Health workers prepared to visit a camp for internally displaced persons in Kismayo, Somalia. Credit: WHO/Ismail Taxte

Mogadishu, 12 December 2022 – Since 2014, 12 December has been commemorated as Universal Health Coverage Day, marking the day in 2012 when the United Nations unanimously endorsed a resolution urging all countries to accelerate progress toward universal health coverage (UHC). The theme for 2022 is “Build the World We Want: A Healthy Future for All.”

UHC means that all people everywhere can access the quality health services they need, without suffering financial hardship. It is rooted in 3 principles: equity of access, quality of services and financial protection. With the impact of COVID-19 which is estimated to have rolled-back 2 decades of global progress towards UHC and with humanitarian crises increasing around the world, advancing access to health for all remains crucial.

In Somalia, decades of conflict, recurrent climatic shocks and the COVID-19 pandemic have weakened the already-fragile health system and further exacerbated widespread poverty, underdevelopment and social and gender inequality. Currently, the country sits at the bottom of the UHC index, indicating that it has the lowest level of UHC in the world.

Building the world we want

To rectify the dire situation, the Somali Federal Government has started to implement a transformative agenda through its Essential Package of Health Services 2020 (EPHS), aimed at rebuilding its health system towards achieving UHC using primary health care services as the main entry point. In this regard, WHO has been supporting the strengthening of access to medical oxygen, by having procured pressure swing adsorption oxygen plants and installing solar-powered oxygen concentrators at hospitals across the country; improving surveillance activities, including through the deployment of community health workers and rapid response teams, as well as by enhancing the capacities of laboratories to test for epidemic-prone diseases; the procurement and distribution of essential medicines and supplies and developing infrastructure to ensure that health services are available to those who need them most.

The roll out of large vaccination campaigns across the country, integrated with other basic services, provide the opportunity to reach “zero dose children” and their underserved communities, with expansion of coverage of essential services – one step forward to deliver the EPHS.

Working in partnership with the government, United Nations sister agencies, donors and other stakeholders to deliver essential services in the short-term and build the capacity of the Somali health service in the longer term, the goal of ensuring that every family is able to access quality health care without falling into poverty is possible. 

Leaving no one behind

Despite the above gains, Somalia is now in the grip of one of the worst droughts the country has seen in decades, putting further strain on the fragile health system. It is currently affecting 7.8 million people, 1.1 million of whom have been displaced from their homes, on top of the 2.5 million people already displaced.

The need for quality, accessible health services does not stop in emergency contexts – in fact, it increases. Not only are children missing out on essential lifesaving vaccinations, but a lack of access to health services can allow epidemic-prone diseases to rapidly circulate, with long-lasting consequences for individuals, communities and for the health of Somalia as a whole.

To overcome this challenge, WHO is working with Federal and State Ministries of Health as well as frontline health workers in an effort to ensure that no one is left behind and that progress made towards UHC is not lost. To achieve this, WHO has deployed community health workers and rapid response teams for community-based surveillance of epidemic-prone diseases, the provision of basic services, referring patients to health facilities, and risk communication and community engagement.

 “A child born today in Somalia is about 16.5 times more likely to die before the age of 5, than a child born elsewhere,” said Dr Sk Md Mamunur Rahman Malik, WHO Representative and Head of Mission to Somalia. “Evidence shows that it is the most vulnerable and marginalized families who have the least access to health care. Universal health coverage is key to correcting this injustice. Moreover, fragile contexts like Somalia face multiple challenges in achieving UHC but the progress made in recent years show that it is possible. By strengthening the health system to withstand shocks and identify and respond to emerging health risks, as well as supporting the delivery of basic services including to the most vulnerable, we can build a healthy future for all.”

For additional information, please contact:

Kyle DeFreitas
External Relations Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Fouzia Bano
Communications Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Related links

WHO EMRO | Universal health coverage | Priority areas | Somalia site

Essential Package of Health Services (EPHS) Somalia, 2020 - Somalia | ReliefWeb

A health worker inoculating a child in a nomadic settlement during the integrated immunization campaign in Hobyo district of Galmudug state. Credit: WHO/Fouzia Bano  Mogadishu, 7 December 2022 – A complex humanitarian crisis caused by conflict, protracted drought and emanating displacements of populations in Somalia has put more than 3.6 million under-5 years children at risk as their immunity is running dangerously low and vulnerabilities are on the rise with each passing day.

