced people, populations living in border districts inside the country and along shared international borders) with fractional doses of inactivated polio vaccine. Campaigns will be conducted in phases, using bOPV and fractional inactivated polio vaccine.
  • Expand environmental surveillance to other major cities, including Hargeisa, and three sites in Kismayo and Baidoa to monitor viruses in the environment in these cities.
  • Continue community-based surveillance through the use of village polio volunteers mainly in inaccessible areas and areas with no health infrastructure, including international borders.
  • Deploy transit point vaccinators to vaccinate children at ports of entry across the country.
  • Continue to implement the polio transition and integration plan. This plan aims to use polio assets (human resources, physical assets and infrastructure) and systems to strengthen disease surveillance, response to health emergencies and routine immunization, and the overall health system, while at the same time working to maintain the country's polio-free status.
  • Continue to strengthen capacity of health workers and conduct regular programme reviews in different areas to maintain high standards of health care delivery.
  • Continue polio containment activities and the implementation of the International Health Regulations (IHR) recommendations to work towards the certification of a polio-free country.
  • Continue to negotiate access to reach 537 000 children under 5 years in difficult-to-reach areas.

EWARN

Early Warning and Response Network (EWARN) is a network of health facilities and public health professionals that support the early detection and timely response to epidemic-prone diseases through collection, reporting, investigation, analysis and dissemination of epidemic-related data.

EWARN was first implemented in Somalia in 2012: following its collapse during the ongoing conflict, it was relaunched in 2017. Information is now collected on mobile devices (tablets) which are preloaded with EWARN software containing the necessary forms and reports for information sharing. The software is designed to auto-generate analytical and epidemiological reports to aid decision-making.

Information is gathered by trained health workers and hospitals: they investigate alerts and collate data through district focal points which are then analysed by EWARN epidemiologists at the regional and national level. The reports are shared with health partners and health authorities for multi-level decision-making to enact effective outbreak prevention and response.

Somalia has 450 designated EWARN sites across the country. The coverage is sufficient to ensure timely alerts to prevent and respond to disease outbreaks.

Communicable diseases

Safeguarding against high-burden endemic diseases:HIV/AIDS, malaria and tuberculosis

Our mission is to end HIV and AIDS, malaria and tuberculosis by providing technical, strategic and operational support for the diagnosis and case management of these diseases, undertaking data analysis to inform decision-making and supporting the achievement of other control and elimination goals through the development of appropriate policies and strategies and provision of training and capacity-building of the health workforce.

Who we are

The HIV programme of the WHO country office supports activities to reduce HIV infection and AIDS, and coinfection of HIV and tuberculosis (TB) in the country. Services are delivered through 16 health facilities that provide antiretroviral therapy and 93 TB treatment facilities.

The malaria and vector control team supports actions to reduce malaria and improve vector control across the country. Our activities span all levels of the health systems. The whole population of Somalia is considered at risk of malaria. However, in 2019, 51% of the country’s population was living in a high-risk transmission zone for malaria (> 1 case per 1000 population).

The TB programme implements the national TB programme jointly with national TB programme managers and other partners implementing TB control activities.

What we do

In collaboration with health authorities and partners, we work to tackle HIV/AIDS, malaria and TB in Somalia, primarily through the following activities:

» HIV/AIDS

Developing capacity of health workers

We provide formal and on-the-job training on HIV/AIDS testing and counselling, which is the gateway to HIV/AIDS treatment, as well as training on anti-retroviral therapy.

Enhancing laboratory services

We conduct external quality assurance of HIV testing to validate the accuracy of HIV testing.

Supporting people living with HIV/AIDS

We train staff at HIV treatment facilities on monitoring the health of HIV/AIDS patients, offering supportive counselling and following up on adherence to instructions on taking the medication.

Collecting and analysing data on HIV

We conduct HIV sentinel surveys every 2–3 years to measure the prevalence of HIV and generate national estimates for various population groups. We collect data from 20 antenatal clinics and five clinics for patients with sexually transmitted infections.

Advocating to guide appropriate responses

We use the data collected on the HIV/AIDS situation in the country to advocate for policy responses and decisions.

