Copie de SOM_HealthFNL

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Infant, child and maternal mortality rates in Somalia are among
the highest in the world. Diarrhoeal disease-related                  Insecurity and poor
dehydration, respiratory infections and malaria are the main          access makes Somalia
killers of infants and young children, together accounting for
more than half of all child deaths. Cholera is endemic in
                                                                      one of the most
Somalia, with outbreaks occurring annually from December to           challenging countries in
May. The major underlying causes of diarrhoea are the lack of         the world in which
access to safe water and poor food and domestic hygiene. The          humanitarian agencies
MICS 2000 survey found that almost 24 percent of under-five           operate. Vaccination
children had diarrhoea in the two weeks preceding the survey.
                                                                      campaigns must employ
Though data is limited, Somalia remains among the countries           innovative methods to
with the highest incidence of tuberculosis in the world.              reach population groups
Overcrowded camps and lack of treatment facilities,                   that are sometimes
unsystematic and poor quality drugs and increased malnutrition        volatile and often hard to
keep tuberculosis as one of the main killer diseases.                 reach. Highly mobile
Neonatal tetanus and other birth-related problems also
                                                                      nomadic groups
contribute significantly to infant mortality, while measles and its   increase the complicated
complications result in widespread illness and numerous child         logistical planning.
deaths when outbreaks occur. Susceptibility to measles is
compounded by poor nutritional status, and transmission is            These and other factors
rapid in crowded living conditions such as congested
                                                                      lead to generally low
urban/peri-urban and displaced person’s camps. Immunisation
coverage is not yet sufficient to prevent measles outbreaks.          vaccination coverage
                                                                      rates. However, the EPI
Reproductive health is a major problem in Somalia, with the           programme continues to
maternal mortality rates of 1,600 per 100,000 placing Somali          register an increasing
women among the most high-risk groups in the world.                   number of under-1year
Haemorrhage, prolonged and obstructed labour, infections and
eclampsia are the major causes of death at childbirth. Anaemia
                                                                      and pregnant women
and female genital mutilation (infibulation) have a direct impact     vaccinated.
on, and aggravate these conditions. Poor antenatal, delivery
and postnatal care, with an almost complete lack of emergency
obstetric referral care for birth complications, further contribute
to these high rates of mortality and disability.

The UNICEF Health Programme is comprised of three projects:
Strengthening of Childcare Services, Safe Motherhood and Child
Immunization. In each, the access, utilisation and quality of
essential health services are enhanced through support to an
increasing number of facilities offering a minimum
package of care. Provision of basic health care services
is complemented by support to the development of
institutional capacities, including training of health care
personnel, support to the development of policies and
continued health sector reform. Cost sharing
approaches will be expanded, while ensuring that safety
nets for the most vulnerable groups continue to exist.

The Expanded Programme of Immunisation (EPI),
together with routine immunisation and NIDs, aims to
cover a progressively larger group of children against
vaccine preventable diseases. Polio eradication efforts
will continue at an expanded level to ensure the
eradication of the virus from Somalia during the
programme period. UNICEF continues to provide
supplies such as basic drugs, insecticide-treated nets to
prevent malaria, vaccines and medical equipment, while
ensuring timely and effective response during
emergencies. Special emphasis is placed on safe motherhood
practices, support to ante-natal care and home delivery
assistance and emergency obstetric care. In conjunction with the
education programme, the school health project will be
expanded. Information dissemination and health education
continues through community health workers, traditional birth
attendants and media channels. In all interventions, UNICEF
work closely with Somalia Aid Coordination Body health sector
partners, local authorities, the private sector and community-
based organisations.

Key results during the current 2004-2008 UNICEF country
programme for Somalia include:

•   Availability of essential drugs and medical equipment in
    health centres, provided by UNICEF together with training of
    medical staff on supervision and monitoring.
•   Outbreaks of malaria, measles, meningitis and cholera
    prevented and controlled through immunisation and related
    awareness campaigns, training of health staff and provision of
    vaccines and cold chain supplies. No reported cholera
    outbreak in 2004/2005 transmission season.

