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26 years of building a solid foundation for polio eradication
Polio champion Maryan Jama Du’ale retires after 2.5 decades
Maryam Jama Du’ale at her retirement farewell ceremony hosted by WHO Somalia in Hargeisa, Somaliland. Photo credit: WHO/WHO Somalia31 July 2024 – In April 1998, certified nurse and public health officer Maryan Jama Du’ale was invited to a workshop to get familiar with a new initiative: the National Polio Eradication Programme. She made an impression at the event, which was hosted by WHO and the health ministry of the self-declared administration of Somaliland. Within a few weeks, Maryan joined the programme as a district polio officer in Hargeisa, Somaliland.
Her role included setting up surveillance sites to search for poliovirus in children aged under 15 years. She was also tasked with supporting the implementation of polio vaccination campaigns in Somaliland and supervising her teams to quickly address any setbacks.
When Maryan began her work, Somalia was engulfed in a civil war, its health infrastructure was in ruins and vaccine-preventable diseases, such as polio, were rampant. Back then, many people in the country did not know that polio existed – even though Somalia confirmed 12 wild poliovirus (WPV) cases in 1998.
Like many other communities around the world, many people in Somalia were afraid of vaccination. Limited awareness of polio-related activities also meant that some were initially sceptical about the need to collect stool samples from children presenting with acute flaccid paralysis (AFP), a common symptom of poliomyelitis.
“Community members thought vaccination would stop childbirth or that it was against our religion,” explains Maryan. “It took us a lot of time and effort to help people to understand that polio vaccines are safe and rigorously tested before use. Vaccine acceptance is much better now, although we face other challenges, such as complexities in reaching children in insecure areas. However, most people now understand that we collect stool samples from children with AFP to test for poliovirus.”
Inspired by a child to eradicate polio
Group photo taken with retiree Maryan Jama Du’ale at her farewell ceremony. Photo credit: WHO/WHO SomaliaEarly on in her work, Maryan met a child who had been paralysed by WPV in the village of Qool-buulale, on the Somalia–Ethiopia border. It was a meeting that shaped the rest of her career.
“That first encounter with a child paralysed by polio moved me. It made me understand the importance and impact of our work. I saw first-hand how our work could prevent further spread of polioviruses and protect children from lifelong paralysis,” she says.
The available health facilities, which were inadequate and far apart, could not address emerging cases and the need to provide vaccines.
“When we heard about polio cases, we often had to use donkey carts or camels to transport vaccines to reach remote villages or mountains. When a case was reported near the border, we would cross all kinds of terrain to reach children,” adds Maryan.
Over her career, Maryan and her teams helped ensure children received polio vaccinations and other health services. They did this with the help of dedicated medical doctors and trained health volunteers, and through social mobilization and outreach campaigns, among other strategies, backed by partners.
Owing to these immense efforts, the National Polio Eradication Programme made significant progress. Four years after the immunization programme was established, Somalia interrupted transmission of WPV, in 1998. Later, Somalia confirmed and closed a couple of imported WPV1 outbreaks, from 2005 to 2007 and from 2013 to 2014.
WHO Somalia Communication Officer Khadar Hared is pictured with Maryan Jama Du’ale after interviewing the polio champion about her experiences in Hargeisa. Photo credit: WHO/WHO SomaliaThe last time Maryan saw a child with WPV in Somaliland was in 2017 in Burco, Togdheer. In October 2017, however, Somalia confirmed an outbreak of variant poliovirus, which occurs in places where children have low immunity. Although Somalia has closed WPV and variant polio outbreaks before, the variant poliovirus that was detected in 2017 is still smouldering in the country. Maryan firmly believes Somalia will end this outbreak soon too.
“Witnessing that our collective efforts, alongside the government and partners, had contributed to stopping poliovirus spread, time and again, continuously filled me with immense pride and happiness,” adds Maryan.
Passing on the baton after 26 years of service
Gradually, by earning communities’ trust and working to expand the programme over the years, Maryan rose through the ranks to become a state polio eradication officer. In this role, she managed eradication efforts across Somaliland. She retired in January 2024, after 26 years of exemplary service.
Maryan’s story reveals the power of resilience and the unwavering commitment of the health workforce to end polio in Somalia, even amid great adversity.
