WHO and Ministry of Health personnel check for IDSR priority conditions during a joint support supervision visit to a health centre in Beledweyne district, Hirshabelle state, Somalia. Photo credit: WHO/WHO Somalia11 June 2024, Somalia – Amid the complex humanitarian emergency that is ongoing in Somalia, the population is highly vulnerable to disease outbreaks. In such a situation, early detection of disease outbreaks is crucial for an appropriate public health response and interventions.

Somalia has been successfully strengthening its multi-disease surveillance system by implementing the Integrated Disease Surveillance and Response (IDSR) system. These efforts have been made in collaboration with the WHO Regional Office for the Eastern Mediterranean and the WHO Country Office in Somalia.

IDSR improves the efficiency and effectiveness of health information systems. IDSR data are hosted on DHIS2, the open-source software platform used nationally to collate district health information. Health workers use this platform to record, in one place, real-time information on health events and analyse data for early detection and prompt response to disease outbreaks.

IDSR system implementation

“IDSR has enabled the Ministry of Health and Human Services to stay ahead of the public health events and safeguard the health of our communities by detecting outbreaks early,” said Dr Sahro Isse Mohamed, Head of the Integrated Disease Surveillance and Response Unit, Ministry of Health and Human Services, Federal Government of Somalia.

WHO Somalia supported the development of a 3-year, multiphase operational plan. This includes technical guidelines for IDSR implementation, standard operating procedures, and training material tailored to the surveillance needs of health workers.

As of January 2024, the country has been implementing the second phase of the plan, which aims to:

improve the quality of data that health workers report to the IDSR system

link surveillance data with laboratory information

strengthen the capacity for data use at the subnational level

monitor and evaluate the implementation of the IDSR system through supportive supervision

monitor indicators

conduct review meetings with all stakeholders.

A WHO team member and Jubaland public health laboratory technicians discuss how to increase the testing capacity of IDSR priority conditions in Kismayo district, Jubaland state, Somalia. Photo credit: WHO/ WHO Somalia

Phase one was completed in 2023, with health workers from 371 out of 620 (59.8%) health facilities trained, surpassing the target coverage for the training. State-, regional- and district-level managers also took part in the training.  

Thanks to these training efforts, by the end of 2023, these health facilities had submitted reports on 42 priority conditions. From epidemiological week 3 to week 13 of 2024, this number increased to 409. Of the health facilites that have received the training, 80% have been regularly submitting surveillance data.

The IDSR system has been instrumental in detecting cholera, diphtheria and pertussis alerts in Somalia since April 2023. Also, the capacity of health workers at different administrative levels has been enhanced to develop weekly epidemiological bulletins with analysis and trends of various conditions reported by health facilities. The weekly bulletins are shared with a wide range of stakeholders for decision-making and resource coordination and to the health workers as a form of feedback.

Transforming plans into actions

Planning for IDSR began in 2020, when Somalia made a strategic decision to implement such a system. In 2021, the country established a functioning IDSR system for the first time. In 2022, guidelines and training materials were developed to build health workers’ capacities to successfully use and implement the IDSR system. All these efforts have contributed to reduce morbidity and mortality associated with disease outbreaks.

The final phase of the operational plan will complete in 2024. The IDSR system will then provide a holistic approach to public surveillance of priority diseases and conditions, as well as address response needs.

Somalia has also initiated steps to implement event-based surveillance, especially at the community level, to complement the IDSR system. The country is also strengthening its public health laboratory capacity to ensure that priority diseases reported through the IDSR system are diagnosed in good time.

Rapid response teams will be trained to respond to emergencies within the community. There are also plans to establish surveillance and response systems for antimicrobial resistance, and maternal and perinatal deaths.

WHO is committed to support Somalia as it continues to develop and refine its IDSR system. This support is vital for strengthening Somalia’s surveillance system to improve the country’s preparedness and response plan to disease outbreaks.

