COVID-19 pandemic has overwhelmed and severely strained health systems around the world, the social and political context of Somalia has presented particularly unique challenges to maintain the country’s achievements in progressing towards universal health coverage (UHC). For the last 30 years, Somalia has been in a complex humanitarian emergency situation with compromised security and fragile health systems due to decades of civil war and recurring climatic shocks, such as chronic droughts, floods, and cyclones. Therefore, the WHO Country Office’s (WCO) preparations for COVID-19 in Somalia began in January 2020, long before the first case was confirmed on 16 March 2020.

The WCO assumed a key technical advisory role for national health authorities, supporting the development of the national pandemic preparedness and response plan and the incident management system team in the Federal Ministry of Health and Human Services. Through active engagement and transparent communication with donors, the WCO also mobilized approximately US$ 15.6 million bilaterally.[1] As a result of WHO’s fostered collaboration with the UN agencies and multilateral donors, close partnerships emerged with the European Union (EU) Delegation to Somalia, World Food Programme (WFP), and UN Humanitarian Air Service (UNHAS). Each provided in-kind flight support to WHO for the transportation of crucial equipment that enabled the establishment of testing laboratories, and the provision of life-saving supplies to maintain essential health services. In addition, as a result of WHO’s coordination role among partners, Somalia continued the collection of samples for testing both during and after the lockdown period.

Furthermore, the WCO directly operationalized its test, track, trace and treat strategy using data, innovation and technology to improve national surveillance and monitoring efforts. COVID-19 was rapidly added to the Early Warning, Alert and Response Network (EWARN)—an existing web-based epidemic-prone disease surveillance system, with 694 health facilities currently enrolled. Public Health Emergency Officers from the WCO trained staff at 260 newly-included facilities to identify and report cases through this system. In addition, WHO deployed 3 372 community healthcare workers (CHW), comprised mostly of women, to increase COVID-19 awareness in communities, identify suspected cases, follow up with confirmed cases, refer the severe cases to designated health centers, and trace potential contacts. Of all confirmed cases of COVID-19 in Somalia, approximately 42% were detected by CHWs at the household level. Rapid response teams comprising of 200 staff from WHO’s polio network went to 51 districts, including those with compromised security or lack of infrastructure. While there continues to be a gap in surveillance in many inaccessible areas, the effective use of technology and the mobilization of CHWs has kept community spread under control in Somalia’s fragile setting.

In focus: transforming immediate challenges into lasting health impacts

Before COVID-19 reached Somalia, there was little to no medical grade oxygen supply in the country. In To meet the immediate need for medical oxygen and related equipment WHO conducted a survey for existing supply and based on the survey’s results procured required equipment to address the identified gaps. Leveraging these measures, the WCO is working with United Nations Children’s Fund (UNICEF), WFP and UN Population Fund (UNFPA) through the Global Action Plan to scale up the availability of oxygen in all health centers which is likely to have a significant impact in preventing deaths, including from childhood pneumonia. Furthermore, three polymerase chain reaction (PCR) machines had been procured by WHO for setting up testing laboratories in Mogadishu, Hargeisa, and Garowe in 2020. Moving forward, the WCO plans to expand laboratory testing capacity through additional PCR machines in other states, including the use of GeneXpert technology. This will not only be useful for increased COVID-19 testing capacity but also the detection of other epidemic-prone diseases.

Ongoing activities on scaling up the oxygen programme, research and evaluation for recovery of health systems, as well as WHO’s support to the government on maintaining essential health services (e.g. routine immunization for polio and measles and improving access to care for HIV/AIDS, tuberculosis, malaria and essential medicines) have proved vital to maintain Somalia’s achievements in progressing towards UHC. WHO’s work on ensuring that health systems strengthening and emergency response activities go hand in hand has reaffirmed the Organization’s key technical advisory and operational role in Somalia.

Key takeaways

1. Need to improve efficiency of work processes within the Organization to promptly respond to resource constraints to provide contextually-appropriate responses in countries such as Somalia, which has a fragile health system and security-compromised areas.
2. Need to plan for and transition to supporting capacity-building for government entities to work sustainably towards UHC and a stronger health systems in the long-term.

---

Photo caption: Ensuring continuity of essential health services in Somalia.

Photo credit: WHO Somalia

Disclaimer: This image was taken during a time of no community transmission of COVID-19. Community transmission is defined as the inability to relate confirmed cases through chains of transmission for a large number of cases, or by increasing positive tests through sentinel samples (routine systematic testing of respiratory samples from established laboratories). Preventative measures such as mask wearing and physical distancing should be used to prevent the spread of COVID-19.