Somalia

Integrated Health Care Programme (IHCP) Baseline Survey Report Somali Red Crescent Society (SRCS), June 2014

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  1. Background

The Somali Red Crescent Society (SRCS) is an independent, non-political humanitarian organization that was founded in 1963 and was established with presidential decree in 1965. The Society has been providing humanitarian services, including health care, to the most vulnerable people in Somalia throughout the conflict and insecurity over the last two decades. It is currently the largest indigenous humanitarian organization with branches in all 19 regions of Somaliland, Puntland and South and Central Somalia and a network of approximately 5,000 volunteers.
The integrated health care programme (IHCP) has been the core programme of the SRCS since 1992 and has been supported by both Red Cross/Crescent Movement (RCM) partners and non-movement partners such as the United Nations Children’s Fund (UNICEF), the World Health Organisation (WHO), the World Bank and recently the World Food Programme (WFP). The IHCP comprises a network of Maternal and Child Health/Out Patient Department (MCH/OPD) clinics and related mobile outreach and community based activities. The National Society has increased the number of the MCH/OPD clinics it operates, from 20 clinics in 1992 to 69 static and 26 mobile clinics in 2011.1 However the numbers keep fluctuating, particularly in South/Central Somalia due to the activities of the “difficult authorities” or the Al-Shabab militant group ordering the closure or opening of some of the clinics at will in areas under their control. As such as at the end of December 2013, the SRCS was operating a total of 60 active static MCH/OPDs and 23 mobile health clinics.
The SRCS network of MCH/OPD clinics is able to offer a range of health services in line with those defined by the Essential Package of Health Services (EPHS) for the country.2 Services include the Expanded Programme of Immunization (EPI), therapeutic and preventive nutrition services, case management of childhood and common ailments, safe motherhood (antenatal, delivery and post-natal care, provision of micronutrients, clean delivery kits) and the referral of complicated cases to regional hospitals. The SRCS also supports community-based activities through trained volunteers. These include a range of preventive and promotive activities as well as awareness creation on HIV/AIDS and other stigmatized and harmful traditional practices including female genital mutilation and cutting (FGM/C) and the promotion of Fundamental Principles and Humanitarian Values of the Red Cross/Crescent Movement.

  1. Rationale for baseline survey

Due to the emergency circumstances surrounding its set up in 1991, the IHCP did not include a baseline study and has never had a comprehensive evaluation conducted since its establishment. Some project specific evaluations have been carried out on components of the IHCP, such as the Qarhis Project (Community-Managed Health Care Service Provision Model) supported by the World Bank in 2004. Similarly, there have been various multilateral and bilateral evaluations conducted on specific projects under the broader IHCP.

It was decided by the SRCS and the IFRC Somalia Country Representation together with other Movement partners to conduct a baseline study on the IHCP. It is envisaged that the study will provide inputs for the development of partner proposals for the coming years as well as providing a basis for measuring programme impact and service delivery of the clinics over time. It will also provide inputs for refining and developing SMART3 indicators in operationalizing the SRCS Health Strategy 2013-2017. Furthermore, it will allow SRCS to identify areas of divergence in order that services are of high quality and uniformly delivered across the three zones.

The study focused on 16 MCH/OPDs in Somaliland and Puntland as well as 10 in South/Central zone of Somalia.
Annex 1 provides information on the distribution of MCH/OPD clinics that have been purposefully selected for inclusion in the baseline study.

  1. Methodology

The Terms of Reference for the baseline survey are provided for in Annex 1. The baseline survey employed a mixed method design involving the use of both qualitative and quantitative data collection instruments. A household survey (Annex 2) was administered using the Rapid Mobile Phone-Based (RAMP) technology.
A team of two consultants were responsible for the overall execution of the baseline survey and worked in close consultation with the RAMP experts and a technical team comprised of SRCS and Movement partners both in Nairobi and at Somalia zonal level. The consultant team developed the three qualitative survey instruments and oversaw their administration. They were responsible for the collection of qualitative data, the data compilation, analysis and report writing. The qualitative survey included: 1) interviews with SRCS clinic staff: 2) facility checklists and 3) FGDs with Community Health Committees as well as male and female community members. Senior and supervisory SRCS staff was not surveyed for the baseline. However, staff members were actively involved in the training, the supervision of enumerators and in qualitative data collection. The survey instruments have been reproduced in Annex 3.
The core household survey questionnaire had been developed by a consultant originally contracted to conduct the baseline. This was subsequently revised in consultation with Movement partners. Similarly, the qualitative survey instruments were prepared and revised by the consultant team in consultation with staff and partners. Field work for the administration of the baseline survey began 16thNovember, 2013 with a brief training of enumerators prior to testing the survey instruments at a clinic site close to Hargeisa, Somaliland.
As discussed in Section 3.5, events beyond the control of the consultant team affected the planned training and testing schedule which was to have taken place over a four-day period. In the event, the training of the enumerators and testing of the quantitative and qualitative instruments was conducted 16th-17 th November, 2013.
The first training of enumerators (SRCS volunteers from the survey sites) for the household survey and of staff members for the FGDs was conducted jointly with the RAMP consultant 18th -21st November, 2013 at the Maansoor Hotel, Hargeisa. South/Central staff training for the qualitative study took place 26th -28th November 2013 at the Shamo Hotel, Mogadishu while that for the enumerators for the quantitative component took place between 6 th and 10th December. Training of staff from Puntland who were undertaking the FGDs and selecting enumerators for the Household survey took place at the 30th November -2 nd December 2013 at the SRCS training room in Garowe.
That for the enumerators for the quantitative data collection on the other hand took place at the New Rays Hotel in Garowe between 12th and 16th December 2013. An outline of the training can be found in Annex 4.