Attachments
Author: Kate Sadler, Philip James, Amir Samnani and Emily Mates
Executive summary
Somalia has been in a state of protracted crisis for many years, characterised by a complex political environment, extreme poverty, food insecurity, conflict and instability. In recent years, Somalia has faced devastating drought emergencies, mainly as a result of reduced rainfall in most parts of the country. In some areas, escalated insecurity in recent years has resulted in new waves of displacements. Alongside drier than normal conditions that reduce milk availability below normal levels, as well as the recent food price rises, the deteriorating security situation has aggravated the already-poor nutrition situation.
Multiple Micronutrient Supplements (MMS) programming has been included as part of antenatal care (ANC) services in Somalia since the launch of the 2014 National Micronutrient Deficiency Control Strategy.
MMS programming has also been included in the national Maternal, Infant, Young Child & Adolescent Nutrition (MIYCAN) strategy. Somalia has 74 districts in total, of which 69 are labelled ‘accessible’ and the national MIYCAN programme is active in all 69 accessible districts. While geographic coverage of MMS through the MIYCAN programme is therefore high, population coverage of women reached with any kind of ANC services remains low at 31%. The MMS supply chain has been reasonably stable under UNICEF’s management and the distribution system established both through health facilities and community platforms, where staff and resources allow, works well. There were, however, some MMS supply breaks through 2023 due to funding challenges, with UNICEF working with government on resource mobilisation to help address these.
An earlier strategy (the Somalia National Micronutrient Deficiency Control Strategy 2014-2016), dedicated to micronutrient deficiency control in Somalia, did feature the use of MMS for pregnant and breastfeeding women as one of the priority interventions to be implemented under it and referred to the joint United Nations 2007 recommendations on MMS in emergencies. It is unclear why MMS was not written into the updated (2020) national nutrition and linked strategies, but this does not appear to have affected its inclusion in ANC components of the national nutrition programme. That said, this omission is likely to have limited the development of clear programme guidance and protocols for the use of MMS, both of which need considerable improvement. There is now work ongoing that will help with this, including an update to the Reproductive, Maternal, Neonatal, Child and Adolescent Health Strategy 2020-2024 by the Ministry of Health and Human Services and the development of updated guidance for the current national MIYCAN programme.
Key informants suggested the primary reasons for the low population coverage of ANC services include the need for more financial resources and community-based staff who can access and mobilise women to increase demand for, and access to, these ANC services. If demand were to increase, however, key informants felt that ensuring supply can meet demand may be a challenge, particularly as current stocks are entirely donor/ UNICEF dependent.
In summary, the key issues to address for scaling up MMS in Somalia include: the revision of national strategy and improving programme guidance to clarify the protocols for MMS within ANC provision; improving health worker motivation and understanding to prioritise nutrition and MMS within services for pregnant and breastfeeding women; increasing demand among women through more community mobilisation and improved access to ANC services; stabilisation of supply issues through support for buffer stocks of MMS at facility level; and more reliable and flexible funding support from donors for prevention of micronutrient deficiencies and poor pregnancy and birth outcomes.