USAID supports set up of subnational Health Cluster structure in Somalia, boosting localization
Dr Uday Raj Naidu Canchi Bhoopal (pictured in the middle), a WHO subnational Health Cluster coordinator, joins the Health Cluster strategic advisory group in a humanitarian fund allocation review exercise for partners in Jubaland. Photo credit: WHO/WHO Somalia3 July 2024, Mogadishu, Somalia – Ms Fatima Abdirazak Ahmed joined WHO in Somalia at the beginning of 2024 as a subnational Health Cluster coordinator in Hirshabelle state. Having just finished a meeting with 15 Health Cluster partners, she heads to the office of Hirshabelle State Ministry of Health. Here, she will brief and discuss with the Director-General the ongoing efforts of the Health Cluster to reach vulnerable and underserved communities with health services during the measles and cholera outbreaks across the state. Health Cluster partners thus play a crucial role in the collection and reporting of disease surveillance data.
Dr Uday Raj Naidu Canchi Bhoopal is a subnational Health Cluster coordinator based in Kismayo, Jubaland. He leads regular Health Cluster meetings to coordinate partners’ actions on humanitarian response, from provision of supplies to service delivery, particularly for measles and cholera outbreak response. He also coordinates critical training for Health Cluster partners. Recently, he facilitated training for 12 health professionals, from various health facilities, on clinical management of severe acute malnutrition with medical complications, and cholera case management. The latter gave health workers the knowledge and practical skills to manage cholera cases appropriately and promote infection prevention and control in cholera treatment units in line with globally recognized practices and protocols.
Along with Fatima and Naidu, 5 more state-level Health Cluster coordinators are deployed across Somalia to ensure subnational coordination among partners and with state ministries of health. These subnational Health Cluster coordinators play a pivotal role in emergency response – for example, understanding demand and coordinating the provision of essential supplies – and in health system strengthening. For instance, they promote the use of the Somalia Essential Package of Health Services (EPHS) as a harmonized standard for health service delivery and outbreak response efforts.
Importantly, the Health Cluster coordinators also work with the other clusters, including the Food Security, Nutrition, WASH (Water, Sanitation and Hygiene) and Protection clusters. This coordination enables integrated responses to people in need of humanitarian assistance.
In Somalia, the Health Cluster comprises 81 partners: 28 international non-governmental organizations (NGOs), 42 national NGOs, 4 United Nations agencies, 3 donors, 3 observers and a single national authority. It is co-led by WHO and Save the Children.
Initially, only the national-level Health Cluster Coordination structure was in place. WHO was able to recruit 7 subnational Health Cluster coordinators (4 international and 3 national staff) thanks to funding support from the United States Agency for International Development (USAID) Bureau for Humanitarian Assistance (BHA). Having a well-functioning subnational Health Cluster structure supports operational coordination much closer to the affected population and better adapted to its specific needs, enabling true localization.
Since the subnational Health Cluster coordinators were deployed, the regular Health Cluster coordination meetings have fostered stronger coordination and collaboration among health actors. The impact of the new coordinators’ efforts was showcased at a recent meeting of the Somalia Health Partner Group (SHPG). At the meeting, Erna van Goor, National Health Cluster Coordinator, based in Mogadishu, presented to the donors and partners illustrative maps produced and monitored by the Health Cluster. These maps show the locations and functionality of health facilities and current availability of health services across the country. This presentation vividly demonstrated the complexities and triumphs of the work of the Health Cluster and its coordinators, which was highly valued by humanitarian and development actors for their essential role in preventing duplication of efforts, monitoring service availability and quality, and addressing the health needs of the most vulnerable populations.
For more information, please contact
Erna van Goor, National Health Cluster Coordinator, WHO Somalia
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Madinur Saydahmat, Partnerships Officer, WHO Somalia
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Prime Minister launches Somalia Immunization and Polio Eradication Task Force, calling for swifter action to end vaccine-preventable disease outbreaks
1 July 2024, Mogadishu, Somalia – In a landmark step to accelerate progress towards accelerating immunization coverage and ending polio in Somalia, the Prime Minister of Somalia, His Excellency Mr Hamza Abdi Barre, launched a national task force on immunization and polio and a related forum on 29 June 2024.
