Introduction (Why I Chose Somalia)
After the civil war that saw the toppling of hitherto president of the country in 1992, Somalia has remained in the category of failed states torn by civil war and other natural catastrophes (World Bank, 2009). The country is located in the Horn of Africa to the Eastern part of the continent. Due to the continued state of anarchy, the country continues to record high mortality rates much of which goes unreported due to the ineffectiveness of government agencies (Menkhaus, 2005). Just recently, the country suffered one of the worst famine and drought that not only threatened the lives of the children but also the entire population. In fact, the World Health Organization (2011) says the hunger and famine experienced in 2011 reflected the worst natural catastrophe to hit the country in almost half a century. Over 3 million children faced starvation and malnutrition risking high rates of early deaths (WHO, 2011).
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Menkhaus (2005) asserts that Somalia borders Djibouti, Yemen, Kenya and Ethiopia in the Eastern part of Africa. The east of the country has the longest coastline that extends from southwest coastal border of Kenya to the Gulf of Aden. Although the country is largely arid and numerous people rely on nomadic pastoral activities, there are highlands and mountainous regions especially in Shebelle where agriculture thrives (Menkhaus, 2005).
By 2009, Somalia had a population of approximately 9 million people half of whom lived below the poverty line of less than a dollar daily according to United Nations High Commissioner for Refugees (UNHCR, 2009). This implies that the country is highly impoverished and the large proportion of the population is vulnerable to poverty and disease.
Under the rule of Siad Barre, the country was stable politically. Since the political unrest, lawlessness and civil war ensued after 1992 coup d’état, the country has never been under a stable government. Tribal factions have continued to run the country periodically. This has led Somalia to be vulnerable to external forces especially terrorists networks such as Al Qaeda that have continued fund extremist groups such Al Shabaab (Menkhaus, 2005). This has compounded the political instability making the country to be the most politically unstable in the world according to the international center for governance. With that in mind, most of the institutions and government facilities are unable to offer health care services to the population. Health sector is the most affected with only few health care providers, medical and nursing practitioners. The number of health care practitioners can barely meet the health demands making it the major reason for high mortality rates (Menkhaus, 2005).
For over two decades, Menkhaus (2005) highlights that the country’s economy has been unstable since there exists only a handful of effective economic institutions. The informal economy has however flourished with the World Bank records indicating that the country has a Gross Domestic Product (GDP) of approximately $5.7 billion by the end of 2009 (World Bank, 2009).
State of Health
Ministry of Health was in charge of public health sector before the collapse of the nation’s government in early 1990s..Although the provision of healthcare was mainly in the urban areas, the medical officials located in major region of the country enjoyed considerable influence especially in enhancing accessibility to health care services (Menkhaus, 2005). Health care services continue to dominate the health care sector notwithstanding the opposition directed towards them during the reign of Siad Barre. According to Menkhaus (2005), the rationale is that the civil war that erupted devastated and destroyed public health facilities and structures. Private sector constituted mainly by community and relatively affluent citizens run the current medical clinics and hospitals. This predisposes the people to high cost of health care services contributing to high mortality rates in the country.
By 2010, the life expectancy of Somalis stood at 50 and 48 years for females and males respectively (WHO, 2011). The number of children under the age two years immunized against Measles fully is low according to the WHO (2011). Indeed, the report showed that only four out six children have received full immunization from the disease implying that approximately 60% had not received any such immunization. For other life-threatening diseases like tuberculosis and malaria, the children remain vulnerable to infections. Infant mortality stands above 10% implying that about 110 children out of 1000 births die. To compound the already complex scenario, the number of medical physicians remains very low. Indeed, the country had less than fifteen qualified medical doctors. This implies that around 100, 000 people can only access health services from one physician (WHO, 2011). This has created a thriving ground for private healthcare services and unqualified medical practitioners. In addition, only 430 midwives and less than 300 nurses had received training in the whole country insinuating that each of them served at least 1000 people (WHO, 20011). With the civil and political unrest being more of a norm than exception in the country, the nursing and medical schools within the country have failed to provide qualified practitioners to serve in the healthcare sector. The reason behind this assertion is that ‘brain-drain’ is alarming since newly qualified practitioners flee to other countries mainly due to the grave state of affairs in Somalia (Menkhaus, 2005).
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Culture and Traditional Medicine
This has created a gap that traditional herbalist fill. While we consider that over 80% of the country’s population live in the rural areas, access to affordable healthcare services remain a huge challenge (Menkhaus, 2005). World Health Organization (2011) articulates that well above 30% of the people receive healthcare services from herbalists as of the year 2010. While many international organizations have been proactive to improve access to medical services, the rise of militia and extremist groups has impeded these efforts. Mainly, the militias have been kidnapping humanitarian workers who take services to the rural areas of the country. Due to the frailty of the government, the country lacks any organization that standardizes the quality of the healthcare services by nurses or any other caregivers. Quack doctors and medical practitioners have been on the rise compromising the quality of healthcare services. These are among major reasons for high mortality rate within the country.
Healthcare System and Delivery
To that end, Somalia ought to prioritize on ensuring that the major international healthcare providers like Flying Doctors and AMREF continue to operate in the country at least for now (WHO, 2011). The rationale is that the country still struggles to have a stable government that would see more practitioners and nurses coming out of nursing and medical institutions to fill the apparent gap in the health care sector. Nonetheless, this would serve as a short-term measure to counter the ever-increasing rates of infant mortality from preventable causes. Besides, there exists no nursing accreditation agency and a nursing council given the porous situation of the country.
A long-term measure would entail prioritization of preventive care that will lower the number of people in need of health care services considerably. World Health Organization recommends an aggressive sensitization of people on health care services, provision of water and sanitation facilities across the country, setting up institutions where nurses can acquire requisite skills and setting up a body that will monitor and standardize the quality of service provided by nursing professions (WHO, 2011).
To achieve these goals and health priorities, the nursing profession in the country will have to expand its confines to prioritize on care provision in the rural areas. It requires the relevant authorities to set up training schools that will produce increased numbers of nurses to offer healthcare services to the people in the rural areas (Menkhaus, 2005). The nursing professions will therefore play an important role of ensuring that the communities in which they serve can access information of preventive care rather than curative care. Lowering the mortality rates requires that a higher number of people access healthcare information that may lead to sensitization. Nonetheless, it is important to notice that all these efforts will be futile if the status of unending civil and military war continue to typify the polity institution of the country. Without a stable form of government, the health priorities will remain elusive since the government will ultimately face challenges in achievement of the goals. It is therefore the role of humanitarian organizations to step in and provide health care services lacking in the country (Center for Disease Control, 2011). This will not only counter the rise of mortality rates but also offset the pressure that the transitional government experiences especially in providing healthcare services to citizens of a war-ravaged country.
Center for Disease Control (CDC). (2011). “Population-Based Mortality Assessment—Baidoa and Afgoe, Somalia”. MMWR, 41(49): 913–917.
Menkhaus, K. (2005). Somalia: State Collapse and the Threat of Terrorism. Washington: Routledge Publishers.
United Nations High Commissioner for Refugees (UNHCR). (2009). “USCIRF Annual Report 2009 – The Commission’s Watch List: Somalia”.
World Bank. (2009). World Development Report: Investing in Health. Washington D.C.: Oxford University Press.
World Health Organization (WHO). (2011). Health Facilities: Overview of Somalia. New York: McGraw Hill Publishers.