1 SITUATION ANALYSIS CHILD HEALTH IN SOMALIA: SITUATION ANALYSIS 2 CHILD HEALTH IN SOMALIA December 2011 CHILD HEALTH IN SOMALIA: SITUATION ANALYSIS 4 CHILD HEALTH IN SOMALIA © World Health Organization, 2012 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Cover photo: © WHO Somalia Design and layout: blossoming.it 5 SITUATION ANALYSIS Chapter 1. Introduction and background 1.1 Purpose and scope of the study 1.2 Methodology 1.2.1 Literature review 1.2.2 Interviews 1.2.3 Limitations of the study 1.3 Background: Somalia 1.3.1 Geography and demography 1.3.2 Economic and social development 1.4 Child health-related indicators for Somalia 1.5 Somalia’s ratification of child health rights instruments Chapter 2. Child mortality and morbidity in Somalia 2.1 Child mortality and morbidity in a developing context 2.2 Childhood mortality in Somalia 2.2.1 Pneumonia 2.2.1.1 Tuberculosis 2.2.2 Diarrhoea 2.2.3 Measles 2.2.4 Malaria 2.3 Common causes of morbidity among Somali children 2.4 Neonatal mortality Chapter 3. Determinants of child morbidity and mortality in Somalia 3.1 Nutrition 3.2 Water, sanitation and hygiene (WASH) 3.3 Social and economic factors 3.4 Health system 3.5 Education 3.6 Conflict page 18 19 21 21 21 21 23 23 25 26 26 page 28 29 32 36 37 38 39 39 41 44 page 46 47 50 52 52 53 54 Table of Contents 6 CHILD HEALTH IN SOMALIA 3.7 Cultural and traditional aspects 3.7.1 Traditional health seeking behaviour 3.7.2 Educated vs. traditional attitudes 3.7.3 Gender issues 3.7.4 Birth spacing 3.7.5 Breastfeeding 3.7.6 Home deliveries 3.7.7 Female genital mutilation Chapter 4. Structure and performance of the health system related to child health 4.1 Governance 4.2 Service delivery 4.2.1 Structure of health care delivery 4.2.1.1 Referral hospitals 4.2.1.2 District hospitals 4.2.1.3 Maternal and child health (MCH) clinics 4.2.1.4 Outpatient therapeutic programmes (OTPs) 4.2.1.5 Health posts 4.2.2 Delivery of preventive and supportive child health services 4.2.2.1 Antenatal care 4.2.2.2 Deliveries 4.2.2.3 Postnatal care 4.2.2.4 Extended programme of immunization (EPI) 4.2.2.5 Other child health promoting interventions Vitamin A Deworming Growth monitoring and nutritional counselling 4.2.3 Capacity for service delivery 4.2.3.1 Availability 4.2.3.2 Accessibility 4.2.3.3 Quality of care 4.2.3.4 Demand 4.2.3.5 Coverage 4.2.4 Outreach campaigns 4.2.4.1 Polio programme 4.2.4.2 Measles campaigns 4.2.4.3 Child health days (CHD) 4.3 Health-care workforce 4.3.1 Qualified health professionals 4.3.2 Unqualified health workers: traditional birth attendants 55 55 56 56 57 58 59 60 page 62 63 65 65 66 66 67 68 68 69 69 69 70 70 72 73 73 76 76 78 78 82 82 83 84 87 87 88 7 SITUATION ANALYSIS 4.4 Health information systems 4.4.1 Health management information system (HMIS) 4.4.2 Communicable disease surveillance and response (CSR) 4.5 Medical products and vaccines 4.6 Financing and funding 4.6.1 Health expenditures and financial aid 4.6.2 Financial distribution of aid to the health sector Chapter 5. Conclusions and recommendations 5.1 Neonates and infants 5.2 Nutrition 5.3 Water, sanitation and hygiene 5.4 Infectious diseases 5.5 School-aged children and adolescents 5.6 Support, guidance and management 5.7 Way forward References Annex I. Interview guide Annex II. Articles 6 and 24 of the United Nations Convention on the Rights of the Child Annex III. Lists of kits for medicines and equipment provided to Somali health care facilities from UNICEF Somalia (according to EPHS) 90 90 90 91 92 92 93 page 96 97 99 100 101 102 103 103 page 104 page 106 page 108 page 109 8 CHILD HEALTH IN SOMALIA Latest available data on selected child health indicators for Somalia Health-seeking behaviour for children with pneumonia Basic WASH-figures for Somali households Number and types of health facilities in Somalia Coverage rates for routine immunization with standard EPI vaccines by the age of 1 in Somalia Interventions and target groups for the child health day campaign Distribution of physicians, nurses and midwives in Somalia Map of Somalia Global causes of mortality for children under the age of five Under-five mortality rates for Somalia