Mrs Abdia Adan and her son Mohamed at Garasbaley Health Centre, Kahda district, during his final follow-up appointment to check on his condition. Photo credit: Action Against Hunger/Ahmed Issack11 June 2024, Mogadishu, Somalia – Abdia Adan returns to Garasbaley Health Centre, in the heart of Kahda district, Banadir Region, for her 8-month-old son’s final follow-up at the facility. This visit proves different from her previous encounters as young Mohamed Hussein is now healthier. Abdia visited the health centre with Mohamed in November 2023 when he had a fever and was vomiting. His condition has significantly improved since the doctors diagnosed him with pneumonia and malnutrition, thanks to Abdia’s love and the attentive quality medical care received at the facility.

Living in the Sodonka camp in Kahda, a district in Mogadishu inhabited mainly by people affected by Somalia’s prolonged drought crisis of 2022–2023, Abdia’s family has faced numerous challenges. Her husband’s meagre earnings as a teacher are barely enough to sustain their family of 7. There are more than one million people sharing the fate of being displaced from their areas of origin into internally displaced camps in Mogadishu due to conflict, drought and floods. The living conditions in the camps are harsh, and limited access to basic services, such as water, sanitation, food and health services, increases the risks of disease outbreaks and malnutrition.

To address the critical issue of disease outbreaks, severe acute malnutrition and improve access to health and nutrition services, the WHO in Somalia initiated an emergency response, working with Action Against Hunger, an international NGO, and as well as the Juba Foundation, a local partner in Lower Shabelle Region. The joint venture was made possible thanks to generous and timely support provided by the Central Emergency Response Fund (CERF).

The emergency response was successfully implemented. Disease surveillance teams, community health workers, and health centres played crucial roles in delivering life-saving health and nutrition interventions. Working together enabled WHO and Action Against Hunger to avoid service duplication and smooth referral between community and facility-based care. More vulnerable people were reached in the targeted districts through complementary interventions, leverage of resources and knowledge sharing.

Garasbaley Health Centre, where Abdia had brought her ailing son, is one of the facilities that was supported by the project. Over her 4 years of living in the camp, Abdia knew the community health workers serving her neighborhood and had seen them refer sick children to nearby facilities like Garasbaley Health Centre, giving hope to families.

Young Mohamed is now better following treatment for fever and vomiting made possible by CERF-funded primary health care in Kahda, implemented jointly by WHO and Action Against Hunger. Photo credit: Action Against Hunger/Ahmed IssackThe project supported dedicated disease surveillance teams and community health workers and improved the availability of services at Garasbaley Health Centre, as well as other facilities. As a result, young Mohamed received the necessary medical attention and care, including amoxicillin, paracetamol, vitamin A, and ready-to-use therapeutic food, leading to his improved health and well-being.

The project’s impact extended beyond Abdia’s family and reached almost 15,000 people affected by drought in the Banadir, Bay and Lower Shabelle regions, with the provision of essential health and nutrition services in health facilities, such as outpatient consultations, safe delivery services, vaccination, antenatal care (ANC) and postnatal care (PNC), nutrition support, as well as mental health and psychosocial support.

The story of Mohamed and his family shows the importance of collaborative efforts among partners, community engagement, and access to quality health care and nutrition services in crisis-affected regions. It highlights the positive outcomes that can be achieved when organizations like WHO and Action Against Hunger work in partnership with local communities and stakeholders to address the urgent needs of vulnerable populations.

For more information, please contact: 

Madinur Saydahmat, Partnerships Officer,
WHO Somalia
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Ahmed Issack Hussein, Communication and Advocacy Coordinator, Action Against Hunger
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A mother and her child at a Public Health Centre of one of the drought-affected districts in Kismayo, Somalia. Photo credit: WHO Somalia/I. Taxta1 May 2024, Mogadishu, Somalia – A 12-month project led by the WHO Country Office in Somalia over the course of 2023 reached 3 137 217 people affected by drought or flood. The project was made possible thanks to the generous support of the Government of Japan.

Initially intended to address drought, Japan’s support swiftly adapted to the evolving situation in Somalia. Starting in October 2023, the country was hit by El Niño-related heavy rainfall. This resulted in severe flooding that affected more than 2.4 million people and led to the destruction of 31 health facilities. The surge in demand for emergency health services prompted the reallocation of Japan’s available funds to also facilitate WHO’s flood response.