•   Somalia has been free of the wild polio virus since 2002
    through polio eradication efforts in collaboration with WHO.
                                                                      National Immunization
•   Availability and use of essential supplies, particularly clean
                                                                      Days (NIDs) move
    delivery kits, for safe home delivery and obstetric care.
                                                                      Somalia closer to total
•   Improved capacity of local authorities in the management of
    health care systems, supported through training development       eradication…
    of health sector policies and establishment of standards.
                                                                      Over six years after
Strengthening of health services                                      UNICEF and WHO
Efforts to support the health system continue, primarily through      launched a campaign to
partnership agreements with non-governmental organisations.           eradicate polio in Somalia,
Drugs and medical supplies for the primary health care sector         commendable gains have
throughout the country are procured and delivered, and 400            been made, but work must
health facilities including hospitals, MCH centres and health         continue in order to
posts receive essential drugs and basic medical equipment.            achieve total eradication.
Improvements have been made in the number of facilities being
supervised and in the quality of services rendered.
                                                                      Since 2000, when an
Expanded Programme on Immunization (EPI)                              outbreak of 46 cases was
Although routine immunization coverage has remained low, more         reported in Somalia, there
children and women are benifitting from EPI activities throughout     has been a steady drop in
Somalia. In 2004 Over 137,000 children under-1 year were              cases. By 2002, circulation
vaccinated against Tuberculosis, 80,000 against diphtheria,           of the virus had reduced to
tetanus & whooping cough and nearly 150,000 pregnant women            only three cases reported
against maternal and neonatal tetanus. To achieve further             in and around Mogadishu.
increases, a more targeted 'acceleration' approach in highly-         No wild virus cases were
populated areas is being used.                                        reported in 2003.
Routine immunization for all antigens is continuing with
consideration being given to the National Immunization Days           Polio eradication activities
(NIDs) schedule, where possible.                                      were initiated in Somalia in
                                                                      1997. In 1998, the first
Disease Control                                                       round of national
Cholera is endemic in Somalia, with outbreaks occurring annually      immunization days (NIDs)
from December to May/June, mainly corresponding to the dry            covering the entire country
season, and linked to the contamination of water sources.             was planned. This was the
Outbreaks tend to concentrate in urban areas and densely              first nationwide activity
populated IDP camps, and are further exacerbated by the               carried out by the Somali
combination of malnutrition and the prevalence of communicable        community since the civil
diseases. A cholera preparedness and response plan developed
                                                                      war began in 1991. In
under the technical guidance of UNICEF provides guidance for
cholera task forces and local authorities to respond in a timely      2003, every zone received
and efficient manner to outbreaks. UNICEF provided 45 cholera         at least two rounds of
kits, chlorine and close to one million sachets of oral rehydration   immunization days. An
salts (ORS) to all partners in addition to financial and technical    average of 1.2 million
support for training, community awareness campaigns,                  children were vaccinated
chlorination of wells and supervision of cholera treatment centers    in each round.
                                                                      continued next page…
A dramatic drop in the case fatality rate to 1% in 2004, far below
the critical threshold of 5% and no outbreaks registered in 2005

are clear indications of the success in the measures put in place     National Immunization
to combat cholera in Somalia.                                         Days, continued…