Underlying causes of mortality for Somali children under the age of five Morbidity pattern for under-fives attending Somali MCH clinics Global estimate of the distribution of conditions responsible for neonatal mortality Schematic structure of the zonal health systems in Somalia Regional availability of MCH clinics Regional immunization coverage of DPT3 and measles vaccine (MCV) through routine EPI during 2009 Approximate distribution of international financial support to different parts and programmes of the health sector in Somalia in 2009 WHO definitions of anthropometric deviations due to malnutrition Defining the characteristics of BEmOC and CEmOC facilities at the hospital level Immunization schedule for Somalia 27 36 51 65 79 84 88 23 30 32 34 42 44 64 75 81 94 48 67 71 Tables and figures Table 1. Table 2. Table 3. Table 4. Table 5. Table 6. Table 7. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 10. Box 1. Box 2. Box 3. 9 SITUATION ANALYSIS ACF ACT AFP AMISOM AMREF ARI ART AWD BCG BEmOC CEmOC CGS CHD CISS COSV CHW CISP COSV CSR CSZ DALY DOTS DPT ECHO EPI EPHS FSNAU GAVI GDP GFATM GNP GPEI GTZ Action Contre la Faim Artemisinin-based combination therapy Acute flaccid paralysis African Union Mission in Somalia African Medical Research Foundation Acute respiratory infection Anti-retroviral therapy Acute watery diarrhoea Bacillus-calmette-guerin (TB-vaccination) Basic emergency obstetric care Comprehensive emergency obstetric care Child growth standards Child health days Coordination of International Support to Somalia Comitato di Coordinamento delle Organizzazioni per il Servizio Volontario (Coordinating Committee of the Organizations for Voluntary Service) Community health workers Comitato Internazionale per lo Sviluppo dei Popoli (International Committee for the Development of Peoples) Coordinating Committee of the Organizations for Voluntary Service Communicable disease surveillance and response Central South Zone Disability-adjusted life-year Directly observed treatment short courses Diphtheria-pertussis-tetanus Humanitarian Aid Department of the European Commission Extended programme of immunization Essential package of health services Food Security Nutrition Analysis Unit Global Alliance for Vaccines and Immunization Gross domestic product Global Fund to Fight AIDS, Tuberculosis and Malaria Gross national product Global Poliomyelitis Eradication Initiative Deutsche Gesellschaft für Technische Zusammenarbeit (German Agency for Technical Cooperation) Acronyms 10 CHILD HEALTH IN SOMALIA HDI Hib HMIS HP ICRC IDP IFRC IMC IMCI IU KAPS MCH MDG MICS MoH MSF MUAC OCHA OPD OPV ORS ORT OTP RDT RUTF SFP SHSC SRCS TB TFC TFG TFR UNDP UNFPA UNICEF UNOPS VCT WASH WFP WHO Human Development Index Haemophilus influenzae type B Health Management Information System Health post International Community of the Red Cross Internally displaced person International Federation of Red Cross and Red Crescent Societies International Medical Corps Integrated management of childhood illness International unit Knowledge attitude practices survey Maternal and child health Millennium Development Goal Multiple indicator cluster survey Ministry of Health Médecins Sans Frontières Measurement of the upper arm circumference United Nations Office for the Coordination of Humanitarian Affairs Outpatient department Oral polio vaccine Oral rehydration salt Oral rehydration therapy Outpatient therapeutic programme Rapid diagnostic test Ready-to-use therapeutic food Supplementary feeding point Somali Health Sector Committee Somali Red Crescent Society Tuberculosis Therapeutic feeding centre Transitional Federal Government Total fertility rate United Nations Development Programme United Nations Population Fund United Nations Children’s Fund United Nations Office for Project Services Voluntary counselling and testing Water, sanitation and hygiene World Food Programme World Health Organization [...]