Somalia | Priority areas | Communicable diseases

Somalia

WHO in Somalia

Communicable diseases

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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.