» Malaria and vector control

Enhancing diagnosis and treatment

We distribute rapid diagnostic tests for prompt diagnosis of malaria and provide medicines to improve access to malaria treatment anywhere at any time.

Supporting vector control

We distribute insecticide-treated nets and carry out indoor residual spraying in high-risk areas, supplemented by management of larval sources.

Monitoring

We monitor malaria drug efficacy and resistance to inform treatment policies and to ensure early detection of, and response to, drug resistance.

Collecting and analysing data on malaria

We collect surveillance data on malaria in a standardized way to estimate the malaria burden and map risk to guide control interventions.

Developing capacity of health workers

We train health workers on laboratory diagnosis, case management, vector control and malaria surveillance.

»TB

Developing capacity of health authorities and partners

We manage drug-sensitive and drug-resistant TB in 96 TB management units and three centres for treatment of multidrug-resistant TB. In addition, we develop training materials for health workers on TB detection, diagnosis, treatment and care.

Adapting global strategies to stop the spread of TB

We assist the health authorities to adapt WHO-developed policies and guidelines to the country context and implement them to meet national TB control targets and goals.

Managing TB drugs

We ensure that all TB patients have timely access to effective drugs so they can recover from TB. This management includes drug quantification, receipt, clearance and distribution, and reporting on drug consumption.

Collecting and analysing data

We gather and analyse data on TB in line with WHO standards, and provide periodic feedback to ministries of health and implementing partners.

What we have achieved

» HIV/AIDS

  • Established 16 treatment centres for antiretroviral therapy: at the end of 2019, 3472 patients (32.5% of all people estimated to be living with HIV/ AIDS) were alive and on treatment.
  • Supported 79.8% of patients with TB coinfected with HIV to begin antiretroviral therapy, thus very nearly attaining the target of 80%.
  • Screened 75% of people living with HIV to check for TB during clinic visits, more than the target of 72%.
  • Supported 89 of 93 (96%) TB centres in providing HIV testing and counselling; as a result, 91.2% of TB patients learnt of their HIV status in 2019.
  • Provided technical assistance for transition planning to the new dolutegravir-based regimens for antiretroviral therapy.
  • Completed analysis of data for the 2018 round of HIV sentinel surveillance. We also provided support to the country to update the national estimate of HIV prevalence, beyond pregnant women and people with symptoms of sexually transmitted infections.

» Malaria and vector control

  • Malaria case finding substantially increased from 2014 to 2019, a 188% increase.
  • Use of rapid diagnostic tests for case detection substantially increased from 2014 to 2019, a 322% increase.
  • Use of long-lasting insecticidal net substantially increased from 2014 to 2019: 1.36 million people protected (18% of people living in high malaria transmission zone) in 2019 compared with 697 089 in 2014, an overall increase in coverage of 95%.
  • Indoor residual spray to prevent malaria outbreaks after flooding in several parts in the country in 2019 protected 183 629 people.
  • Detected Anopleles stephensi, which was suspected of being responsible for recurrent and prolonged malaria transmission in several regions, such as Bossaso, Bari and Berbera.
  • Conducted two therapeutic efficacy studies in 2019, in line with plans to conduct at least two studies on an annual basis.
  • Systematically monitored the efficacy of insecticides used for vector control and developed national guidelines for insecticide use.
  • Introduced new vector control management, such management of larval sources through distribution of larvivorous fish and rehabilitation of berkit (reservoirs).
  • Conducted capacity-building for health workers at selected health facilities supported by the private sector.
  • Conducted a programme review for the malaria programme towards the development of the National Strategic Plan (2021–2025) for Malaria Control and Elimination.

»TB

  • TB incidence decreased from 286 per 100 000 in 2010 to 262 per 100 000 in 2019.
  • Notification of TB cases increased from 10 469 in 2010 to 16 965 in 2019 – a 62% increase in less than a decade.
  • TB notification rate increased from 35% in 2014 to 43% in 2018.
  • A 90% treatment success rate maintained in 2019 among newly diagnosed TB patients.
  • Estimated mortality rate decreased from 95 per 100 000 in 2000 to 67 per 100 000 in 2019 – a 29% decline.
  • 44 TB detection centres established with advanced GeneXpert TB diagnosis machine for testing of both drug-sensitive and multidrug-resistant TB.

