Health for all is Somalia’s answer to COVID-19 and future threats to health

12 January 2021 - 

Somalia’s experience in addressing COVID-19 illustrates how investing in universal health coverage sets a strong foundation for heath emergency preparedness and response. The Government is working to ensure that people can access quality health care without experiencing financial hardship. Learn how Somalia is working to protect its population from COVID-19 and future health threats.  

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7 January 2021 – After Cyclone Gati struck Puntland State of Somalia on 22 November 2020, heavy rains and floods washed away homes, livestock, crops, and fishing boats. In its wake, the cyclone destroyed health facilities and safe sanitation systems in the area, leaving thousands of vulnerable people exposed without any shelter and livelihoods, as it hit districts in the midst of the coronavirus disease (COVID-19) pandemic, further affecting communities’ economic recovery.

Twenty-nine-year-old Aamino Ahmed and her family were among the people who were forced to flee to internally displaced people (IDP) camps following the cyclone. Along with her husband and nine children, Aamino moved to the Isnino IDP camp in Bossaso, where they are currently struggling to have a means to earn a living and access to basic needs like food, water, sanitation and health care, which have been totally destroyed.

Understanding urgent needs of afflicted populations

By the end of December, the storm had killed 9 people and over 63 000 livestock (sheep and goats), and affected around 183 000 people.

Overall, the districts affected most by the cyclone include Alula, Benderbayla, Bosasso, Iskushuban and Qandala in Puntland, as well as Erigavo and Laasqoray in Somaliland. In these locations, afflicted communities, including families like those of Aamino Ahmed’s, and local authorities have appealed for support and increased interventions to support livelihoods, particularly targeting affected nomadic pastoralists, fishermen and traders. They have also requested for support in the repair of damaged infrastructure and basic social amenities such as schools, health facilities and water points.

In efforts to understand the humanitarian impact of Cyclone Gati and determine the most urgent needs of the population, the Humanitarian Affairs and Disaster Management Agency (HADMA) and UN Office for the Coordination of Humanitarian Affairs (OCHA) collaborated with the World Health Organization (WHO) and other humanitarian agencies to conduct a rapid inter-agency assessment in the affected areas, from 24-30 November 2020. The WHO team comprised health experts knowledgeable with the localities, and included regional polio officers, district polio officers and public health emergency officers.

The assessment also determined the available resources and capacities within districts affected, and will guide an effective response to the storm. The most immediate humanitarian needs of affected populations include food, water, sanitation and hygiene (WASH), emergency shelter and the prevention of waterborne, vector-borne and communicable diseases. These include cholera, malaria, dysentery, diarrhoea, and skin diseases due to families being inundated with contaminated water. Stagnant water in some areas also threatens to serve as ideal breeding grounds for mosquitoes. The situation is already resulting in an increase in malnutrition due to lost livelihoods and assets, and a potential increase in COVID-19 and other airborne diseases due to crowded living conditions.

Support provided so far

Since the cyclone struck, humanitarian partners and Somali authorities reached over 78 000 affected people with relief assistance as of 13 December. This support ranged from food, emergency shelter, nutrition, health, protection, Camp Coordination and Camp Management (CCCM) services and WASH interventions.

Partners and organizations in the food security, livelihood and health and nutrition clusters have reached an estimated 72 000 affected people among those targeted. Shelter and WASH cluster partners have reached 25 000 and 38 000 people respectively, while the CCCM cluster is assisting about 26 000 people affected by the cyclone floods in Bossaso, one of the worst-hit cities.

As part of the response to the storm, on 10 December 2020, the Delegation of the European Union (EU) to Somalia commissioned a special flight at the request of the WHO in Somalia to airlift 3.1 tonnes of life-saving medicine and other emergency hospital supplies to Garowe. This joint operation remains part of the bilateral technical coordination mechanism established between WHO and the EU in Somalia, which aims to strengthen operational response activities, including for COVID-19.