World Health Organization (WHO), in collaboration with the United Nations Children’s Fund (UNICEF), has helped the Federal and State Ministries of Health to immunize all eligible children under 5 in 2022 to protect them from vaccine-preventable diseases like measles and polio. Since January 2022, WHO has helped the ministries of health to conduct one integrated nationwide campaign (November 2022), 2 nationwide polio campaigns (February, October 2022) in addition to conducting one targeted measles and 3 polio campaigns across high-risk districts in vulnerable states.

A recent nationwide integrated campaign, which started from 12 November, lasted for 5 days across the country and managed to immunize 2.61 million children under 5 (0–59 months) with trivalent oral polio vaccine (tOPV). This is the first time Somalia used tOPV in campaign mode after its switch in 2016. The campaign also helped to vaccinate 2.31 million children aged between 6 and 59 months against measles, administered vitamin A and deworming tablets to about 2 million children under 5.

“We are thankful to all the partners and Gavi - the Vaccine Alliance for supporting the first ever national integrated campaign after 2019, which aimed exclusively to vaccinate children against tOPV along with measles and boost their immunity with supplements like vitamin A and deworming tablets across the country and is likely to help cut down mortality and morbidity rates across the country,” commented Dr Muhammad Farid the lead for WHO's immunization programme.

Integrated approach paying dividends

In a resource-starved and fragile health system, WHO's immunization programme in Somalia adopted a one-team multiple-goals approach to roll out an integrated immunization campaign across the country by collaborating with partners. A package of deliverables was finalized with  partners to vaccinate around 2.6 million children under 5 in this first phase of a 5-day campaign, which began on 12 November 2022. This package included administering measles vaccine targeting children aged 6-59 months, tOPV targeting children aged 0-59 months, vitamin A supplements for children aged 6-59 months and deworming tablets (Albendazol) for children aged 12-59 Months.

A health worker prepares for a vaccination session at a camp for internally displaced persons (IDP) in Puntland State during the nationwide integrated immunization campaign. Credit: WHOSomalia/Mukhtar Sudani After several rounds of meetings with all the stakeholders (ministries of health) at the state, region and district level, a total of 4088 teams (each team comprising of 3 skilled persons, 2 recorders, one social mobilizer) were deployed across the country to roll out, record and report the campaign using an online digital platform. WHO also helped partners to establish the points of vaccine-administration by using the existing permanent health facilities in each district and setting up outreach posts at nearby accessible schools, mosques, bus stations, and camps for internally displaced persons (IDPs). Social mobilizers were deployed in advance of the campaigns to mobiles the communities, raise awareness about the vaccine uptake and familiarize the communities with available vaccination points in their proximity.

“Currently, these are one of the most vulnerable times for the children of Somalia and WHO is employing all its available resources and innovative approaches such as integrated campaigns, solarization of health facilities to maintain vaccine cold chain and engaging local communities to save the lives of millions of Somali children who deserve bright and healthier lives,” said Dr Mamunur Rahman Malik, WHO Representative for Somalia. He added that “WHO is thankful to all our partners and especially the donors like the Global Polio Eradication Initiative and Gavi - the Vaccine Alliance to help us roll out vaccine campaigns across the country with the single aim of protecting as many children as possible in some of the most fragile health and living conditions worldwide.”

Immunization status in Somalia

Somalia is currently facing one of the most severe droughts in its history, with a looming famine and possibility of severe loss of life due to hunger, malnutrition and disease. Currently, 7.8 million people are affected and 1.1 million are displaced (on top of 2.5 million which were already displaced) as they are in search of food, water, shelter, health care and any assistance available. As of October 2022, a total of 15 143 cases of measles, 4 cases of cVDPV2 in humans and 4 isolates in environment reported since January 2022. The administrative data coverage, as of August 2022 shows that only 88% of eligible children received one dose of measles while only 11% have received a second dose across the country. Combined these figures indicate low immunity of children against measles and polio and this risk is further aggravated by a complex humanitarian crisis caused by conflict and droughts, and related displacement.

