By Mohamed Abdi Hassan, PhD

Three years ago, many in the health sector rejoiced and welcomed President Hassan Sheikh Mohadmud’s rise to the top office in the hope that he will contribute to health service delivery in availing good leadership and top management commitment which is a pre-requisite for a better service delivery. One of the promises the president made was to enhance health service delivery. The pledge which is encompassed in the new deal includes:

1) Build health systems that guarantees primary health care to all citizens;
2) Improve public health to eliminate the threat of infectious disease
3) Establish and empower a national quality control mechanism that regulates drug and food

Somalia today suffers some of the world’s worst health indicators, including a maternal mortality ratio of 1,200 per 100,000 live births, an infant mortality rate of 165 per 1,000 live births, while Under-five Mortality Rate UMR: 180 per 1000 live births. Most of the health infrastructure was destroyed and many health workers were killed or forced to live in exile.

The above figures are a non-issue to his Excellency the president. In his recent speech during the inauguration of his 3 years at the helm, the president said and I quote “Today we have health clinics providing vaccinations to tens of thousands of Somali children, eradicating polio and other diseases that have held Somalia in their grip for so long. We are providing mothers with places to give birth safely. We are investing in building a healthy nation, able to look after itself and care for each other”. The statement is not only an abstract but very pedestrian. The reality belies what the president said.

The government has no single clinic that provides vaccination or immunization nor do we have a government run hospital or health facility that provides pregnancy and birth services for mothers to give birth safely. The government hospitals that receive support from the international community are run by a plethora of militia groups and self proclaimed medics. On the other hand, the clinics are operated by NGO’s, whether local or international.

Therefore the president statement on his government contribution to the health sector is a gimmick and a mockery of the public. It not only tells us the zealotry with which the president defends his seat but also his ignorance on how healthcare is provided in Somalia. The government under his leadership has failed the health sector despite enormous support from the development partners both traditional and non-traditional donors. In 2014 alone USD 70 million was used to support the health sector, this figure does not include the contribution from the non-traditional donors such as Turkey, Emirates, Qatar Red crescent and others.

The government of Somalia has only contributed a paltry USD 881,332 that is paid as wages to the less than 90 ministry staff of which 70% are remnants of the previous minister that constitute; security, cleaners, drivers and subordinate staff only a few-less than 15- have professional background that relates to health.

Fortunate enough we have young men and women with lots of zeal to rebuild the health sector in Somalia. With support from the international donors and partners, a joint mechanism was established in recent years to fund health sector. A vehicle such as the Joint Health and Nutrition program (JHNP) was initiated which supported government ownership. All saw the opportunity to work with the new government bodies to provide technical expertise and the resources required to construct a health system for the Somali context. As part of this process, important decisions were made across all of the six health system strengthening building blocks: service delivery; health workforce; information; medical products, vaccines and technologies; financing; and leadership and governance.

The MOH FGS has recognized that the last building block, leadership and governance, is critical to the efficient and effective use of scarce resources for delivering quality health care to local populations. As they worked to rebuild their health system, Somalia’s health authorities also worked to improve the way that health providers were managing and leading their facilities and teams. However, the top echelon failed in availing the necessary steers at the top. The government has perennially appointed persons that hold nothing between their ears and those with the least leadership skills to manage the health ministry. Such resolves reiterates that health is a non-issue to the current leadership in Somalia.

Mohamed Abdi Hassan,
PhD, Public Health
Health sector specialist
Email: mshukriah@gmail.com