... child health issues Develop a full Somali child health strategy Situation analysis 17 Child Health in Somalia Chapter 1 Introduction and background © Soyda 18 Situation analysis 1.1 Purpose and scope of the study The present report contains an analysis of the child health situation in Somalia, with its principal focus on children in the under-five age group It is mainly based on a review of existing... community health workers Ensure continued outreach campaigns of essential health packages (child health days); immunization, including TT 2 (to pregnant women), vitamin A, deworming, water purifying tablets, and possibly ORS Support MCH clinics to increase routine immunization, from fixed sites as well as in outreach-mode, for future phasing out of child health days-campaigns Addressing school-aged children... partners in the Somali Health Sector Committee for contributing to interesting and informative meetings within the Health Cluster, and I convey my special thanks to Dr Kamran Mashhadi, Health Sector Coordinator (until March 2010), for supporting me so well and providing valuable reports and other materials Finally, I want to express my sincere gratitude to the following persons for participating in interviews... household level Addressing infectious diseases: • • Introduce new vaccines to the national immunization scheme; 1) exchange DPT for Pentavalent (adding Hib- and hepatitis B-vaccine), 2) pneumococcal vaccine, and 3) oral rotavirus-vaccine Distribute zinc-containing sachets of oral rehydration solution (ORS) through MCH-clinics and community health workers 15 Child Health in Somalia • • • Introduce structured... mortality Information of this kind has been collected in some individual hospitals and larger clinics, but these are managed by several different health- care providers, and have not been collectively compiled into clinical data usable by the health authorities or agencies involved in the joint international support effort for the health sector Stand-alone information on diseases responsible for childhood... fifth of the child mortality in Somalia In line with international estimates, we may assume that a substantial part of these unspecified causes should fall into the neonatal category if the data were of better quality and if the reporting health sector had more insight into child deliveries and children’s first period of life About 90 per cent of child deliveries in Somalia are performed in households... Coordination of Humanitarian Affairs (OCHA) and the United Nations Office for Project Services (UNOPS) These interviews were less structured, since the agencies play more of a supportive role and do not provide regular health services on the ground 1.2.3 Limitations of the study There are many challenges involved in assessing the child health situation in Somalia First, the health situation of children... (5–14 years) – includes extensive household work and working for family business 49 % [b] Prevalence of female genital mutilation 98 % [b] Sources: [a] = UNICEF, The State of the World’s Children 2009; [b] = MICS Somalia 2006 27 Child Health in Somalia Chapter 2 Child mortality and morbidity in Somalia © WHO/Lucie Ngugi 28 Situation analysis 2.1 Child mortality and morbidity in a developing context The... prime instance for consultation whereas the private clinics are mainly frequented by relatively better off Somalis in urban areas The country’s MCH clinics constitute the back-bone of maternal and child health care, particularly in terms of preventive and health promoting services, but some of them also offers in- facility deliveries Here, staffing is under dimensioned, especially in terms of trained... complications and neonatal infections The high neonatal mortality is at least partly maintained by the fact that ninety per cent of deliveries take place at home, without professionally skilled attendance or mandatory follow-up at a health care unit Infections are the main cause of death during remaining infancy and childhood Pneumonia and diarrhea are the main killers, each contributing to 20-25 per cent . 1 SITUATION ANALYSIS CHILD HEALTH IN SOMALIA: SITUATION ANALYSIS 2 CHILD HEALTH IN SOMALIA December 2011 CHILD HEALTH IN SOMALIA: SITUATION ANALYSIS. full Somali child health strategy. 17 SITUATION ANALYSIS 18 CHILD HEALTH IN SOMALIA Chapter 1. Introduction and background © Soyda 19 SITUATION ANALYSIS 1.1