By Adam Abdulkadir Mohamed and Farah Isse Mumin
As a fragile and post-conflict state, Somalia is in the process of re-structuring and re-shaping its health sector. Given this challenging health situation and the recent development in the political process between the federal government and the federal member states, the Health Sector development and Financing (HSDF) is an essential step in building the government’s capacity to improve access to health services for the people of Somalia.
The National Development Plan “NDP 2020-2024” indicated improving the health outcome of the people with particular focus on the reduction of maternal and child mortalities as well as the prevention and control of communicable diseases1. This looks like an idealistic and precise framework for the allocation of national resources in reducing the private dominated health care but sensibly and practically, jumping from this private out-of-pocket healthcare system to national wide public healthcare system within five to ten years is unachievable and unrealistic.
Somalia is one of the African countries facing catastrophic out of pocket health financing, a situation where people have to pay fees or co-payments for health care. There are over three million displaced people across all regions in Somalia. The primary factors of these displacements are the recent droughts and prolonged wars between the government and the terrorist groups. The internally displaced peoples’ sites are generally overcrowded with inadequate and limited Water, Sanitation and Hygiene “WASH” and health services making this contagious COVID 19 disease more transmissible. Currently, the virus is at the stage of spreading across all the regions of the country. As of Thursday, May-7, the federal minister of health announced 55 new cases, making the total confirmed cases 928 and 44 deaths.
Demand and Sufficiency of Essential Personal Protective Equipment supplies in Somalia
March this year when the coronavirus outbreak reached almost all of the countries in the world, the World Health Organization highlighted that, due to shortage of personal protective equipment, global healthcare workers who are in the frontline of saving lives are at higher risk and rely on this PPE to protect themselves and other people. Somalia is among the 54 African countries that received the consignment of medical equipment from the Jack Ma and Alibaba Foundations. Somalia also received medical supply donations from the United Arab Emirates, Turkey, WHO, and USAID, but the reality on the ground is that all of these donations are not enough and are all accumulated either in Mogadishu “the capital” or in the capital cities of the federal member states.
Lack of sufficient awareness on how to protect coronavirus, not following the necessary precautionary guidelines because part of the community and the religious clerics do not believe in coronavirus spread, shortage of personal protective equipment, and lastly limited access to supplies such as N95 medical masks, respirators, gloves, protective gowns, face shields, and gowns are putting frontline doctors, and ministry of health staff lives at risk from the new coronavirus. As Somalia’s ministry of health reported mid-march, most of the first local coronavirus cases were known as medical doctors and ministry staffs, which indicates that many health workers are catching COVID-19. Countries that are badly fighting this outbreak made their priority on how they can protect their hospital staff.
Private health care providers and COVID-19
Somalia’s healthcare private sector that comprises of hospitals, clinics and health centers run by independent entities like not for profit organizations, companies or business individuals, and have full authority to decide the treatment fees and whom to treat and who not to treat in all diseases including this contagious coronavirus disease without government directions or intervention. Even the majority of the hospitals that are under the state-run mostly work as a private wing and collect money from the cash buyers “citizens.”
Mogadishu is so far the hardest hit where privately owned outpatient clinics, and hospitals are neither willing to admit patients with COVID19 similar symptoms due to luck of PPE, ventilators, or testing kits nor they have on-call consultations. Their biggest concern seems to be the prevention of nosocomial infections and staff health hazards in the facility, but the predominant health care providers are failing the nation during this crisis.
The ministry of health is doing fine, bearing in mind the resources at its disposal. The Martini hospital was equipped, and it is the only hospital nationwide solely dedicated to COVID19 patient admission, but the ICU can only occupy not more than few dozens clinically severe patients with respiratory distress. With the help of WHO and other countries, some equipment, consumables, and test kits were also procured for the molecular biology department of the national public health laboratory, which calmed the stress of sending samples abroad and days of waiting for results. The ministry of health regulates health care providers of the country, including private entities, so there is pressing public-private teamwork needed in the course of this brutal COVID-19 battle in the country. Private hospitals can provide ample quarantine facilities with hospital beds, and the government can distribute PPE, ventilators, case management guidelines, and financial support for the health staff in private hospitals.
In the face of the current COVID-19 pandemic, solidarity is vital. The private health sector of the country is not cooperating so far, and if the situation aggravates and more patients fall with severe symptoms of coronavirus infection, there is a fear that hospitals will be empty, abandoned, and health staff will escape for their lives in the absence of protective equipment. The virus will continue to cleanse already affected people, and targets can be those internally displaced due to famine, civil war, and recent locust swarms in the region. Staff from private hospitals should have appropriate skills to protect themselves and other people.
Conclusion
Since the country’s healthcare system is predominantly private, the government should engage the private health sector across the country and give them the necessary support in terms of both medical supplies, financial and moral support. The government can bring the private healthcare providers on board, and why not? they are part of the national task force designed to fight COVID-19.
Private hospitals in most of the regions, including the capital, can provide ample quarantine facilities with hospital beds, and the government can distribute PPE, ventilators, case management guidelines, and financial support for the health staff in private hospitals.
As countries that are fighting this pandemic have created waves of solidarities to support the frontline healthcare workers, Somali activists, business people, faith leaders and everyone that can participate has to show solidarity to both the health workers and other groups that are in need of help including the IDPs and vulnerable people in the community.
Adam Abdulkadir Mohamed and
Farah Isse Mumin
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Adam is a public health Ph.D. candidate at Baskent University, Turkey. Alumni at Pan-African University Scholarship “PAULESI, Nigeria” [email protected], [email protected]
Farah (DVM, MSc in Vaccine production) Dean of faculty of Veterinary Medicine, Red Sea University, Somalia. Alumni at Pan-African University Scholarship “PAULESI, Nigeria” [email protected]
References
National Development Plan, Somalia 2020-2024, http://mop.gov.so/index.php/ndp/somali-national-development-plan/
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