The supplies, which were handed over to the Ministry of Health on 14 December 2020 for further distribution to communities in need, include 10 inter-agency emergency health kits containing various medicines for providing primary health care services, 11 cholera treatment modules, 2 outbreak investigation kits, 100 malaria testing kits. These materials should cover the medical needs of 2200 people over a period of three months and will be adequate in the management of waterborne and vector-borne diseases among 10 000 people for 3 months.

Humanitarian response plans to avert further suffering

Further to the damage already caused, there are additional potential risks of more rainfall and flooding; contamination of water; and severe malnutrition. With the affected people having no access to basic health care needs, and limited sanitation, this could result in an increase in diseases such as vaccine-preventable diseases like measles, and waterborne diseases, and diarrhoea.

Some of Aamino’s family members, for instance, have already been suffering from diarrhoea as a result of consuming unsafe water after the cyclone destroyed water systems. In efforts to support families like Aamino’s, and to stop the spread of waterborne and vector-borne diseases, WHO will provide medical supplies for the management of diseases spread by contaminated water; establish a water quality surveillance system in cyclone-affected districts; and support sample collection and analysis for alerts of epidemic-prone diseases reported in affected districts. WHO will also support the deployment of 2 integrated emergency response teams (IERTs) for 4 weeks for the cyclone response. As additional support, the organization plans to deploy 9 district-based rapid response teams (RRTs) and 300 community health workers (CHWs) that were deployed to support COVID-19 activities in the cyclone-affected districts.

WHO will also provide airtime to health facilities in cyclone affected districts to submit timely reports for epidemic-prone diseases reported in the affected districts through the early warning and response network (EWARN) to strengthen surveillance, timely detection and response to alerts. The organization will further reinforce the coordination, supervision and surveillance activities through the existing health system, in cooperation with the health, WASH and nutrition cluster partners. Additionally, WHO will conduct fogging in 9000 households in Somaliland and Puntland to prevent the spread of malaria and other vector-borne diseases.

As long-term measures to provide sustainable solutions to emergencies, WHO will support the building of resilient health systems that can cope with the multiple hazards and be able to protect vulnerable communities from health emergencies. This will be done through capacity building of existing health workforce, strengthening coordination and leadership with affected communities and their leaders, and other clusters.

In response to the cyclone, humanitarian partners are collaborating with the Government to reach 101 000 people (about 84% of those affected by the cyclone) and are finalizing a response plan that outlines additional financial support they need to avert any additional suffering in the cyclone-affected areas. Overall, WHO requires US$ 1.23 m to continue to implement a timely intervention to prevent deaths and help Somalia overcome the negative consequences of the cyclone.

Mogadishu, 5 January 2021 – On 17 December 2020, the World Health Organization (WHO) country office in Somalia and the Public Health Agency of Sweden signed a non-financial memorandum of understanding (MOU) to formalize a partnership that aims to support the establishment of a National Institute of Health for Somalia.

Years of conflict and recurring natural disasters have weakened the health system in Somalia and limited its capacity. In addition, Somalia lacks a centralized mechanism to gather evidence-based public health information to guide public health decision-making. It is to this end that the Public Health Agency of Sweden, with financial support from the Swedish International Development Cooperation Agency, launched a 4-year project (2019–2023) “Capacity development of the National Institute of Health, Somalia”, in partnership with the Federal Ministry of Health and Human Services.

The overall goal of the project is to support the establishment of an independent National Institute of Health, and to strengthen its organizational and institutional capacity in areas such as health workforce development for public health, field epidemiology training, emergency response, disease surveillance prevention and health promotion activities. A multi-year strategic capacity development programme will be developed in support of establishment of the Institute through a consultative process between WHO, the Public Health Agency of Sweden and the Ministry of Health and Human Services of the Federal Government of Somalia. As the United Nations’s lead technical agency for health, WHO will support this important project with technical support, capacity-building and the facilitation of relevant partnerships, with the collective goal of establishing an effective and efficient National Institute of Health¹ capable of building Somalia’s capacity to deal with public health issues and health threats, including developing a national strategy for integrated disease surveillance and response.

