By Ali Haji Warsame
Historical Perspective
Somalia inherited a basic post-colonial health care system that focused on curing diseases rather than preventing them. Most rural and nomadic populations had limited access to essential health care. From the 1960s to the 1970s, health care services and access improved, including the training of health care professionals and providers. Between the 1970s and 1980s, primary health care (PHC) initiatives and tuberculosis (TB) treatment programs were introduced. However, the civil war completely destroyed Somalia’s health system, as health facilities were either looted, vandalized, or taken over. According to Macalester Digital Commons (2008)[1], Mohamed Gedi Qayad argues that health care services in Somalia have been shaped by various administrations, each adopting different policies, priorities, and approaches to health care, often influenced by local and international paradigms and resolutions.
Unfortunately, all these efforts were undermined by the civil war, and the progress made in the thirty years since independence was reversed due to the economic downturn and political turmoil of the 1990s. At one point, health care services became an unregulated local private initiative.
Post-Conflict initiatives
During the post-conflict period from 1990th to early 2010th, Somalia’s health services and access were exclusively in the hands of the private sector which is profit-oriented and with the financing of health care operations remaining a major challenge for the country due to the growing health needs as well as the absence of a central or state government responsible for providing or regulating social services. As we speak, Somalia is not able to finance the health care needs of its people adequately. Heritage Institute (Somalia’s Healthcare Systems: May 2020) stated one of the biggest impacts on the modest health infrastructure was the fact that a significant number of medical doctors, qualified nurses, midwives and skilled health technicians were either killed or migrated overseas and virtually, all health training institutions become out of service.
According to the WHO (Understanding the Private Health Sector in Somalia), the private health sector, both for-profit and not-for-profit) provides about 80% of all curative care services in Somalia with the main challenges being accessibility barriers, absence of accountability, lack of regulatory environment and lack of coordination with related government agencies. Thus, the majority (roughly 74%) of private health facilities are owned and managed by individuals with most of such facilities being pharmacies.
Access to Costly International Health Services
Somalia’s prolonged civil war has exacerbated the provision of health care in the country and the section of the population that’s hardly hit by the lack of healthcare access are women and children. According to the local and international NGOs operating in Somalia, many women and children in Somalia have to undertake journeys of hundreds of miles to reach medical facilities. Thus, Somalia has one of the lowest universal health coverage index in the world (UHC). The main barriers include limited capacity, insecurity, out-of-hand and unregulated costs and more.
Somali’s Health Care Recovery Phase
Puntland, the first FMS in Somalia, did not have a stable and established health care system. The private health provision was dramatically shrunk to individual clinics. At the same time, the government, led by the Ministry of Health, failed to go beyond providing basic health services and MCHs which was indeed the only feasible improvement in the health sector for the last 26 years. As we speak, Puntland doesn’t have a referral hospital at the State level and the poor management of that Ministry is to be blamed.
It is not hidden from the public how that ministry’s management mismanaged the government’s meagre resources and reasonable international support. The chance of developing that sector was once again mis screwed by the same people interested in managing.
Effective from 2010, Mogadishu was showing signs of steady recovery, especially in the social services sector, spearheaded by the well-established international presence in that sector while Puntland was struggling to address that issue. Many patients used to be transported to Mogadishu effective from 2012 after several large health facilities of international standard were opened in the city including Digfer Hospital, known now as Erdogan Hospital which was officially reopened in January 2015 at an inauguration ceremony in Mogadishu led by then President of Somalia Hassan Mohamoud and President of Turkey Recep Tayyib Erdogan. The renovated 200-bed Somalia-Turkey Training and Research Hospital was constructed by Turkiye’s International Cooperation and Development Agency (TIKA)[1].
According to the Somalia Public Agenda (2022), the role Turkey plays in the improvement of public services and infrastructure in Somalia, particularly access to health care is paramount and that includes both Erdogan Hospital and Yardimeli Hospitals, the second largest hospital built by Turkey based in Mogadishu which was opened in June 2016 to serve Somali women and children. Both of these hospitals were part of Turkish counterpart agreements to improve the health sector in 2013[1]. Besides Erdogan Hospital, some other people preferred to go to Hargiesa due to the close connection to Ethiopia although Somaliland was not much better than Puntland in that regard. During this time, Somali people began seeking healthcare outside of Somalia, particularly in Ethiopia, Kenya, Turkey, and India. Many preferred India because it offers comprehensive health services at a reasonable price. Initially, these services were funded by relatives in the West who could provide financial support. However, as the quality of healthcare in Somalia deteriorated, individuals started to finance their own medical needs.
The Cost of Medical Tourism
In 2019, I visited Hyderabad for the first time, taking family members for medical checkups. At that time, many Somalis seeking professional health care were travelling to Kenya, Turkey, or the UAE. Due to visa restrictions and the high costs of logistics, India had become the country of last resort for many. I didn’t stay long; I left my family in India to complete their medical treatment. In addition to the highly fluctuating medical charges at that time, we had to rent a flat, arrange transportation, and cope with the extremely hot weather in Hyderabad during the summer. Unfortunately, I was forced to extend my stay for almost six months due to Covid-19 travel restrictions, which prevented my family’s return. During this time, I began gathering information on the costs of healthcare for Somalis abroad, particularly in India.
Before my departure, I had been stationed in Garowe since 2013, where I observed that the provision of health services was below standard. This wasn’t the first time I noticed this issue. Since 2007, I spent up to three months each year in Puntland, and I have not seen any improvement in the health sector during that time. Since the formation of Puntland in 1998, health access has been the most affected area, showing minimal progress.
Although many small clinics opened across the state by health professionals, they often lacked specialists or referral hospitals. It’s important to note that after the collapse of the Somali government, Puntland became a center for medical services, particularly Galkayo. This city has been the home of some of the finest Somali doctors, such as Dr. Mohamed Jama Salad Takar, a renowned neurosurgeon, and Dr. Abdulkadir Mohamoud Jama, also known as Dhegacadde, both of whom returned from Italy. However, due to a lack of government support and overall improvement in the health sector, their efforts did not make a significant impact. The evolution of medical tourism is a worldwide phenomenon and many publications done by ETC/UNWTO on exploring health tourism aim to provide a better understanding of the growing segment of wellness and medical tourism. These studies introduce the evolution of health-related tourism products aali.warsame@eau.edu.sond services from around the world, providing insights into the current situation of the industry as well as the future potential. According to William Russel (William-russel.com), worldwide medical tourism, also called health tourism, is a huge and booming industry spanning the entire globe.
Read more: The cost of failing state provision of affordable health care: The case of Somalia
Hon. Ali Haji Warsame
Executive Director – Hiil Institute
Former Puntland Minister of Education
Email: ali.warsame@eau.edu.so
————————-
Related articles
Foreign Doctors with Rising Ill-advised Medical Opinions in Somali Cities By Abdulkadir Hussein
_________
References:
[1] “Weekly Press Conference on the Progress of the Government”. Dayniile. 31 January 2015.
[2] https://digitalcommons.macalester.edu/cgi/viewcontent.cgi?article=1069&context=bildhaan.
[3] “Somalia: Somali President Visits Hospital Renovated By Turkey”. Sabahi. 15 July 2013.
Leave a Reply