For additional information, please contact:

Kyle DeFreitas, External Relations Officer, هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Fouzia Bano, Communications Officer, هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Related links

https://www.emro.who.int/images/stories/somalia/EPI-Watch-week-44_45.pdf?ua=1

https://www.emro.who.int/somalia/news/balancing-priorities-in-the-midst-of-a-drought-vaccination-campaigns-breaking-measles-transmission-among-children-in-somalia-and-saving-lives.html

An outreach workers reaches out to a family in remote area of State of Galmudug, Somalia. Credit: WHO Somalia/Fouzia Mogadishu, 1 December 2022 – The Government of Germany has donated €1.5 million to the WHO country office in Somalia with the aim of providing life-saving health care to the people of Somalia living in dire humanitarian conditions. Health is one of the priority areas among humanitarian partners during the ongoing historic drought. 

This funding will be used to provide essential health care to children and women living in hard-to-reach drought affected areas. It will; however, benefit the wider population as well with long-term measures such as routine immunization. Germany seeks to support Somalia and WHO not only by providing funds but also by extending technical support by deploying a number of German experts to the WHO country office to help with their operations. For the German Government, health globally, but particularly in Somalia, with the current drought, is one of the key areas of its humanitarian engagement. 

“This is why we are supporting Somalia with an additional €1.5 million through WHO within a wider scale-up of €10 million for WHO globally,” stated German Ambassador Sebastian Groth, adding that “Germany stands by Somalia for helping with its immediate needs as well as long term overall improvement in health.” 

WHO will deploy trained community-based health workers in hard-to-reach areas who will go house to house and render community-based essential health and nutrition interventions. In addition, WHO will support community outreach services for the treatment of sick children, and care for pregnant and lactating women, including vaccination against preventable diseases for children and women of childbearing age. These outreach centres will distribute blanket micronutrient supplements, such as iron tablets, vitamin-A and deworming tablets to improve the immunity of these vulnerable populations to prevent them from diseases that are avoidable.    

In recognition of the continued partnership between WHO and Germany, the WHO Representative to Somalia Dr Mamunur Rahman Malik said that, “We are racing against time to try to prevent major outbreaks of cholera or measles. We have seen, deaths and diseases thrive when hunger and food crisis prolong. This is a timely support to our country office from one of the major donors of WHO globally.  On behalf of WHO, I express our utmost appreciation to the Government of Germany for its timely support for the people of Somalia who are facing the risk of famine in one of the most fragile and broken health system setting.” He added, “We will see more people dying from the disease than from hunger and malnutrition combined if we do not act now. The cost of our inaction will mean that children, women and other vulnerable people will pay with their lives while we hopelessly, helplessly witness the tragedy unfold. As we have seen during our collective emergency response operations for COVID-19, early action and delivery of high quality and evidence-based interventions can lead to protecting health and well-being, even if the health system is fragile.”

Background information

WHO has been able to reach nearly 3.3 million people, about 45% of the people who are in need, with life-saving treatments, essential health and nutrition interventions. These services are being delivered through over 2164 community health workers, 148 mobile outreach team, 64 stabilization centres and 280 primary health care centres in the drought-affected districts. Somalia is currently facing one of the most severe droughts in its history, with a looming famine and possibility of severe loss of life due to hunger, malnutrition, and disease. Currently, 7.8 million people are affected and 1.1 million are displaced (on top of 2.5 million which were already displaced) as they are in search of food, water, shelter, healthcare and any assistance available. Furthermore, the drought is increasing endemic-prone diseases, putting millions at risk. For example: 3.5 million persons lack sufficient access to water; and 6 million continue to face severe food shortages, with approximately 1.4 million children facing acute malnutrition, including 329 500 likely to become severely malnourished. Moreover, as of 31 October 2022, a total of 11 332 suspected cases of cholera, 15 143 cases of measles and 96 063 cases of acute diarrhoeal disease have been confirmed in drought-affected areas since January 2022.

For additional information, please contact:

Judith Gosmann
Attaché, Somalia Unit
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Kyle DeFreitas
External Relations Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Fouzia Bano
Communications Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

 Credit: HIV test kit, WHO Somalia/Fouzia

Mogadishu, 1 December 2022 – The World Health Organization (WHO), in partnership with Federal and State ministries of health, has managed to keep the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) prevalence in Somalia on a steady decline, from above 1% in 2013 to 0.10% in 2022, thus keeping the country since 2014 classified as a low-level HIV epidemic country.

