Child Survival

Health Program Overview
The fragility of the country over the past two decades resulted in collapse of the health sector and a subsequent focus on emergency response interventions to recurrent crises. Somalia was completely ‘off-track’ to reach the Millennium Development Goals (MDGs). The Somali health status is poor due to multiple factors including fragmented approaches; inadequate focus on health system low emphasis on community participation and behaviour change; inadequate resource allocation and human resource development. The healthcare system in Somalia remains weak, poorly resourced, and inequitably distributed. Health expenditure remains very low and there is a critical shortfall in the capacity of the health workforce. Available evidence shows that only 3% of births are registered; infant mortality rate is 53 per 1,000 live births; under-five mortality is 137/1000; and New-born Mortality (NM) is 46/1000. The main causes for under-five mortality are pneumonia (24%), diarrhoea (19%), neonatal disorders (17%), and measles (12%) .

Jama Mohamed, Save the Children health programme manager for Save the Children, provides hygiene promotion kits to mothers at Hingod health post in Gardo, Puntland. Photo Colin Crowley/Save the Children

Save the Children is working to improve the quality of health services and increase mother and children’s access to healthcare in Somalia/Somaliland. Save the Children’s health program has directly reached 691,292 (54% children, 32% women) in 2015 alone. This was a result of a huge growth of the portfolio that has made Save the Children the largest health actor in Somalia/Somaliland following the merger with Merlin in 2014. Currently, Save the Children is implementing health programs in Somaliland, Puntland and South Central Somalia. Our health and nutrition programming accounts for 50% of the total portfolio (approx. US$22m). – We need to check the funding figure.

The overall approach is to provide a range of integrated services through sustainable humanitarian and development programming which enhances government and community ownership. We aim to scale up our low-cost, high-impact interventions to hard-to-reach areas and to benefit the most deprived children and advocate with the government and donors for improved access to affordable health services for the most vulnerable populations, especially children.

In 2015, emphasis was placed on improving the quality of our health service provision by enhancing the systems and human capacity of the Ministry of Health and those working at health facilities. In 2015, 228,166 children under 5 have had improved access to quality services for prevention and treatment of child illnesses; and about 150,000 women, girls and children have benefited from knowledge, attitude and practice change initiatives in relation to enhancing health demands, promoting birth spacing and tackling female genital mutilation. 40,769 women of reproductive age had improved access to quality basic maternal health care. 

Key Health Projects
Currently, Save the Children is the largest implementing partner for the Somali Joint Health & Nutrition Program (JHNP) in Somalia/Somaliland with 8 PCA covering 17 districts; a comprehensive multi-donor, multi-partner, five year development program that will scale up the delivery of essential reproductive, maternal, newborn and child health and nutrition services for women and children, thereby reducing maternal and infant mortality, while strengthening the systems that support improved quality and access to health care.

Save the Children is also a key member of the Health Consortium Somalia (HCS); a five year program funded by DFID which aims to increase the range, quality, and use of health services and improve the health status of the Somali people with a focus on reproductive, maternal and child health.

Our Strategic Plan is

  • For children who are deprived have equitable access to health and nutrition services.
  • Preventable new-born deaths are eliminated
  • Women and girls have access to and use quality sexual and reproductive health services.
  • Children under 5 do not die from infectious disease, e.g., pneumonia, diarrhoea, and malaria
  • Global stunting rates are halved and wasting is eliminated
  • Children in humanitarian contexts have equitable access to frontline healthcare services

Nutrition Programme Overview:
Without good nutrition, women and children cannot attain their full potential so SCI Somalia is working in the most under privileged communities in Somalia targeting the most vulnerable children under-fives and pregnant and lactating women by treating malnutrition among these groups. SCI has nutrition programs in Somaliland, Puntland, and in South Central region reached an estimated 228,166 women and children in 2015 both directly and indirectly.  SCI Somalia is targeting the most inaccessible mothers and children with malnutrition in these regions. These nutrition interventions include treatment of acute malnutrition and prevention through the implementation of Infant and Young Child Feeding (IYFC) program.

The median rate of acute malnutrition in Somalia remained at sustained critical/serious situation with a median GAM of 14.9 percent resulting in around 200,000 children U5 being acutely malnourished as per the point estimate. Hidden hunger (Micronutrients deficiencies) is of high public health significance with around 60% of children U5 and 50% of women of child-bearing age suffering from iron deficiency (anaemia). Three in four acutely malnourished children are in southern and central Somalia. Over one third of all children under-5 years and 50% women are vitamin A deficient. This increases the risk of morbidity and mortality among children U5. According to FSNAU post dyre 2014/15 report the national average for stunting were 10.8 percent with variation between the different zones (NW zone 2.6%, NEZ, 15.7% and SCS 11.6%).

SCI is the lead agency in the nutrition consortium (Strengthening Nutrition Security in South Somalia-SNS), a four year DFID funded program operating in Hiran, Baidoa and Mogadishu regions. SCI has also been implementing ECHO project for the past 5 years in Garowe, Bosasso and Hiran regions in Puntland and South Central respectively.

Our future plan: Expand nutrition services especially in the drought affected regions of Somaliland and Puntland by opening new static and mobile nutrition sites to reach out to the high cases of malnutrition in these two zones. In South Central region, SCI will continue implementing nutrition interventions for treatment of acute malnutrition and prevention of malnutrition among children 6-59 months and PLWs in Hiran, Baidoa, Afmadow and Mogadishu.

Water Sanitation and Hygiene (WASH)
In Somalia, 2.8 million Women and men require improved access to water, sanitation and hygiene
(WASH) and inadequate WASH is the main reason for recurrent outbreak of Acute Watery Diarrhea in most part of Somalia.

WASH is an important supporting sector, which delivers adequate water, sanitation and hygiene promotion interventions through health and nutrition centers, schools directly at community level and we have been providing reliable safe and clean water to a total of 28,111 households in Puntland, Somaliland and South Central. This was achieved through water trucking, connection to existing water sources, drilling of borehole, construction/rehabilitation of water facilities and water pipeline extensions. A total of 20,337 households in Somalia have accessed improved sanitation through the construction and maintenance of gender segregated latrines and other sanitation facilities (solid waste pits, placenta pits) in IDP camps and nutrition and health centers. Also 4,340 people, including school going children, participated in hygiene promotion campaigns conducted by trained community hygiene promoters.

Scaling Up our WASH Portfolio in Somalia
WASH is one of the most neglected sectors in Somalia; 2.7 million people are currently in need of WASH assistance. Poor sanitary and hygienic conditions in densely populated, scattered and unplanned IDP and poor host settlements, combined with acute levels of malnutrition, and unsafe water sources, are a recipe for large-scale cholera outbreaks. Access to clean safe water and improved sanitary and hygienic conditions are essential for prevention of such diseases. SCI plans to provide long-term WASH programming through 2016 across various locations in Somalia, which primarily looks at building resilience in the drought and conflict affected villages through provision of more sustainable WASH facilities. Emergency WASH interventions with adequate support to other SC sectors will continue as long as there is a need.  Depending on the emergency situation and stability in Somalia, our WASH intervention, would also focus on exit criterion from emergency response interventions such as water trucking activities, which will be advised by the timing required for a gradual establishment of long term sustainable facilities and transfer of WASH services, structures and/or other entities to local beneficiaries