Mogadishu, 17 September 2021 – While commemorating World Patient Safety Day yesterday, the Federal Government of Somalia, in collaboration with the World Health Organization (WHO), United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA), urged health facilities, health care workers and other stakeholders to step up efforts to ensure mothers and newborns remain safe.

This message echoes this year’s theme for World Patient Safety Day — ‘Safe maternal and newborn care’ — and comes at a time when the coronavirus disease-2019 (COVID-19) has disrupted continuity of already overstretched essential health services across the country.

A national ‘pulse survey’ conducted by WHO over seven months in 2020 and 2021 to determine the continuity of essential services in Somalia found that, during May–September 2020, 33% of essential health services had been disrupted (one out of three services), while during January–March 2021, there was continued disruption of 12% of essential health services (six out of 51 services), indicating that substantial disruptions persisted even after one year of the pandemic. Six of the major essential health services where significant disruptions were noted include reproductive, maternal, newborn, child and adolescent health services, that experienced between 5 and 50% disruption, and immunization services, disrupted by between 5 and 20%.

Even before the COVID-19 outbreak was confirmed in Somalia, the country was known to have one of the highest maternal mortality rates in the world, at 692 maternal deaths per 100 000, and a neonatal mortality rate of 40 deaths per 1000 live births.

“Before the COVID-19 pandemic, 68% of women did not visit health facilities for antenatal care and only one third of births were delivered with the help of a qualified health care practitioner,” said Dr Fawziya Abikar Nur, Minister of Health and Human Services for Somalia. “Since the COVID-19 pandemic was confirmed in Somalia, women have been making even fewer visits to seek help. I would like to encourage all our partners to reconsider their strategies to ensure more pregnant women access health facilities for antenatal care, deliveries, and immunization, to offer young children a safe start to their lives.”

As part of this year’s World Patient Safety Day commemorations, all partners, including WHO, are urging all stakeholders to “Act now for safe and respectful childbirth.” Ensuring appropriate and respectful treatment to delivering women and their babies will increase trust in health facilities, utilization of services and support by the communities.

“At the points of care, we need to continue to develop the capacity of health care workers, while maintaining the highest standards of hygiene and safety to prevent any potential spread of diseases and to ensure patients recover,” said Dr Mamunur Malik, WHO Representative to Somalia. “At the same time, we need to encourage family members, including men, to bring pregnant mothers to their nearest health centres for regular antenatal care and delivery, to prevent women and children from dying of preventable causes and unsafe care. With concerted efforts, we can save more lives, but we all need to act now to make a change.”

“Having a skilled pair of hands – a well-trained doctor, nurse or midwife – present during pregnancy, birth and beyond, is key in giving every Somali child a chance to survive and thrive from the very beginning,” said UNICEF Somalia Representative, Mohamed Ayoya. “UNICEF is proud to partner with the Government of Somalia to enhance its efforts to reach vulnerable women and children, living in the most disadvantaged areas and enduring the harshest conditions, who need the support most, amid the COVID-19 pandemic.”

“Every mother has a right to a safe delivery through skilled birth attendance at birth. This is a service that can be scaled up to reach the underserved and underprivileged population across the country. This can be achieved through the ongoing engagement of the public sector and the services provided by the non-government sector,” said UNFPA Representative, Mr Anders Thomsen.

Mr Thomsen said skilled birth attendance is an evidence-based public health intervention to reduce maternal and neonatal mortality and morbidity. “UNFPA continues to invest in this effort in close partnership with the Ministry of Health, by supporting health facilities providing life-saving skilled birth attendance at birth as well as ensuring the production of qualified midwives who provide the best option in Somalia for truly reaching the most underserved population in the country with safe and life-saving care,” said M Thomsen.