Malaria Prevention & Control                                          Both the quality and
                                                                      geographic coverage of
Cholera is not the only problem brought about by flooding. Since      activities have improved
the 1997-98 floods, there has been an increase in malaria cases       steadily. House-to-house
accompanied by chloroquine resistance. To combat the disease,
                                                                      immunization, introduced
UNICEF has distributed insecticide-treated mosquito nets (ITNs)
and malaria kits to MCHs during the rainy season. In 2004,            in 1999, significantly
almost 100,000 ITNs were distributed to some 60 MCH clinics all       increasing the number of
over Somalia. These nets are dipped in an insecticide that repels     children vaccinated.
and kills mosquitoes.
                                                                      The partnership between
                                                                      WHO and UNICEF country
As malaria continues to be a growing major public health problem      programmes and the
in Somalia, UNICEF with increased funding from the Global Fund        increased input by local
Against AIDs, Tuberculosis and Malaria will scale up the              and international staff
implementation of malaria control activities. This is being done      improved all aspects of
with UNICEF as the principal recipient for the funds and working
                                                                      planning and
with eight Somalia Aid Coordination Body (SACB) members as
sub recipients implementing the funded activities. The SACB is a      implementation. Greater
grouping of UN agencies and NGOs active in Somalia.                   community participation in
                                                                      vaccinator selection, car
The main areas of focus will be:                                      rental, and other issues
• Developing a strategic document that will outline the key           have raised public
   interventions to be employed in malaria control for the next 10    awareness and community
   years and also guide the implementation of malaria                 cooperation.
   prevention and control measures.
• The distribution of Long Lasting Insecticide Treated Nets to        Acute Flaccid Paralysis
   malaria vulnerable groups (pregnant women and children             Surveillance (AFP)
   below five years) will continue. Approximately 216,000 nets
   will be distributed. The nets have an advantage over other
                                                                      In April 1998, an AFP
   types because they don’t require re-dipping with an
   insecticide periodically as before.
                                                                      surveillance system was
• Since pregnant women are at the greatest risk of malaria,           initiated in the northeast
   UNICEF will make available additional anti-malarial drugs to       and northwest zones.
   be provided through MCH clinics for the prevention of malaria
   during pregnancy. This will be in addition to promoting the        Regular surveillance
   use of long lasting nets for pregnant women to access at the       through active case
   same point.                                                        detection visits continues.
• Anti-malarial drug supplies to health facilities and the training
   of health workers in disease management will continue.
   UNICEF will in collaboration with the World Health
   Organization identify and procure more effective anti- malarial
   drugs for supply to MCHs.
• Since laboratory diagnosis to accurately treat malaria is very
   important, UNICEF again working with the World Health
   Organization (WHO) will strengthen the capacity of malaria
   diagnostics through training of laboratory technicians and

    procuring of microscopes and laboratory chemicals to make
    them functional.
•   UNICEF recognizes that if the fight against malaria is to be
    won, then the engagement of communities in malaria control
    is very important. UNICEF will continue to increase
    community access to malaria information through innovative
    communication approaches done by the community and
    distribution of culturally relevant IEC materials through
    partners and other community mechanism so as to access
    the services provided through the MCH.

Reproductive health and safe motherhood
The maternal mortality rate (MMR) in Somalia, among the highest
in the world, dismally reflects how years of conflict have resulted
in virtually all basic facilities such as referral hospitals, MCH
facilities and services being damaged or totally destroyed.

Interventions in this area continued to be structured around two
approaches, support to home delivery assistance and obstetric
care at the health facility level. Clean delivery kits (CDKs) are
now being used throughout Somalia and are sold at a subsidized
price in 99 MCH centres, which represents more than a 100%
increase in relation to 2002.

Health sector reform
Capacity building, management of essential drugs, consolidation
of the cost sharing experience in over three quarters of health
facilities in the NWZ and the development of the National Health
Information system throughout Somalia represent critical
achievements in the area of Health Sector reform. The Integrated
Management of Childhood Illnesses (IMCI) is now operational in
10 MCH centres in Northwest Somalia (‘Somaliland’) and a
review of the IMCI approach planned for December will pave the
way for expansion to all three zones during 2005. Over 77% of
health facilities in Somaliland are also applying the cost-sharing

In Northeast Somalia (‘Puntland’), the health sector reform
process has stalled as a result of competing priorities including
the severe drought emergency of 2003-2004 followed by the
combined effects of inland flooding and the Tsunami disaster of
late 2004.


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