Understanding the factors affecting the humanitarian health and nutrition response for women and children in Somalia since 2000: a case study

Abstract

Background: Somalia has been ravaged by more than two decades of armed conflict causing immense damage to the country's infrastructure and mass displacement and suffering among its people. An influx of humanitarian actors has sought to provide basic services, including health services for women and children, throughout the conflict. This study aimed to better understand the humanitarian health response for women and children in Somalia since 2000. Methods: The study utilized a mixed-methods design. We collated intervention coverage data from publically available large-scale household surveys and we conducted 32 interviews with representatives from government, UN agencies, NGOs, and health facility staff. Qualitative data were analyzed using latent content analysis. Results: The available quantitative data on intervention coverage in Somalia are extremely limited, making it difficult to discern patterns or trends over time or by region. Underlying sociocultural and other contextual factors most strongly affecting the humanitarian health response for women and children included clan dynamics and female disempowerment. The most salient operational influences included the assessment of population needs, donors' priorities, and insufficient and inflexible funding. Key barriers to service delivery included chronic commodity and human resource shortages, poor infrastructure, and limited access to highly vulnerable populations, all against the backdrop of ongoing insecurity. Various strategies to mitigate these barriers were discussed. Incountry coordination of humanitarian health actors and their activities has improved over time, with federal and state-level ministries of health playing increasingly active roles. Conclusions: Emerging recommendations include further exploration of government partnerships with privatesector service providers to make services available throughout Somalia free of charge, with further research on innovative uses of technology to help reaches remote and inaccessible areas. To mitigate chronic skilled health worker shortages, more operational research is needed on the expanded use of community health workers. Persistent gaps in service provision across the continuum must be addressed, including for adolescents, for example. The is also a clear need for longer term development focus to enable the provision of health and nutrition services for women and children beyond those included in recurrent emergency response.

Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

“…DRC, Nigeria, Somalia, South Sudan). [19][20][21] Thanks to the humanitarian system, many maternal and child health and nutrition services are now offered to a majority of those who can be reached in conflict settings. Pre-conflict capacity of health systems as a determinant of WCH priorities There were differences among countries in terms of what services were delivered and how.…”

Health Status and Health Care Needs of Drought-Related Migrants in the Horn of Africa—A Qualitative Investigation

“…Another key area is the lack of evaluations of programs and interventions. A recently published study on the humanitarian health response for women and children in Somalia showed that available quantitative data on intervention coverage is very sparse, making it difficult to detect temporal or spatial patterns [57]. Underlying sociocultural and other contextual factors that affect the humanitarian health response included clan dynamics and female disempowerment.…”

“…Furthermore, the assessment of the needs of the population, donor priorities and insufficient and inflexible funding influence health interventions. Key barriers to service delivery are chronic commodity and human resource shortages, poor infrastructure and limited access to highly vulnerable populations [57]. Migration itself is a very old practice: it is itself a means for coping with environmental hazards and economic hardship [16,58].…”

Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

“…Detailed reports of the BRANCH case studies [13][14][15][16][17][18][19][20][21][22] as well as a cross-case synthesis of findings [23] are published elsewhere. For this additional paper, we aimed to highlight and discuss some of the research challenges faced and the corresponding mitigation strategies used by the international research teams conducting BRANCH case studies in Somalia, Mali, Pakistan and Afghanistan ( Table 1).…”