A stable, prosperous and democratic country is a top priority for the wider Somali national interests and international community. Working within the ‘Somali Compact’ and the ‘New Deal Initiative’, this paper outlines how to help the state to deliver better quality health services to more of those who need them the most.
While there is a positive trajectory after years of instability, the country still faces a fragile economy, precarious governance, infrastructure constraints, off-track Millennium Development Goals (MDGs) and deep conflict/ humanitarian challenges, while effecting transition from humanitarian to development.
According to the World Bank, poverty level in the country is high at 73% (61% in urban and 80% in rural areas), with per capita GDP at US$284 – against a sub-Saharan Africa average of US$1,300 per capita. The economic crisis, low tax base and expenditure on security does not provide much fiscal space to Somali authorities to invest significantly on health and the sector remains dependent on donors’ support.
This paper addresses short-term continued humanitarian and medium-term reconstruction and development challenges by delivering results like:
In conflict & disaster affected areas: Over 1 million women of child bearing age, nursing mothers and children will receive basic health and nutrition services.
Approximately 8 million people will have access to Essential Package of Health Services (EPHS)/ Reproductive, maternal, newborn and child Health and nutrition services by 2018 and beyond.
Around 3.2 million people will have access to Basic lifesaving and Referral Health, Water, Sanitation and Hygiene (WASH) and Nutrition services through humanitarian interventions by 2018 and beyond.
Number of mothers dying during pregnancy will decrease from current annual 3,900 deaths to less than 2,400 deaths per year by 2021.
Number of children <5 dying will decrease from current annual 65,000 deaths to 40,000 deaths per year by 2021.
Number of annual number of skilled deliveries will increase from current level of 125,000 (33%) to more than 230,000 (50%) and unmet need for birth spacing will be from current 26% to 20 % by 2021.
Number of acutely malnourished children will decrease from current level of 203,0007 to less than 130,000 by 2021.
Immunization coverage will increase from 42% (Penta-3)6 to more than 80% by 2021.
Eradication of polio by 2017; 30% reduction in tuberculosis prevalence and effective control measures against HIV epidemic in place by 2021.
Incidence of Female Genital Mutilation (FGM) will decrease by 5% by 2021.
More than 1,000 new midwives and 2,000 ‘Marwo Caafimaad (FHWs)’ will be trained to address the issue of health workforce (especially female) shortages.
We propose a comprehensive approach, costed at US$71 million per year for the humanitarian response and >US$150 million per year for the development initiatives in health sector, with a clear focus on improving the delivery of essential/ basic services, including a significant uplift in support for health system. Making the state more visible and relevant to the citizens by building trust and confidence through the provision of high quality public services is essential. We will invest in quality, cost-effective public private partnerships and skills training models. Gender, FGM, WASH and other social determinants of health will be cross-cutting components. We will continue efforts for improved budget processes, stronger and more accountable public financial management through improved transparency and scrutiny.
We will seek to help create the conditions for peace and stability in conflict-affected areas. We will continue/ scale up our humanitarian relief support and early recovery activities, transitioning into longer term reconstruction activities, where possible. As we develop and implement programmes, we will also put in place improved and credible monitoring & evaluation (M&E) mechanism for all interventions and use of disaggregated data to monitor impact wherever relevant.