Delivering life-saving community healthcare services in fragile states

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Internal conflict spanning more than two decades has resulted in the disintegration of Somalia’s infrastructure and significantly weakened the government’s capacity to respond to the basic needs of the population, such as access to clean water and appropriate sanitation facilities, adequate healthcare and effective security services.

Delivery of key services to prevent maternal and child morbidity and mortality forms the core of the Somali Red Crescent Society’s health programming. Immunization is one of the best, most cost-effective services available to prevent childhood illness. Through its network of 58 maternal and child health/out-patients clinics, 23 mobile health units and 4,600 volunteers, the Somali Red Crescent Society in Somaliland and Puntland provides critical health service to vulnerable populations, including routine immunization.

Insecurity and lack of access to certain parts of Somalia has, rendered it impossible to immunize many children for over three years. This has resulted in the re-emergence of the wild poliovirus in south and central Somalia in 2013, with the total cases reaching 190.

The strong cooperation between the Somali Red Crescent Society and the local health authorities has enabled hard to reach communities to access health care, bridging the gap between the formal and community health system and giving it greater access to health services across all the 19 regions of the country.

In response to the polio outbreak in 2013, the Somali Ministry of Health, with the active support of WHO, UNICEF and the Somali Red Crescent Society immediately planned and implemented an emergency vaccination campaign.

Polio is a highly contagious viral infection that tends to attack mostly children under-five, pregnant women, those with weak immune systems or those who have not been immunized. “As long as one child remains infected, every child in the country remains at risk,” says Kwame Darko, health delegate at the International Federation of Red Cross and Red Crescent Societies (IFRC) Somali delegation. “That’s why it is imperative that we get into every small village and community, to conduct immunizations and ensure the virus does not spread.”

As a part of the national campaign, the Somali Red Crescent Society deployed 90 volunteers to ensure that as many children as possible received polio immunization. Trained volunteers, who live in the same community as the local population and speak the same language, helped reach the most inaccessible, poor and marginalized communities. They made door-to-door visits to sensitize parents on the benefits of immunization. The five-day campaign saw 3,450 children receive polio immunization through the mobile clinics. Of these, 140 had not been vaccinated in previous rounds.

However, in central and south Somalia, the militant group fighting the federal government does not allow house-to-house visits or mass public campaign activities, thus hampering access of the population to immunization services despite their high knowledge of the importance of vaccinating children to prevent diseases. Delivery of immunization activities, in this area is limited to ten of the 30 static clinics.

On 5 May 2014, the World Health Organization has declared the international spread of wild poliovirus a ‘Public Health Emergency of International Concern’.

Somalia had been polio free for six years until May 2013. WHO counts Somalia among the states infected with wild poliovirus but not currently exporting it. “In order to ensure that Somalia remains in this bracket and is able to reach its polio-free status again, we are supporting WHO’s recommendations and will continue to sustain the Somali Red Crescent Society, as well as other Red Cross and Red Crescent societies, in delivering healthcare services – including routine vaccinations – to the doorsteps of those who need it most,” says Dr Stefan Seebacher, MD, MPH, MNM, Head of IFRC’s health department.

Due to its neutral and impartial position and despite challenges, the Somali Red Crescent Society remains operational across the country. Evidence shows that the National Society has a proven track record in delivering health services to remote communities through its trained health volunteers and personnel network, in areas that cannot be accessed otherwise. For example, its immunization coverage among other services is higher than the national average.

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Join us in the conversation on 19 May, 6–8pm, as the discussion on the community health workforce in fragile states gains momentum at the side event of the 67th World Health Assembly. Follow the hashtags #FragileStates and #WHA67.

Community health volunteers’ connections to the community and understanding of the context ideally places them as key resources in developing locally appropriate responses to health issues, encouraging community engagement and promoting sustainability towards reaching universal health coverage.