^{Supportive supervision through rapid response teams helps bring an accountability and results-based management to community based surveillance system across Somalia: A member of RRT collecting feedback from community members about CHWs services at an internally displaced camp in Baidoa.}
Photo credit: WHO Somalia.

To address this, WHO Somalia, together with the FMoH and other UN agencies, conceived an integrated health response to improve access to services across 281 operational health facilities in 79 priority districts of the country. The existing CHW programme, established with 1,538 CHWs for COVID-19, was expanded with the recruitment of additional 626 CHWs through the stakeholders at the state level. They were trained by WHO Somalia and partners on case detection for epidemic prone diseases beyond COVID-19, provide home-based care for children with diarrhoea, malaria and other ailments, and identify danger signs, especially among children and women, and refer them to the nearest health facility. They were also trained on delivering a range of risk communication and community engagement (RCCE) messages during house-to-house visits in order to be able to detect epidemics as early as possible and reduce the turnaround time for response. Further, training on maternal health was provided. They were then deployed to expand the efforts of primary health care services in a country where health facilities are sparsely distributed and where more than 90% are managed by private partners.

To complement the CHWs, the number of district-based RRTs was also increased from 171 to 237 across the 79 districts, comprising of an epidemiologist/surveillance officer, laboratory technician and a communication officer. These serve to verify alerts reported by CHWs and investigate credible alerts with sample collection. RRTs are also responsible for providing supportive supervision to health facilities through the Early Warning Alert and Response Network (EWARN) system and activities of CHWs at household level and points of entry.

‘These community health workers are a means to an end. They are serving as a kingpin to revive the confidence of communities in the government as well as helping the Federal and State ministries of health to get a hand on the pulse of communities, understand their real needs, and fix the shortcomings to revive a system which has remained dysfunctional for almost four decades’

Dr Mamunur Rahman Malik – WHO Representative to Somalia

With the added human resource capacity, it was equally important to maintain operational capacity across key areas of the country for healthcare provision. WHO Somalia supported 64 stabilization centres, 9 cholera treatment centres, 15 oral rehydration points and 281 primary care health facilities in the 79 districts across seven states of Somalia. This support included interagency emergency health kits, trauma kits, cholera kits, severe and acute malnutrition (SAM) kits to treat children with health complications, PCR testing machines with testing kits and genome sequencing devices including laboratory consumables, reagents, and RNA extraction kits, oxygen concentrators, PSA plants, job aids, and office and IT equipment to set up emergency operation centres. The CHWs and RRTs were able to leverage this added operational capacity to ensure cases referred for further examination and management received the required services at referral points. In addition to this support, WHO Somalia also availed supplies of micro-nutrients and treatments for home-base management of mild ailments to CHWs, which also led to improved survival rates due to the provision of appropriate care at the point of contact.

‘WHO has helped us to rediscover the broken health system in Somalia by supporting us to train and deploy these frontline health workers across the country. These CHWs and vaccinators have literally helped us get in touch with the communities and for the first time we are realizing the depth and scale of the public health issues confronted by the communities’

Mukhtar Abdi Shube, Head of the Expanded Programme on Immunization (EPI) section, Ministry of Health, Federal Government of Somalia

Between December 2021 to December 2022, a total of 2,101,700 households were visited by CHWs and RRTs combined, with the RCCE messaging delivered to 14,001,88 people. A total of 21,507 alerts were reported by CHWs of which 10,471 were investigated. In 2022, 328,519 children were screened for malnutrition, of which 97,786 were referred to health facilities for necessary treatment. A further 15,807 children were referred due to severe respiratory issues and 3,960 due to dehydration. The CHWs were able to provide iron and folic supplements to 95,524 pregnant women, along with zinc and vitamin A supplements to 30,547 and 115,491 children, respectively [1].

The expansion of service availability through the CHWs and RRTs has enabled the provision of essential health services to the most vulnerable and remote populations in the country. These efforts continue to be strengthened by WHO Somalia, working in collaboration with local and national authorities along with many partners, to reach as many people as possible in challenging contexts.