Introduced in 2019, World Patient Safety Day aims to promote understanding of patient safety, increase public engagement in health care safety, and promote global action to prevent and reduce avoidable harm in health care. This year, on the World Patient Safety Day, WHO, UNICEF and UNFPA committed to support the Federal Ministry of Health and Human Services to introduce new interventions and measures across the health facilities in the country, which will ensure safer maternal and newborn care every year.

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Editor’s notes

World Patient Safety Day was established in 2019 by the 72nd World Health Assembly through the adoption of resolution WHA72.6 – “Global action on patient safety”. The Day is firmly grounded in the fundamental principle of medicine – first do no harm.

The findings of the second round of the national pulse survey conducted by WHO on the continuity of essential health services during the COVID-19 pandemic for Somalia are available at the interactive dashboard.

16 September 2021 – As the Head of Nurses and Midwives and Capacity Building at the Banadir Hospital, Sahra Mire Mohamed assists midwives to offer mothers and newborns safe and quality care. She ensures that midwives she trains perform safe deliveries, supervises regular mother and child health services offered to mothers and newborns, and helps them when needed, especially if a mother or child is facing any kind of health risk or medical emergency.

On average, Sahra and her teams work with 600 pregnant women a week, many of whom come from far and wide to visit the hospital because treatment for pregnant women in this hospital is free. Mostly, women visit for delivery, although many “expectant mothers” arrive too late to the hospitals and it becomes difficult for the midwives to manage these pregnant women for safe delivery. Sometimes, the family members do not sign a consent form for a caesarian section in the event when normal deliveries are not indicated, owing to the condition of the mother, she explains.

For now, Sahra is pleased to note that this year’s World Patient Safety Day is shining a spotlight on safe maternal and newborn care, and urging policy-makers, health professionals, the general public, health partners and other stakeholders to ‘act now for safe and respectful childbirth’.

With very high maternal mortality and neonatal mortality rates, stakeholders in Somalia need to focus on using innovative strategies to create a safe environment for mothers and newborns, she says.

Challenges that Somali women and newborns face

In Somalia, health facilities do not practise proper infection prevention and control measures leading to patients, health care workers, and even newborns, prone to health care-associated infections. The awareness levels of health care workers on infection prevention and control in many health facilities is also very poor. 

According to Sahra, who has a earned Master’s degrees in both public health and one in disaster resilience leadership and humanitarian assistance, Somali women receive unsafe care when they opt to visit unskilled traditional birth attendants for delivery. In general, women lack awareness about the need to visit health facilities regularly during their pregnancies, which results in them and their newborns missing out on life-saving vaccinations and screenings that can spot and prevent challenges.

Many pregnant women that Sahra sees suffer from pre-eclampsia, excessive bleeding during and after childbirth, high blood pressure, obstructed labour and other complications that arise due to unsafe care during delivery, poor antenatal and postnatal care and also partly due to practice of female genital mutilation.

Need for health education  

To reduce maternal and neonatal deaths and diseases, women should speak to health care workers and their families about how to access health care and reduce risks during pregnancy and childbirth. They need to be aware of the regular check-ups, screening for diseases, and immunization needed during pregnancy to avoid infection during births, and to recognize any red flags in good time to seek timely, life-saving interventions. Families and communities can learn about ways in which they can ensure pregnant women continue to access health services at facilities before childbirth, during delivery and as their children grow.

“We need to educate Somali health workers, as well as Somali women, on what makes a safe and respectful birth for newborns which also do not deny the right of every pregnant woman for safe deliveries across any health facility in this country. We can do it by working together with our partners. Our joint and collective commitment and actions in ensuring safe and respectful childbirth can save many lives — of both mothers and newborns — from preventable causes.” said Dr Mamunur Rahman Malik, the World Health Organization (WHO) Representative to Somalia.

He explained that communities should be aware of the timely and skilled care and emotional support mothers need for their deliveries and to give newborns a great start in life. "Mothers who receive the right antenatal care would be more likely to develop birth and emergency plans and avoid complications," added Dr Malik.