What is next

In collaboration with health authorities and partners, we work to tackle HIV/AIDS, malaria and TB in Somalia, primarily through the following activities:

» HIV/AIDS programme

From 2021 to 2023, the HIV/AIDS programme aims to undertake the following actions:

  • Provide technical support to the programme with the aim of: having 5026 people living with HIV/AIDS on antiretroviral therapy by 2023; and decreasing the proportion of patients dying and being lost to follow-up in the first 12 months of receiving treatment from 24.5% in 2019 to 15.0% by 2023. In addition, the programme aims to increase the proportion of people starting treatment following diagnosis to 93% by 2023.
  • Update the operations and training manual for Integrated Management of Adolescent and Adult Illness in light of the transition to dolutegravir-based regimens.
  • Increase testing among key vulnerable populations through a mix of testing approaches (e.g. facility-based outreach testing and self-testing) and integrate testing and counselling within existing targeted service settings.
  • Work to increase the coverage of testing for viral load, which indicates amount of HIV in a person’s blood, and testing for CD4 (a type of white blood cell), which indicates immune function in patients living with HIV.
  • Scale up further HIV diagnostics and treatment for TB patients.
  • Design integrated social and behaviour change communications for key vulnerable populations.
  • Contribute to health systems strengthening through integrating services into the Essential Package of Health Services.

» Malaria and vector control programme

Enhancing diagnosis and treatment

As part of the national strategic plan for 2021– 2025, the programme aims to implement the following activities between 2021 and 2023:

Case management

  • Test at least 278 654 of an estimated 292 334 suspected malaria cases (95%) for parasitological confirmation.
  • Provide at least 17 888 of an estimated 18 252 confirmed malaria cases (98%) with first-line treatment.
  • Test at least 383 835 of an estimated 417 406 suspected malaria cases (92%) for parasitological confirmation, which confirms malaria and guides treatment.
  • Vector control: through mass campaigns, distribute at least 2 399 488 long-lasting insecticidal nets, covering an at-risk population of 4.319 million.
  • Carry out indoor residual spraying to respond to any early signs of a malaria outbreak.
  • Prioritize six districts for malaria elimination.
  • Specific prevention interventions: provide intermittent preventive treatment in pregnancy in 13 districts where malaria endemicity is more than 10%.
  • Contribute to health systems strengthening through integrating services into the Essential Package of Health Services.

»TB programme

From 2021 to 2023, as part of the national TB plan for 2020–2024, the TB programme aims to undertake the following actions:

  • Increase access to TB services by establishing an additional 25 new TB management units.
  • Increase TB case detection from 16 965 cases in 2019 to 27 000 by 2023, a 59% increase.
  • Increase the number of multidrug-resistant TB cases enrolled on treatment from 335 in 2019 to 1035 in 2023, while increasing the treatment success rate from 79% in the cohort of 2017 to > 85% in the cohort of 2021.
  • Ensure that all diagnosed TB patients are tested for HIV and are aware of their HIV status. In addition, increase the proportion of patients coinfected with TB/HIV receiving antiretroviral therapy from 72% in 2019 to 95% by 2023.
  • Scale up GeneXpert diagnostic capacity – an advanced technology used to diagnose TB – to ensure that all presumptive TB cases have access to GeneXpert diagnosis.
  • Develop treatment guidelines and an operational plan for latent TB infection; this infection is a condition in which TB bacteria survive in the body in a dormant state.
  • Continue data management and reporting for TB.
  • Support the completion of the TB culture laboratories in Mogadishu and Garowe.
  • Contribute to health systems strengthening through integrating TB services into the Essential Package of Health Services.

The TB programme aims to achieve by 2023 (as part of the National TB Strategic Plan):

  • A 30% reduction in the TB incidence rate.
  • A 50% reduction in deaths from TB.
  • A > 20% reduction in the proportion of families affected by TB that face catastrophic costs because of TB.

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