“WHO remains firmly committed to support the establishment of a National Institute of Health as the main technical arm of the Ministry for improving public health capacity of its health workforce. The National Institute of Health would become a national centre of expertise advising the Government on planning and  operationalizing appropriate and effective national responses to public health threats, and at the same time, play its role as the main technical body for improving surveillance, laboratory detection and epidemic risk management in the country,” said Dr Mamunur Rahman Malik, the WHO Representative to Somalia. 

Dr Anders Tegnell, the State Epidemiologist of Sweden and Deputy Director General of the Public Health Agency of Sweden, visited Mogadishu in March 2020 and met among others, the Honorable Minister Dr Fawziya and WHO Representative Dr Malik to consolidate this collaborative project. “The signing of this MoU with WHO Somalia is an important milestone in our joint efforts to strengthen the health system and to deal with emerging health threats. The right to health is a universal right, and collaboration with countries like Somalia will strengthen our capacity to improve health also in Sweden,” Dr Tegnell said.

This MOU between WHO and the Public Health Agency of Sweden is part of a new, innovative partnership between WHO, Sweden and Somalia’s Ministry for Health which aims to diminish persistent health problems by creating an independent National Institute of Health, as well as by modernizing the country’s health information management system.

¹ Note to editors: WHO has been working in Somalia for over 30 years, promoting and protecting the health of the people of Somalia by addressing important public health issues. WHO works in close cooperation with health authorities to build a strong health system and achieve universal health coverage.

20 December 2020 – On 12 December 2020, in line with global celebrations of Universal Health Coverage (UHC) Day, the World Health Organization (WHO) in Somalia joined the Federal Government of Somalia, the United Nations Children’s Fund (UNICEF) and United Nations Population Fund (UNFPA), to raise awareness about the importance of achieving UHC in fragile and vulnerable states, with the aim of ensuring health for all across the country for everyone, everywhere.

At an event hosted in Mogadishu by the Federal Ministry of Health and Human Services of Somalia, with support from WHO, key representatives from the Federal Government, Federal Member States, Members of Parliament, other government agencies, international and donor community, civil society and representatives of United Nations agencies participated. The aim of the event was to raise awareness of the need to build strong and resilient health systems in Somalia and to mark the anniversary of the United Nations historic and unanimous endorsement of UHC in 2012 calling the countries to provide affordable, quality health care to every person, everywhere (A/RES/74/2).

Befitting the theme of 2020‘s UHC Day- “Health for All: Protect Everyone” the event preceded with a discussion on the UHC road map for Somalia, progress achieved to date and how the government, United Nations agencies and civil society could work together to improve health service delivery, ensure access to care, as well as build stronger health systems as the country recovers from the pandemic of coronavirus disease (COVID-19).

During the event, Dr Fawziya Abikar Nur, the Federal Minister of Health and Human Services of Somalia, said that UHC would strengthen health systems, particularly after having witnessed the impact that health emergencies, such as the COVID-19, had had on the social and economic development of a country.

Dr Fawziya Abikar Nur, the Federal Minister of Health and Human Services of Somalia

On behalf of United Nations agencies in Somalia, the acting United Nations Resident Coordinator and the Resident Representative of UNDP Mr Jocelyn Mason spoke on the occasion.

WHO Representative for Somalia Dr Mamunur Rahman Malik emphasized that UHC Day was a reminder to all that health remains a right for everyone and that health care should be affordable and accessible for every citizen in every country. Dr Malik reminded all that increased public financing, monitoring out-of-pocket catastrophic expenditure and government ownership were all critical for achieving UHC.