Sahra echoes these words, with a message to her fellow health care workers, adding, “When patients arrive at health facilities, we should give them care immediately and offer them a comfortable environment. It is up to us to give them relief, look at their safety, and adhere to patient safety guidelines when we attend to patients.” 

Change is trickling in, but more needs to be done

On a brighter note, change is trickling in. The Ministry of Health and Human Services and health partners, including WHO and other UN agencies like the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA), are using various strategies to reduce maternal mortality, such as introducing new interventions like the kangaroo care, providing hospitals with personal protective equipment to reduce the spread of COVID-19, and training health care workers in maternal and neonatal care.

Additionally, health care workers based in health facilities are becoming more aware of and skilled at offering safe quality care and appropriate treatment when required. They are becoming more respectful and paying attention to patients’ needs, thus increasing the trust of families, including men, in the use of health services and facilities. However, more can be done.

Keeping mothers and children safe from COVID-19   

In Hargeisa, Somaliland, Ismahan Abdullahi manages the Hawadlleh Mother and Child Health clinic. On average, she attends to around 100 patients a week, offering antenatal care, postnatal care and childbirth. She also offers advice on family planning to women.

When COVID-19 was confirmed, Ismahan and her colleagues noticed a reduction in the number of visits pregnant women were making to health facilities, most likely out of a fear of being infected with the disease. In response, Ismahan and her team have been working hard to maintain a safe environment at the clinic, as they know how important it is to keep mothers and children safe while they seek medical attention. Ismahan wears masks, washes her hands regularly, uses sanitizers, maintains physical distance when she can, and encourages patients and her team to do the same. 

“Even though we are trying, we need support in getting personal protective equipment for health care workers,” says Ismahan. She explains that health facilities like the one she runs need support in many areas: in training of midwives, nurses, laboratory personnel and pharmacists; and in the provision of supplies such as laboratory solutions, family planning commodities, health kits for deliveries. Training in infection prevention and control would also save many lives, Ismahan adds.

Back in Mogadishu, Sahra raises the same point – that midwives and health professionals need intense training in different areas, and Somali women need support from their communities to raise healthy families.

Giving newborns a good start in life

To give newborns a safe start in life, WHO recommends that midwives and nurses should support with immediate and thorough drying of babies after childbirth; delayed clamping of the umbilical cord and bathing; proper handling of non-breathing babies; and must encourage early initiation of breastfeeding.

“Good care during pregnancy is essential for the health of both the mother and developing unborn baby. Pregnancy is a crucial time to promote health behaviours, to ensure that the baby is getting all the nutrients needed for proper growth and development,” said Dr Al-umra Umar, Head of WHO Somalia’s Reproductive, Maternal, Newborn and Child Health Programme.

This year, on the World Patient Safety Day, WHO, UNICEF and UNFPA are committing to support the Federal Ministry of Health and Human Services to introduce new interventions and measures across the health facilities in Somalia to ensure safer maternal and newborn care every year.

15 September 2021 – Somalia is one of the few countries in WHO Eastern Mediterranean Region without a functioning surveillance system for seasonal influenza. The electronic-based Early Warning Alert and Response Network (EWARN) surveillance system used in Somalia enables health workers, as well as state and national surveillance teams, to conduct real-time surveillance and promptly respond to epidemic-prone diseases. However, the system provided limited information required for epidemiological surveillance and the country lacked the capacity to conduct virological surveillance for seasonal influenza and other common respiratory viruses.  

In April 2019, the WHO RegionalOffice for the Eastern Mediterranean conducted a technical mission to Somalia and assessed the suitability of 3 sentinel sites for conducting surveillance for severe acute respiratory infection (SARI). The mission also visited a number of primary health care centres to assess the feasibility of conducting surveillance for influenza-like illness (ILI). Some of the major gaps identified included the limited capacity of health workers to conduct influenza surveillance and the lack of capacity of the laboratories to conduct molecular tests for influenza viruses.