With the critical support of donors, including Japan, humanitarian and development actors worked with the Government of Somalia on the drought response. This successfully prevented a nationwide famine arising from the 2022–2023 drought crisis. There is still much work to be done, however, as the same communities continue to be affected by the impacts of other extreme climate events.

“The support from Japan played an important role in enabling WHO to reach millions of vulnerable individuals in Somalia who were affected by extreme climate events,” said Dr Ifeanyi Okudo, Incident Manager at WHO Somalia. “We are pleased to deliver the project objective of averting preventable loss of life by strengthening the outbreak detection and implementing an integrated health and nutrition package for the most affected.”

With over US$ 700 000 in financial support received from Japan, WHO was able to deploy 369 community health workers and 121 mobile outreach teams in drought-affected areas. These provided essential health and immunization services to local population with a special focus on children and pregnant and lactating women.

Through this project, basic health and nutrition services were delivered to more than 1.5 million people, including nearly 480 000 children aged under 5 years and more than 250 000 women of childbearing age. Through routine immunization efforts, close to 410 000 children received the pentavalent 3 and measles-containing vaccines.

This surge capacity to provide essential services effectively complemented the routine activities of the local health system, mitigating severe service disruption caused by climate events and consequent mass population displacement. The project also supported health facilities: for example, 369 primary health care units were provided with essential medicines and supplies, benefiting over 3 million people who receive their health services in these health facilities.

Japan’s funding also enabled WHO Somalia to support the treatment of children with severe acute malnutrition, by providing 29 stabilization centres with supplies and supervision support. A stabilization centre is a fixed health care unit where children with severe acute malnutrition with medical complications are referred, admitted, and treated. These WHO-supported stabilization centres maintain a cure rate of above 90%.

“The support from Japan and WHO has been vital in responding to drought and floods, and providing treatment to children suffering from severe acute malnutrition with medical complications [SAM/MC] at our stabilization centres,” said Mr Farhan Mohamed, Head of Nutrition, Federal Ministry of Health.

“Thanks to the comprehensive training sessions provided to health care providers, we have been able to enhance the capacity of our health care workers and provide high-quality services, resulting in a high cure rate for SAM/MC,” he added. “In addition, the funding made it possible for us to deploy critical resources and personnel to the most severely affected areas, where they had a significant impact on saving lives and averting famine.”

Finally, the project allowed WHO to help the Federal Ministry of Health enhance its epidemic surveillance and response mechanism through community-based surveillance. Now, community health workers send alerts based on danger signs they see in the communities they serve, and rapid response teams verify the alerts. As a result, 84.2% of all outbreak alerts raised in 2023 were addressed within 48 hours, and 92.1% of all cases were confirmed. WHO has also been assisting the Federal Ministry of Health to produce weekly epidemiological situation reports.

For more information, contact:

Madinur Saydahmat, Partnerships Officer, WHO Somalia
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Fouzia Bano, Communications Officer, WHO Somalia
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Minister of Health Dr Ali Hajiadam Abubakar poses for a group photo with health partners to kick-start World Immunization Week 2024 in Mogadishu, Somalia. Photo credit: UNICEF/Maslah29 April 2024, Mogadishu, Somalia – While marking World Immunization Week this year, Somalia’s Federal Ministry of Health, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have jointly urged partners and donors to accelerate immunization efforts to reach every child in Somalia.

This year’s World Immunization Week coincides with the 50th anniversary of the global Essential Programme on Immunization and aims to spur greater engagement around immunization, to reiterate the importance of vaccination and improve the health and well-being of every child, everywhere. This year’s commemoration highlighted the successes of immunization in Somalia since 1978 and the challenges that require a concerted effort – the uninterrupted, 7-year circulation of the polio variant; the large number of children who have never been vaccinated (zero-dose children); the recurrent outbreaks of vaccine-preventable diseases like measles, diphtheria and whooping cough; and the need for an expanded resource envelope to tackle these challenges.

Speaking at a press conference in Mogadishu on Sunday, Federal Minister of Health for Somalia Dr Ali Hajiadam Abubakar said that despite Somalia having had the best-performing immunization programmes in the Eastern Mediterranean Region historically, prolonged conflict and instability in the last few decades have resulted in a weakened, fragmented and severely underfunded health system.