The Somalia Immunization and Polio Eradication Task Force (SIPE), which the Prime Minister himself will chair, will oversee and coordinate polio eradication and immunization efforts across the country. It will mobilize financial and technical resources and ensure that every child in Somalia is reached with life-saving vaccines. SIPE comprises key health officials at federal and state levels and international partners.
Speaking at the launch in Mogadishu, Prime Minister Barre reiterated his government’s commitment to stop the transmission of polio by providing strong support and oversight of polio eradication and routine immunization activities in Somalia.
“The establishment of the national task force on immunization and polio is a testament to my government’s commitment to this cause,” he said. “We commit to mobilize support for the implementation of the Somalia Emergency Action Plan, including working closely with the Federal Member States of Somalia and neighbouring countries to stop cross-border transmission.”
SIPE signifies Somalia’s commitment at a very high political level to stop polio – which has been circulating uninterrupted in the country for 7 years – and immunize children against vaccine-preventable diseases.
South-central Somalia is one of 7 areas identified by the Global Polio Eradication Initiative as consequential geographies. Such areas are prone to repeated polio outbreaks, which are hard to control because of overpopulation, fragile health systems and conflict. The other 6 areas are eastern Afghanistan; southern Khyber Pakhtunkhwa, Pakistan; Tete province and its hinterland in northern Mozambique; eastern Democratic Republic of the Congo; northern Yemen; and northern Nigeria. Outbreaks in these areas may be exported to other countries.
Since 2021, Somalia has confirmed 16 cases of polio, all in the south-central region. An estimated 1.5 million children have never been vaccinated and Somalia is one of 5 countries globally with an under-five mortality rate greater than 100 deaths per 1000 live births. Without intensified efforts, Somalia is unlikely to meet its 2030 Sustainable Development Goal target of no more than 25 deaths per 1000 live births.
The Prime Minister also launched the Child Survival Forum, which will review progress and devise strategies and an action plan to further reduce child mortality.
“I am proud to say that the Government of Somalia, along with our partners, has taken several steps to address these challenges, including initiatives such as Damal Caafimaad and Better Lives, to ensure universal health coverage for all,” said Minister of Health Dr Ali Hajji Aadam Abubakar. “I call upon all to support integrated service delivery, especially for children.”
“Immunization is a cornerstone of our public health strategy and has proven to be one of the most effective ways to protect our children from preventable diseases,” said Dr Abdirashid Mohamed Nur Jiley , Special Envoy of the President of Somalia on Health and Nutrition. “We have numerous challenges in Somalia but our commitment to immunization remains strong. Let us continue with renewed determination, knowing our efforts will yield a legacy for generations to come.”
Speaking virtually, Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, appreciated the honourable Prime Minister and Minister of Health’s commitment to address the pressing health challenges facing children in Somalia. “This high-level forum will be instrumental in addressing the protection of more than 1.5 million zero-dose children, who have never received a dose of life-saving vaccines, and help in bringing the longest-running outbreak of variant poliovirus to an end,” she said.
With 77 000 children in Somalia dying every year before their fifth birthday, and Somalia in urgent need of accelerated progress to reduce these deaths, the government has stepped up the much-needed leadership. Later in 2024, Somalia will introduce the pneumococcal and rotavirus vaccines to prevent deaths caused by pneumonia and diarrhoea, both leading causes of child mortality.
At the global level, a resolution initiated by Somalia calling for accelerated action to end maternal and child mortality around the globe was adopted at the Seventy-seventh World Health Assembly. This places Somalia among countries leading the way in tackling maternal and child mortality.
“The Global Polio Eradication Initiative is grateful for Somalia’s leadership and strong commitment to their children,” said Mr Andrew Stein, Deputy Director, Polio, Bill & Melinda Gates Foundation. “Through the government’s leadership, in partnership with nongovernmental organizations, work to stop polio and increase access to immunization is more robust than ever. I am confident that Somalia will prevent thousands of cases of polio, measles, pneumonia and vaccine-preventable diseases.”
At the heart of intensified efforts is immunization, which alone can prevent two thirds of child deaths. Yet, current immunization services in Somalia fall short of the scale and consistency required to make a positive impact on mortality. A recent assessment of health facilities found that immunization services are available in only 56% of public hospitals, 68% of health centres and 19% of primary health care units.
