THET

Somaliland

Basic health indicators in Somaliland are among the worst in the world. After years of war and underinvestment, the public health system is extremely weak. There is a critical shortage of skilled personnel in almost all public sector health institutions. The government health budget barely covers the salaries of health service staff, let alone costs of electricity, water, fuel, medicines, ambulances, equipment, bandages, dressings and supplies needed to run a hospital.

Somalia ranked 161 out of 163 states in terms of the level of human development (UNDP, 2001)
The risk of maternal death in Somalia is 1:20 (UNDP, 2001)
Nearly a quarter of all children (22.4%) die before their fifth birthday (UNDP, 2001)
Infant mortality is estimated to be 118 per 1000 live births (UNICEF, 2004)
The maternal mortality ratio 1,400 per 100,000 live births (WHO, 2007).

THET in Somaliland
THET began working in Somaliland in 2000 after establishing the Kings/THET/Somaliland Partnership (KTSP). The Link initially focused on training staff to improve standards of care and providing academic support to the medical schools. Work soon expanded to include other health institutions, professional associations, regional health authorities and the Ministry of Health and Labour.

Renewing this 10 year partnership THET and King’s Health Partners have taken further steps to develop their shared agenda and create a new centre of activity within King’s Health Partners. The new partnership aims to expand delivery of the ‘Health Systems Strengthening’ work, as well as to promote greater involvement of younger members of the health profession by creating further opportunities to be engaged in and learn about global health.

How THET is helping
THET draws on the knowledge, skills and experience of dedicated health professionals at Kings College Hospital (KCH) to provide professional support to Somaliland partner organisations. The work is driven by the needs of partner healthcare institutions in Somaliland and allows them to identify areas where input from the UK can make a difference. Programmes are designed that have achievable goals and that are able to have lasting impacts.

Medical Education and Training
The KTSP support to medical education helped lead to the graduation of the first locally trained doctors in the history of Somaliland in 2007; this was a landmark moment for the health sector. These graduates are now working in the public health system – ensuring daily cover on several wards at two hospitals that previously had no full time doctors. Another 75 medical students are currently enrolled and will graduate between 2008 and 2012.

KCH staff work closely with the Deans of Hargeisa and Amoud Medical schools to develop medical undergraduate teaching and provide support as external examiners and also support a two year medical internship programme for junior doctors. The competency of medical school graduates working in the KTSP supported intern programme has led to increased public faith in the health system.

KTSP has also established a training programme for Clinical Officers, a new cadre of mid-level health worker that sits between nurses and doctors. This type of position has been identified by the Somaliland Ministry of Health and Labour as one that they are particularly keen to develop further.

Nursing and Midwifery Training
We have established a nurse tutor training programme, an initiative designed to create the next generation of well qualified nurse teachers who will help raise the standard of nursing in the country, and saw the first graduation in October 2009.

A new nursing curriculum for the republic of Somaliland is due to be rolled out in May 2010 across all of the nursing institutions. This is project funded by DfID to implement a nursing diploma. It will be the first committed step towards standardisation of examinations across the country which is set to increase over the next three years.

Equipment and Resources
With donor funding THET has been able to develop the capacity of health training institutions by supplying books and training equipment, supporting key staff, helping review training curricula and providing technical teaching assistance through KCH. We have also helped to equip maternity clinics, to improve the level of post natal care.

$60,000 has been spent on books and equipment for four nursing and midwifery training institutions in 2007/8 alone – ensuring that student doctors and nurses have access to up to date information. With the role out the new nursing curriculum each nursing school will be provided with the books on the essential reading list.

What has been achieved

The Revolving Drug Fund is the first of its kind in Somaliland. It is a source of good quality medication that is available 24 hours of the day either at affordable prices or provided free to the poorest sections of society who cannot afford to pay.
Setting up a blood bank and improving laboratory and pathology skills and services so diseases can be accurately diagnosed and treated
Supplying the first ambulance at Hargeisa Group Hospital, the main public hospital in the capital city. This vehicle played a crucial role in transporting patients during the 2007 cholera epidemic.
Training members of the Regional Health Board (RHB) to better enable them to manage public health facilities
Incorporating mental health into the training of a wide variety of health practitioners to address an issue which is critically in need of support
Supporting the establishment of the Health Professionals Council in the development of frameworks for systems of accreditation and providing the foundation for regulation in the health sector. Working with government, health institutions and international agencies to inform policy and engage in the development of health strategies

To find out more about our programme work in Somaliland, please visit the KTSP website at http://ktsp.thet.org/.