During the COVID-19 pandemic, WHO helped the Government of Somalia establish 3 molecular laboratories with biosafety level 2, which are capable of testing COVID-19 using
rt-PCR assay. Currently, under the European Union-funded project titled “Emergency operational response to COVID 19 in Somalia to support the prevention of large-scale community spread through public health systems strengthening”, building on WHO’s investment in enhancing country’s capacity for detection of COVID-19, WHO is now supporting the Federal Government of Somalia and Federal Member States and expand the existing system of epidemiological and virological surveillance for COVID-19 to include sentinel-based surveillance system for severe acute respiratory infection and influenza-like-illness. In order to build the system for surveillance of seasonal influenza, leveraging on current system for COVID-19, WHO organized a series of trainings, whereby 60 frontline health workers (20 females and 40 males) from the 3 selected sentinel sites were trained on conducting epidemiological surveillance for seasonal influenza and reporting; four virologists from the public health laboratories of Somaliland and the National Public Health Reference Laboratory in Mogadishu were trained on the detection and diagnosis of seasonal influenza using molecular test. In addition, 5 data managers were trained to collect and report ILI/SARI epidemiological information. WHO also equipped the 3 public health laboratories across the country in Mogadishu, Hargeisa and Garowe with necessary equipment and provided laboratory supplies for molecular detection of seasonal influenza.

“Working alongside the Federal Government of Somalia, we have taken bold steps to ensure Somalia makes progress for the detection and diagnosis of seasonal influenza and contributes to the WHO’s network of Global Influenza Surveillance and Response System (GISRS) whose main function is to monitor the circulation of novel influenza viruses as well as seasonal and  zoonotic influenza viruses with epidemic and pandemic potentials,” said Dr Mamunur Rahman Malik, WHO Representative to Somalia and Head of Mission. “The support of the European Union (EU) Delegation to Somalia in establishing this surveillance system for seasonal influenza as part of our ongoing COVID-19 response will build back better and prepare the country’s readiness to face future pandemic from influenza and other respiratory viruses.”

In the coming months, and with support from the EU, the WHO country office for Somalia plans to continue to support the Government to establish this sentinel-based surveillance system for seasonal influenza during the coming months of winter. WHO will also continue to support in the areas of epidemiological and virological surveillance for influenza and other epidemic- and pandemic-prone respiratory viruses and ensure the sharing of viral isolates with WHO collaborating centres across the world for vaccine strain selection.

The WHO country office for Somalia will continue to work with the Gvernment of Somalia to strengthen the health system in the country and provide essential health and nutrition services to the most vulnerable populations across the country with funding support from the EU Delegation to Somalia.

Note to editors

This important multi-year partnership stems from a Bilateral Technical Coordination Mechanism previously established between WHO Somalia and the EU Delegation to Somalia, which sought to strengthen joint operational response capacities for COVID-19 and other health emergencies. In addition to providing in-kind flight support to transport vital medical equipment, supplies and COVID-19 samples for testing during the flight lockdowns, the EU also provided WHO with US $5.8 million to support COVID-19 response and health systems strengthening initiatives, while an additional US$ 1.9 million was provided by the European Civil Protection and Humanitarian Aid Operations (ECHO) to WHO in January 2020, in support of WHO’s COVID-19 emergency preparedness and response operations in Somalia. 

Related links

EU and WHO Somalia sign multi-year agreement to combat COVID-19 and strengthen health systems

WHO and EU unite to fight COVID-19 in Somalia

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European Union and WHO Somalia deliver more emergency hospital supplies

EU and WHO deliver emergency life-saving supplies to flood-affected areas in Somalia

Responding to Cyclone Gati in Puntland: immediate assistance needed for prevention of waterborne diseases

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A health care worker briefs an elderly gentleman after he receives his COVID-19 vaccines, Banadir Hospital, March 2021. Photo: WHO

15 September 2021 – Since the day the news of availability of safe and effective COVID-19 vaccines emerged, the Federal Government of Somalia has worked hand in hand with the World Health Organization (WHO) and other key partners to secure vaccines for Somalis.  