“For Somalia to attain progress, immunization services need to be provided more widely and consistently in as many health facilities as possible,” said acting United Nations Children’s Fund (UNICEF) Representative in Somalia Mr Charles Lolika. “We believe that with Somalia’s resilience and determination, supported by partners and strategies and guidelines to enhance maternal and child health, rapid progress is possible.”
The challenges facing Somalia are well documented. Decades of conflict have complicated service delivery, and climate-induced shocks such as droughts and floods have displaced millions of people, who now live in overcrowded areas with limited access to services. The country’s health system remains fragile, with inadequate human resources and a limited network of cold chain facilities for delivery of vaccines, especially in remote and hard-to-reach areas.
Notes to editors
Download media content on the launch of the task force and forum.
For more information, 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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Japan and WHO’s new project targets 900 000 flood- and drought-affected people in Somalia
WHO Representative to Somalia Dr Reinhilde Van de Weerdt (left) met with H.E. Mr OKANIWA Ken, Ambassador of Japan to Somalia, to express appreciation for Japan’s support. Photo credit: WHO Somalia/M. Saydahmat12 June 2024, Mogadishu, Somalia – A critical project led by the WHO Country Office in Somalia aims to reach nearly 900 000 people with life-saving interventions over the course of 2024. The project targeting people in Somalia who are still living with the impacts of extreme climate events is supported by the Government of Japan with a generous grant of over US$ 700 000.
This new project follows the completion of an earlier project that benefited over 3 million people affected by drought and floods in Somalia with integrated health and nutrition services. This latest funding, allocated under the Japanese Supplementary Budget, thus represents continued support to Somalia from the Government of Japan.
The project is titled “Ensuring Access to Essential and Emergency Health Care for Drought (and Flood) -affected Communities Living in Hard-to-reach Areas in Somalia” and spans the entirety of 2024. It targets 15 flood- and drought-affected districts across the country. Working with the Ministry of Health and Human Services, WHO aims to mitigate the health impacts of recurrent climate shocks, food insecurity and disease outbreaks, especially cholera, while strengthening health system resilience.
“Japan’s continuous contribution will enable WHO to enhance our ongoing activities in responding to recurring and escalated cholera outbreaks in Somalia, particularly in areas affected by extreme weather events,” said Dr Reinhilde Van de Weerdt, WHO Representative to Somalia. “We are grateful for Japan’s longstanding support of our efforts to save lives and improve health outcomes in Somalia and the Greater Horn of Africa region, focusing on emergencies from COVID-19 to the drought and floods.”
Somalia has an ongoing cholera outbreak, which has been made worse since the floods of December 2023, which destroyed sanitation facilities and caused further displacements. Cholera spreads easily amid the poor sanitary conditions and limited access to basic health care. The outbreak is mainly concentrated in the Hirshabelle, Puntland, and South West states. Since January 2024, the country has reported over 9914 cases. Forecasts predict that the outbreak will continue due to anticipated heavy Gu rains expected until the end of June 2024, potentially leading to flash floods.
“The Government of Japan recognizes the urgent need to address the health challenges exacerbated by extreme weather events in Somalia,” said His Excellency Mr OKANIWA Ken, Ambassador of Japan to Somalia. “We are pleased to continue our partnership with Somalia. Through this project, we aim to support WHO’s efforts in delivering vital health care services, aiming to save lives and enhance resilience against the impacts of droughts and floods.”
Thanks to Japan’s funding, WHO will be able to improve access to essential health services through community-based interventions in underserved communities across 15 districts. These services will target 866 860 beneficiaries out of the almost 3.2 million people in need in those districts. The effort will focus on providing health and nutrition services, including immunization, for sick children and pregnant and lactating women.
The project will also strengthen referral linkages between communities and health facilities to improve quality, access and coverage of critical care. This includes in-patient treatment at stabilization centres for children with severe acute malnutrition with medical complications.
With Japan’s support, WHO will also assist the Ministry of Health and Human Services in strengthening prevention, early detection and prompt response to disease outbreaks, including cholera, at the district level.
For more information, contact:
Madinur Saydahmat, Partnerships Officer, WHO Somalia
Email:
Fouzia Bano, Communications Officer, WHO Somalia
Email:
