Strengthen health system in local communities

In Somalia the combination of conflict, mass displacement, recurrent droughts, flooding and extreme poverty, coupled with very low basic social services coverage, has seriously affected food security and significantly increased the population’s vulnerability to disease and malnutrition.

The health system in Somalia remains weak, poorly resourced and inequitably distributed. In addition, there is critical shortage of capacity for health workers – there are only about 6300 doctors, nurses and midwives working in Somalia. Based on a population of approximately 12 million people, this is about 1900 people per health personnel. This situation complicates the provision of health services and puts the health of the affected communities at dire risk.

Long distance to health facilities, lack of medicines, equipment and services, absence of personnel and unqualified personnel are major barriers to utilisation of public health services.

The main objective of our community health project in Somalia is to improve the medical care of mothers, new-borns and children. We ensure access to medical advice and treatment for entire communities and strengthen social responsibility in communities.

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Goal 1 We improve medical care of mothers, new-borns and children.

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Goal 2 We ensure access to medical advice and treatment for entire communities.

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Goal 3 We strengthen social responsibility in communities.

Ayan (18 Months) and Rahma

Rahma brought her 18 month old daughter *Ayan to the stabilisation centre, suffering from severe acute malnutrition.

Our approaches to reduce mother and child mortality

We see the following three principles as the most important approaches to helping children and reducing child mortality in health projects like the one in Somalia. They are practice-focused and suitable for application in different situations and countries.

Maternal and new-born health

The first 28 days are the most critical time for a new-born – 2.7 million new-borns die each year during this period. Most neonatal deaths can be prevented by providing targeted education and support for mothers during pregnancy and postpartum. Poor infant and young child feeding practices, including lack of exclusive breastfeeding, are major contributors to high and persistent malnutrition levels.

Nutrition for young children

As one in seven Somali children dies before reaching their fifth birthday, we call for and support the nutrition of toddlers to ensure their survival and to enable their healthy physical and cognitive development. Acute malnutrition, micronutrient deficiency, as well as poor access to potable water and poor personal hygiene practices are major underlying causes of under-five mortality.

Involving the community in projects

When we involve entire communities in health programs, children can be treated at home, even in remote areas; this can often be a life-saving factor.

Flexible and adaptive project work

In order to ensure responsiveness to the changing context and our continuous learning, we are not proposing a definitive package of activities to be implemented during the project period. The following strategies describe the ‘pathways’ we will use to achieve the outcomes with flexibility and adaptation.

To improve the quality of health services provided, health facilities will be supported through improved physical infrastructure and capacity of the workforce. The health service provision will include a community outreach by mobile medical teams, and the networks of Community Health Workers, benefitting remote and hard-to-reach locations.

Sustainability is at the core of this project, both at Ministry of Health and community level. This project will prioritise a decentralized system for the delivery of health care services which empowers district level health authorities, as well as communities, while maintaining the support, supervision and accountability role of the regional and national authorities.

Community ownership and accountability has re-emerged as a top priority for health systems all over the world. One approach to reach this is through direct involvement of users or the general public in health service delivery and quality which prevent the building of a social distance and culture gap between service providers and the communities they serve.

Community ownership and accountability has re-emerged as a top priority for health systems all over the world.

Carlos Diaz Head Humanitarian Save the Children Switzerland

Fatima (9 months) was referred to the stabilisation centre with malnutrition where she got special nutritious food.

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