Framework for Rebuilding Public Framework for Rebuilding Public Health Systems in SomaliaHealth Systems in Somalia

Fozia Abrar, MD, MPH

Department Head/Medical Director

HealthPartners Occupational and Environmental Medicine

Facts Facts

Life expectancy at birth: 50 yrs. Maternal mortality ratio: 1044 per 100,000 live

births ( WHO- world health statistics 2010) U5 mortality rate: 200 per 1,000 births Access of population to clean water: 29% national

( 59% urban, 11% rural) Infant mortality rate: 113/1000 Childhood immunization coverage<30%

HealthHealth

• It is estimated that Somali children have the highest infant and child mortality and morbidity rates in the world.

• Lack of access to primary and basic secondary health services.

• Lack of access to safe water and sanitation• Lack of access to conduct vaccination and other

life-saving activities in some regions continues to impact negatively on the health of children.

Leading causes of Death in Leading causes of Death in SomaliaSomalia

Infectious Disease (HIV,TB)ARI (children)Diarrheal Diseases ( Children)MeaslesPoverty/Malnutrition

Contributing factors to Contributing factors to Maternal MortalityMaternal Mortality

FGM related complicationsMalnutrition/anemia in pregnancyInadequate maternal health services Delayed referral systemsUnskilled birth attendants

Major human costs of Somalia since 1991Major human costs of Somalia since 1991

450,000–1,500,000 excess deaths caused by Somalia’s intermittent conflicts

Nearly one million Somalis live as refugees in Kenya, Djibouti, Ethiopia and one third of Somalis are currently displaced.

350,000 to 750,000 people are facing famine conditions and are at risk of death

Disease Outbreaks are challenge in South Central Somalia.

OCHA ( United Nation Office for the Coordination of Humanitarian Affairs)

Public health programs have an Public health programs have an opportunity costopportunity cost

Difficult to attach value to something prevented

The cost of providing services to thousands of polio victims if child was not vaccinated.

Preventing HIV infection by changing behavior versus treating cases

Preventing heart disease, stroke versus treating complications: death

Public health programs contPublic health programs cont’’dd

Preventing diabetes versus treating complications

Reducing tobacco use versus treating lung, throat cancer, MI

Access to prenatal care versus maternal and infant deaths

Preventing maternal/infant HIV transmission versus treatment

Leading Causes of Death in USA Leading Causes of Death in USA ((Minino et al 2002Minino et al 2002))

Heart DiseasesCancerCerebrovascular DiseaseChronic (lower) Respiratory DiseaseUnintentional InjuriesDiabetes MellitusInfluenza

Recommendations for the Future Recommendations for the Future

Training community health care workers to work with and among pastoralist and agro-pastoralist communities

Role of Diaspora is very important in rebuilding the health and education sector

Strengthening MCH and Health posts Access to safe water and sanitation

RecommendationRecommendation

– Trained/motivated public Health workers– Money from major donors– Building public health clinics– Strengthening local health departments– Public/private initiatives– Investing in prevention/community medicine.

Investing in preventionInvesting in prevention

Heath educationChildhood immunizationMaternal health programs

Role of the Diaspora CommunityRole of the Diaspora Community

FundraisingTeaching at local universitiesVisiting professorsSponsoring medical students

Role of donorsRole of donors

MoneyCapacity-building

Role of the governmentRole of the government

Reestablishing the National Health Policy: to provide equitable and affordable preventive and curative health care services and thus ultimately better health status ie. reduce morbidity and mortality that will increase life expectancy”

Building capacity of health centers

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