One year after the first case of COVID-19 was confirmed in Somalia on 15 March 2021, the first consignment of 300 000 AstraZeneca vaccines for COVID-19, received through the COVAX Facility, arrived in Mogadishu. In the following months, frontline workers, including health care workers; the elderly people; and people with chronic health conditions were targeted for vaccination as the first priority groups to receive COVID-19 vaccines. 

An insight from a nurse trained to offer vaccinations 

As a nurse and being a frontline health worker, 26-year-old Ikram Ahmed Mohamed was among the first to be fully vaccinated against COVID-19. 

“I work 6 days a week at the Banadir Hospital – and feel like this is the busiest COVID-19 vaccination site in the country,” says Ikram. “In the beginning, most of the people were elderly, but nowadays, more young people aged between 20 and 40 years are coming to get vaccinated. For some reason though, we have been seeing more men than women taking the vaccines.” 

Health care workers like Ikram are trying their very best to dispel rumours and fears. He explains, “Sometimes I do meet people who do not want to get vaccinated. But it is my job to convince them to trust the vaccine. I explain to them the benefits of vaccination and tell them I took it too.”

“Initially, I was a nurse, but before the first COVID-19 vaccines came to Somalia, the Government and WHO trained health professionals like me to administer COVID-19 vaccines safely,” adds Ikram. “Today, I am happy and proud to be a vaccinator, as I feel I am working to combat deadly diseases like COVID-19. I really feel like I am contributing to my community.”

Intensifying the race against time to keep people safe

Every day trained health care workers, enter key personal and demographic data on every COVID-19 vaccinees into an online database. This helps the Government to track the vaccine recipient for the second dose and monitor any adverse events following vaccination. Photo: WHO

Along with many other countries around the world, Somalia too is in a race against time to boost the uptake of COVID-19 vaccines and keep communities safe. As the pattern of COVID-19 cases continued to surge and plummet, on 8 August 2021, another shipment of 108 000 doses of AstraZeneca vaccines, donated by the Government of France through the COVAX Facility, landed in Somalia. A week later, the United States of America donated a consignment of 302 400 doses of Johnson & Johnson single-shot vaccines, also supplied through the COVAX Facility.   

To protect more Somalis, and boost vaccine uptake, the Ministry of Health and Human Services, in collaboration with WHO, and the United Nations Children’s Fund (UNICEF) and other partners, have introduced various strategies. For instance, they deployed special outreach teams of vaccinators to visit different areas in Banadir during the last round of campaign. The same strategy was used in Somaliland. In addition to searching for people with COVID-19 to offer them the right support, community health workers have been trained to explain the benefits of vaccination and COVID-19 preventive measures.  

So far, Somalia has 18 019 confirmed cases of COVID-19 and 982 deaths. As of 12 September 2021, of the 408 000 doses of AstraZeneca, 200 000 doses of Sinopharm and 302 400 doses of Johnson & Johnson doses received by Somalia either through COVAX directly or through donation via the COVAX, 342 063 doses (83%) have been administered, with 116 267 Somalis having been fully vaccinated (0.77%). 

Together, the Ministry of Health and Human Services, State ministries, WHO, UNICEF and other partners are regularly meeting to monitor vaccine uptake, manage the distribution of and monitor life-saving supplies, and strengthen strategies to interrupt transmission of the disease. 

Acknowledging the crucial role of donors 

The response to the COVID-19 outbreak in Somalia has been made possible with the generous support of donors and partners, particularly the European Union (EU) Delegation to Somalia which has provided funding to cover the operational costs for the rollout of COVID-19 vaccinations all across the country.  This support has enabled the country to roll out the vaccination against COVID-19 effectively to end the pandemic and help in recovery of the health systems towards building a fairer and healthier world.