WHO Representative for Somalia Dr Mamunur Rahman Malik

The WHO Representative also emphasized that health services in fragile states like Somalia should be designed and organized in a way that made health care accessible to vulnerable populations, especially internally displaced persons (IDPs), refugees, migrants and people living with disabilities who were often marginalized and excluded from social safety nets.

How the concept of UHC came about

Inspired by and as a follow up to an initial United Nations resolution passed in 2015 on making progress towards the 2030 Agenda for Sustainable Development (A/RES/70/1), the United Nations General Assembly convened a high-level meeting on UHC on 23 September 2019. Held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” this meeting aimed to accelerate progress toward UHC, particularly with regard to financial risk protection and access to affordable, quality essential health-care services, in efforts to leave no one behind in the field of health.

Taking the opportunity to build back better

In 2020, in response to the swiftly-spreading COVID-19 pandemic in Somalia, the Federal Government of Somalia and partners launched an urgent and robust response to ensure the country was able to test, track and monitor and care for cases of COVID-19.

Taking into account lessons learned and best practices used to curb the spread of the COVID-19, the Government and partners agreed to use the response to the pandemic as an opportunity to build back better, and recover better and stronger. Since primary health care is the backbone of UHC, interventions to strengthen access to health at community and household levels will be prioritized.

Renewing commitment to UHC

Speaking on behalf of United Nations agencies, particularly UNICEF, UNFPA and WHO, the Resident Representative of UNDP and the acting United Nations Resident Coordinator Mr Jocelyn Mason reiterated that the UN system would redouble its efforts to support the Government of Somalia’s vision and desire to achieve UHC in the country.

He also announced a 3-point plan that UNICEF, UNFPA and WHO in Somalia are partnering and committing to in 2021 to take meaningful strides towards UHC. The 3 agencies, as the principal signatories of Global Action Plan for Healthy Lives and Well-being, have pledged to work together to improve health in 3 critical areas which will be pivotal in reducing deaths from preventable causes, especially among children and women in the country:

First, the 3 agencies plan to scale up the availability of oxygen at the primary health care level, leveraging on the COVID-19 response.

This intervention will save the lives of at least 20-30% of an estimated 15 000 children aged under 5 who lose their lives to pneumonia every year. The intervention will also contribute to the WHO/UNICEF’s Integrated Global Action Plan for Prevention of Diarrhoea and Pneumonia by 2025. Scaling up the availability of oxygen will also improve emergency obstetric care across the country.

Second, in honour of health personnel in Somalia, and given that 2021 has been designated as the “International Year of Health and Care Workers”, UNICEF, UNFPA and WHO will invest in the readiness, education and learning of the health workforce, particularly health workers and midwives at the community level.

These investments have the potential to change the health situation, public and private health systems, and human rights in Somalia forever. Midwifery, in particular, provides a strong opportunity to impact the health and well-being of women and children.

Third, the 3 agencies will strive to ensure every child is immunized against common and preventable childhood diseases, as immunization is a basic pillar of child survival and a strategy to end disease outbreaks.

While Somalia has made some progress in immunization coverage over the past 5 years, vulnerable children living in urban, remote rural and nomadic communities are missed regularly. Furthermore, the 2020 Health and Demographic Survey report for Somalia indicates that only 11% of children aged 12–23 months had received all basic vaccinations. By intensifying cold chain expansion, community engagement and outreach services, as part of the newly updated essential package of health services meant for all, this situation can be turned around. These efforts would also contribute to a successful reproductive health programme aimed at reducing high maternal deaths in the country.

A pledge of health for all and protection for all sounds like a colossal undertaking, and is by no means a small feat. However, with partnerships and action, it can be achieved. As Somalia begins its new journey to rebuild its health systems in the aftermath of the pandemic, on behalf of the UN, Dr Malik urged all health and development partners, civil society and other actors to collaborate, forge strong partnerships, and align their work towards attaining the dream of UHC in Somalia, even in the most fragile and vulnerable settings.