“This year’s theme – Humanly Possible – serves as a powerful reminder of our collective responsibility to ensure that every child in Somalia has access to life-saving vaccines. The introduction of new vaccines such as the pneumococcal conjugate vaccine and rotavirus vaccine later this year will further help us to combat pneumonia and diarrhoea, 2 diseases that contribute greatly to child mortality in Somalia,” he said.

“The coverage in Somalia is still insufficient to effectively combat vaccine-preventable diseases, and consequently we have experienced various outbreaks,” said Ms. Patience Musanhu, Senior Country Manager for Gavi, the Vaccine Alliance. “I wish to reiterate Gavi’s commitment to continue its investment in vaccines and immunization to ensure equitable vaccination coverage across the country. I strongly urge all stakeholders to redouble their efforts to increase vaccination coverage to safeguard children against vaccine-preventable diseases.”

“Vaccines are one of the greatest success stories of public health. And yet, despite all the knowledge and resources available globally, children in Somalia continue to contract vaccine-preventable diseases. For example, in first quarter of 2024, 382 people have been confirmed for measles, 75% of which are children under 5 years of age in Somalia,” said Dr Reinhilde Van De Weerdt, WHO Representative to Somalia. “Greater efforts are needed, with an integrated approach to tackle the systemic challenges the country is facing by its health system, that affect the delivery of essential health services and hinder progress in Somalia’s commitment toward universal health coverage.”

Globally, immunization programmes have been the bedrock of primary health services in communities and countries due to their reach and coverage. A major landmark study released this week reveals that global immunization efforts have saved an estimated 154 million lives – or the equivalent of 6 lives every minute of every year – over the past 50 years. The vast majority of people saved – 101 million – were infants.

The study, led by WHO and to be published in The Lancet, shows that immunization is the single greatest contribution of any health intervention to ensuring babies not only see their first birthdays but also continue to lead healthy lives into adulthood.

“In Somalia, the threat from vaccine-preventable diseases remains alarmingly high, with an estimated 1.5 million children under 5 known as ‘zero-dose’ children. These children are the most vulnerable, having never received any vaccines, and are disproportionately affected by diseases such as measles, diphtheria and whooping cough,” said UNICEF Representative to Somalia Ms Wafaa Saeed. “Let us all commit, as leaders, health professionals and global citizens, to safeguard the future of our children by ensuring that every child in Somalia receives their right to immunization. Let’s make this humanly possible.”

Some of the challenges Somalia faces in ensuring all communities have access to vaccinations include a fragile health system, further impeded by conflict and natural disasters; limited access to cold chain facilities in remote areas and among hard-to-reach populations; and difficulty in reaching people living in insecure and inaccessible locations.

“The high number of unimmunized and underimmunized children in Somalia who live in contexts such as IDP [internally displaced person] camps, urban poor settings and hard-to-reach areas increases risks of vaccine-preventable disease outbreaks. For the past 5 years, we have been grappling to respond to at least 2 outbreaks each year, as evident from the national surveillance reports,” said Save the Children Acting Country Director Dr Binyam Gebru. “While we stand here today in solidarity to mark this World Immunization Week, let’s reaffirm our commitment to ensure every child in Somalia gets immunized, which is a basic human right, and I believe with concerted efforts, this is humanly possible."

Over the years, WHO, UNICEF and partners have extended support to Somalia to develop systems to store different vaccines, establish systems to vaccinate children, and to compile and store data around immunization for decision-makers to use. Despite all the challenges, Somalia has had some success in getting more children vaccinated using strategies such as mobile outreach facilities in addition to fixed vaccination sites. Additionally, teams of health workers and social mobilizers, supported by the government, WHO and UNICEF, are regularly visiting communities to share messages on the benefits of vaccination.

Yet the country needs more support to protect children, particularly vulnerable ones, from vaccine-preventable diseases such as measles, cholera, polio, diphtheria, tuberculosis, pertussis and tetanus.

For additional information, please contact:

Mohamed Osman, Head of Communication and Public Engagement, Federal Ministry of Health
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Victor Chinyama, Chief of Communication, UNICEF Somalia
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Fouzia Bano, Communications Officer, WHO Somalia
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