Out of over 3978 recorded HIV patients in Somalia who are on antiretroviral (ARV) treatment, 87.3% were virologically suppressed, that is, the quantity of virus had been brought down below the threshold required to gauge the treatment as being effective. Monitoring of viral suppression in HIV-positive patients on antiretroviral treatment (ART) is important both for optimizing patient health and for reducing risk of HIV transmission. Mortality and morbidity rates in ART patients are critically dependent on viral suppression and viral suppression in ART patients is critical to reducing HIV incidence at the population level. This success rate has been achieved on account of WHO’s close monitoring of the HIV/AIDS situation in the country including ensuring equitable access to patient care, close follow up of patients who are on ART and regular monitoring of clinical conditions of the HIV/AIDS patients.   

On the occasion of World Aids Day 2022, commemorated this year under the theme- “Equalize”, WHO joins its partners to call upon the global leaders and citizens to boldly recognize and address the inequalities which are holding back progress in ending AIDS; and equalize access to essential HIV services particularly for children and key population groups who are at risk of contracting HIV/AIDS.

In its support to HIV/AIDS response activities in Somalia, WHO has worked with national and international stakeholders to provide training to national staff for HIV testing and counselling; treatment, including anti-retroviral therapy (ART); conducting periodic sentinel surveys to assess trends in the levels of the infection in the population; and in conducting annual HIV epidemic projection modelling exercises. In addition, WHO has supported capacity-building for monitoring HIV/AIDS treatment, including the measurement of the quantity of the HIV virus for patients on ART, as well as for conducting cohort analyses of patient outcomes. Furthermore, WHO has supported regular external quality assurance (EQA) assessments on the accuracy of HIV testing conducted by national staff at various HIV testing facilities across the country, including for voluntary counselling and testing, tuberculosis (TB), antenatal care and child delivery service outlets, as well as those who test blood prior to transfusion.

WHO’s Medical Officer for HIV/AIDS Dr William Rogers Busulwa, while appreciating the reported decline in the prevalence of AIDS in Somalia, said that, “We still have a lot of ground to cover to ensure that communities and especially high-risk segments of society are regularly and consistently engaged for raising awareness about the deadly disease, in addition to infected people are given equitable means of getting treatment without any fear of ostracization.”

HIV prevalence in Somalia

Somalia was classified as being a low-level HIV epidemic in 2014, but for 10 years prior to that antenatal HIV rates had been marginally above 1% in Somaliland, with  this area classified as having had a generalized HIV epidemic. The HIV prevalence among the general population has seen statistically on a significant decline, with the most recent 2018 sentinel survey showing that antenatal HIV prevalence dropping to 0.15% in Somaliland, 0.17% in Puntland and 0.04% in South Central Somalia. The mean antenatal HIV prevalence for all 3 areas was 0.10% – positive signs that the disease continues to be on the decline.

For TB patients, HIV rates have also been on the decline, even as the coverage of HIV testing among them has increased to include more peripheral TB facilities. This prevalence declined from 5% in 2011, when systematic testing was launched, to 3.33% in 2014 and finally to 0.60% during January to June 2021.

Despite challenges of accessibility, ongoing drought, and security, WHO data reveal that by June 2022, out of recorded 3978 patients receiving ART, 82.7% of whom were already on the newer and more effective dolutegravir (DTG) based regimens. ART coverage of the estimated people living with HIV went up from 34.7% in 2018 to 44.7% in 2021. The data further reveal that during 2021, 49.6% of all patients enrolled on ART for at least 6 months received an HIV viral load test and 87.3% of these were virologically suppressed, that is, the quantity of virus had been brought down below the threshold required to gauge the treatment as being effective. This virological suppression increased from 69.1%.in 2018 when the service was first introduced, and from 80.7% in 2020.

For additional information, please contact:

Kyle DeFreitas
External Relations Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Fouzia Bano
Communications Officer
هذا البريد محمى من المتطفلين. تحتاج إلى تشغيل الجافا سكريبت لمشاهدته.

Related links

https://www.emro.who.int/somalia/news/world-aids-day-reaching-more-people-with-hiv-services-and-reducing-inequalities.html

World AIDS Day 2022 (who.int)